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Kirchner H, Bohn A, Hulsmans N, Brzoska P, Pajonk FGB. [Impact of the 2020 lockdown on prehospital psychiatric emergencies in a large city]. Anaesthesiologie 2024; 73:26-32. [PMID: 38214705 DOI: 10.1007/s00101-023-01370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/06/2023] [Accepted: 11/23/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic represented a serious challenge for healthcare systems worldwide. Special psychiatric patients represent a vulnerable group and are particularly affected by lockdown interventions. Knowledge on the possible effects for this group of patients in an emergency physician setting is low. OBJECTIVE The aim of this paper is to investigate the impact of the first lockdown during the COVID-19 pandemic in 2020 on emergency ambulance services for psychiatric patients in a large German city. MATERIAL AND METHODS A retrospective analysis was conducted on all prehospital psychiatric emergencies in a large German city during the first pandemic-related lockdown from 22 March 2020 to 4 May 2020, with the same period in 2019 serving as a reference. RESULTS During the first lockdown there was a significant increase in the number of emergency missions with respect to psychiatric cases. A substantial rise in substance-associated deployments was observed. Moreover, there was an increase in the proportion of psychiatric patients who did not meet emergency criteria. Suicidal tendencies and agitation status played a minor role during the lockdown. CONCLUSION The lockdown had a notable impact on the frequency and profile of emergency physician calls in the metropolitan area studied. The substantial increase in substance-associated callouts can be interpreted as both a deterioration in access to the healthcare system and an expression of the increased stress faced by the general population and vulnerable groups in particular.
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Affiliation(s)
- Heribert Kirchner
- Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58455, Witten, Deutschland.
| | - Andreas Bohn
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster, Deutschland
- Feuerwehr, Ärztliche Leitung Rettungsdienst, Stadt Münster, Münster, Deutschland
| | - Nik Hulsmans
- Fakultät V, Department für Psychologie, Universität Siegen, Siegen, Deutschland
| | - Patrick Brzoska
- Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58455, Witten, Deutschland
| | - Frank-Gerald B Pajonk
- Zentrum Isartal, Kloster Schäftlarn, Schäftlarn, Deutschland
- Klinik und Poliklinik für Psychiatrie am Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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Kirchner H, Ullrich H, Neu P, Hulsmans N, Juckel G, Brzoska P. The significance of nonurgent psychiatric emergencies in an ED: a retrospective study. BMC Emerg Med 2023; 23:131. [PMID: 37940880 PMCID: PMC10631003 DOI: 10.1186/s12873-023-00900-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND In emergency departments, patients with mental health conditions are a major concern and make up the third or fourth of the most common diagnosis seen during all consultations. Over the past two decades, there has been a noticeable rise in the number of cases, particularly due to an increase in nonurgent visits for somatic medical issues. The significance of nonurgent visits for psychiatric patients is yet to be determined. This study aims to uncover the significance and identify the characteristics of this group. METHODS A retrospective analysis of psychiatric emergency visits at an interdisciplinary emergency department of a German general hospital in 2015 was conducted. For this purpose, patient records were reviewed and evaluated. An analysis was conducted based on the German definition of psychiatric emergencies according to the German guidelines for emergency psychiatry. RESULTS A total of 21,124 emergency patients visited the evaluated Emergency Department. Of this number, 1,735 psychiatric patient records were evaluated, representing 8.21% of the total population. Nearly 30% of these patients did not meet any emergency criteria according to German guidelines. Significant differences were observed between previously treated patients and those presenting for the first time. CONCLUSIONS The high proportion of nonurgent psychiatric patients in the total volume of psychiatric emergency contacts indicates a possible control and information deficit within the emergency system. Just as prior research has emphasized the importance of investigating nonurgent somatic medical visits, it is equally imperative to delve into studies centered around psychiatric nonurgent presentations.
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Affiliation(s)
- Heribert Kirchner
- Faculty of Health, School of Medicine, University Witten/Herdecke, Herrhausen-Straße 50, 58455, Witten, Germany.
| | - Heiko Ullrich
- Center of Mental Health, Kreisklinikum Siegen, Weidenauer Str. 76, 57076, Siegen, Germany
| | - Peter Neu
- Department of Psychiatry and Psychotherapy, Jewish Hospital Berlin, Heinz-Galinski-Straße 1, 13347, Berlin, Germany
| | - Nik Hulsmans
- Department of Psychology, University of Siegen, Adolf-Reichwein-Straße 2a, 57076, Siegen, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1, 44791, Bochum, Germany
| | - Patrick Brzoska
- Faculty of Health, School of Medicine, University Witten/Herdecke, Herrhausen-Straße 50, 58455, Witten, Germany
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Ullrich H, Kirchner H, Hulsmans N, Müller H, Pajonk FGB. [What Influence did the Lockdown 2020 have on the Use of a Central Emergency Room by Psychiatric Emergency Patients]. Psychiatr Prax 2023; 50:29-35. [PMID: 35878615 DOI: 10.1055/a-1896-8129] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The current coronavirus pandemic (Covid-19 disease) poses major challenges to healthcare systems worldwide. The aim of this work was to identify the impact on psychiatric emergency presentations in an ED during the implemented lockdown. METHODS A retrospective survey of all psychiatric emergency presentations in the ED during the lockdown was conducted. The same period in 2019 served as the reference year. RESULTS There was a decrease in psychiatric patients. Changes were observed in the age and diagnoses. CONCLUSION Some clear effects of the lockdown on psychiatric emergencies in an ED setting can be described. However, the changes were smaller than in other countries with other health care systems.
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Affiliation(s)
- Heiko Ullrich
- Abteilung für Psychiatrie und Psychotherapie, Kreisklinikum Siegen gGmbH
| | - Heribert Kirchner
- Abteilung für Psychiatrie und Psychotherapie, Universität Witten/Herdecke, Fakultät für Gesundheit, LWL-Klinik, Münster
| | | | - Helge Müller
- Fakultät für Gesundheit, Universität Witten/Herdecke
| | - Frank-Gerald B Pajonk
- Klinikum rechts der Isar der Technischen Universität München, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Psychiatrie und Psychotherapie, Praxis Isartal, Psychiatrie und Psychotherapie
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Kirchner H, Schaefer M, Ullrich H, Hulsmans N, Juckel G, Brzoska P, Pajonk FGB. Factors predicting admission of psychiatric emergency contacts after presenting to the emergency department: results of a regression analysis. Ann Gen Psychiatry 2022; 21:42. [PMID: 36352413 PMCID: PMC9647959 DOI: 10.1186/s12991-022-00421-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychiatric emergency patients have great relevance in the interdisciplinary emergency department. Emergency physicians in this setting often have to make decisions under time pressure based on incomplete information regarding the patient's further treatment. The aim of this study was to identify possible predictors associated with an increased likelihood of inpatient psychiatric admission. METHODS A retrospective cross-sectional study of all psychiatric emergency contacts in an interdisciplinary emergency department (ED) of a general hospital in a large German city was conducted for 2015. A binary regression analysis was performed to identify possible predictors. RESULTS In 2015, a total of 21421 patient contacts were reported in the emergency department, of which 1733 were psychiatric emergencies. Psychiatric emergency was the fourth most common cause presenting to the ED. The most common diagnosis given was mental and behavioral disorders due to the use of psychotropic substances (F1). Factors associated with an increased probability of inpatient psychiatric admission were previously known patients, patients under a legal care order (guardianship), and previous outpatient medical contact. No association for gender or age was found. Data demonstrated a negative relationship between a neurotic, stress-related and somatoform disorder diagnosis and admission. CONCLUSIONS The present study shows some significant characteristics associated with an increased likelihood of emergency admission. Independent of the health care system, the predictors found seem to be relevant with regard to the probability of admission, when compared internationally. To improve the treatment of patients in emergency units, these factors should be taken into account.
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Affiliation(s)
- Heribert Kirchner
- Faculty of Health, School of Medicine, University of Witten/Herdecke, Witten, Germany.
| | - Martin Schaefer
- Department of Psychiatry, Psychotherapy, Psychosomatics and Addiction Medicine, Evang. Kliniken Essen-Mitte, Essen, Germany.,Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Heiko Ullrich
- Department of Psychiatry, Psychotherapy and Psychosomatics, Kreisklinikum Siegen, Hospital, Siegen, Germany
| | - Nik Hulsmans
- Department of Psychology, University of Siegen, Siegen, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Patrick Brzoska
- Faculty of Health, School of Medicine, University of Witten/Herdecke, Witten, Germany
| | - Frank-Gerald Bernhard Pajonk
- Zentrum Isartal Am Kloster Schäftlarn, Schäftlarn, Germany.,Department. of Psychiatry and Psychotherapy, Technical University Munich, Munich, Germany
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Kirchner H, Sinani G, Ullrich H, Pajonk FGB, Juckel G. [Analysis of the psychiatric emergency inpatients in an ER setting at a general hospital]. Fortschr Neurol Psychiatr 2020; 89:409-414. [PMID: 33207373 DOI: 10.1055/a-1268-8110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Evaluation of psychiatric emergency contacts in an interdisciplinary emergency room. METHODS We conducted a retrospective examination of all psychiatric consultations of 2015. RESULTS The three most common emergency syndromes could be assigned in descending order to the F1 (32.2%), the F2 (25.9%) and the F3 diagnoses (21.2%). The admission rate was 58.9% and more than half of the patients came to the emergency room on foot (55.7%). Diagnosis-specific differences were found between first-time presenters and patients who had presented previously. CONCLUSION The psychiatric emergency has high relevance in the emergency room. The majority of the patients admitted to hospital meet the emergency criteria according to the guideline.
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Affiliation(s)
| | | | - Heiko Ullrich
- Abteilung für Psychiatrie, Kreisklinikum Siegen gGmbH
| | - Frank Gerald Bernhard Pajonk
- Psychiatrische und Psychotherapeutische Praxis Isartal.,Klinik und Poliklinik für Psychiatrie am Klinikum rechts der Isar, Technische Universität München
| | - Georg Juckel
- LWL-Universitätsklinikum der Ruhr-Universität Bochum für Psychiatrie, Psychotherapie und Präventivmedizin
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Kirchner H, Sinani G, Ullrich H, Pajonk FGB, Juckel G. [Characterization of Ambulant Emergency Contacts in an Emergency Room at a General Hospital]. Psychiatr Prax 2020; 48:25-30. [PMID: 32659792 DOI: 10.1055/a-1190-7514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Scientific interest in emergency psychiatric patients has increased significantly over the last two decades. Nevertheless, current knowledge of this group of patients in the setting of an interdisciplinary emergency department is surprisingly low. METHODS A retrospective examination of all ambulatory psychiatric emergency contacts in the emergency room of a regional hospital in 2015 took place. RESULTS Solely F4 diagnoses accounted for 48.1 % of all first-time patients. Female patients younger than 25 years used the ER twice as often as their male control-group. Almost half of all outpatients fulfilled no emergency criteria. CONCLUSION There are specific age and gender differences. The proportion of patients without any emergency criteria was surprisingly high. More scientific research is needed in order to scrutinize this possible inappropriate use of an ER by psychiatric patients.
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Affiliation(s)
| | - Gjergji Sinani
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Kreisklinikum Siegen
| | - Heiko Ullrich
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Kreisklinikum Siegen
| | - Frank-Gerald B Pajonk
- Praxis Isartal, Kloster Schäftlarn.,Klinik und Poliklinik für Psychiatrie am Klinikum rechts der Isar, Technische Universität München
| | - Georg Juckel
- LWL-Universitätsklinikum der Ruhr-Universität Bochum für Psychiatrie, Psychotherapie und Präventivmedizin
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Kirchner H, Kirchner-Overfeld EC, Juckel G, Schäfer M. Häufigkeitsentwicklung alkoholassoziierter Vorstellungen in einer interdisziplinären großstädtischen Notaufnahme: Vergleich 2009 vs. 2014. SUCHT 2018. [DOI: 10.1024/0939-5911/a000534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Einleitung: Das Ziel dieser Untersuchung war es, anhand eines 5-Jahres-Vergleiches in einer interdisziplinären Zentralen Notaufnahme (ZNA) mit psychiatrischer Vollversorgung bei alkoholbezogenen Patientenvorstellungen mögliche Veränderungen des Patientengutes herauszuarbeiten. Methodik: Hierzu erfolgte eine retrospektive Datenerhebung von alkoholbedingten ZNA-Vorstellungen in den Jahren 2009 und 2014. Patienten von mindestens 18 Jahren und mit einer alkoholassoziierten Vorstellung wurden in die Studie aufgenommen. In einem ersten Schritt erfolgte die Analyse der ZNA-Dokumentation. Danach wurde die digitale Klinikdokumentation hinsichtlich psychiatrischer und somatischer Komorbiditäten, erneuter C2-bedingter ZNA-Wiedervorstellungen und einer konsekutiven Inanspruchnahme eines suchtspezifischen stationären Behandlungsangebotes untersucht. Ergebnis: Im Jahr 2009 wurden in der Zentralen Notaufnahme 2267 psychiatrische Patientenvorstellungen erfasst. Davon konnten 596 (26.30 %) als alkoholassoziiert identifiziert werden. Im Jahr 2014 wurden 3.400 psychiatrische ZNA-Kontakte identifiziert, davon waren 1.021 Kontakte alkoholbedingt (30 %). Am Gesamtaufkommen aller ZNA-Kontakte machte die rein alkoholassoziierte Vorstellung im Jahr 2009 ca. 3,5 % aus, im Jahr 2014 lag der Anteil mit 4,2 % etwas höher. Es fand sich eine Erhöhung der produzierten Fälle pro Patient von 1,5 im Jahr 2009 auf 2 Fälle im Jahr 2014. Die Patientengruppen waren in beiden Jahren zu 70 % männlich und das Alter der Patienten, die sich alkoholassoziiert in der ZNA vorstellten, lag im Jahr 2009 im Mittel bei 45 Jahren (SD 11.7) und unterschied sich somit von Patienten aus dem Jahr 2014 mit einem Alter von 46 Jahren kaum (SD 13.1). Ein Großteil der Patienten nahm in den 12 Folgemonaten eine stationäre Behandlung wahr. Im Jahr 2009 waren hiervon 78,5 % der Pat. stationär im Jahr 2014 waren es 70,2 %. Es überwog im Jahr 2014 die kurze Verweildauer mit fast 50 % aller stationären Behandlungen (bis zu Zwei-Tage-Behandlung). Somatische Komorbidität hatte Einfluss auf die Verweildauer, psychiatrische Komorbidität erhöhte die Inanspruchnahme einer stationären Behandlung. Diskussion: Zwischen 2009 und 2014 hat sich die Charakteristik der alkoholbezogenen Patientenvorstellungen nicht wesentlich verändert. Jedoch konnte eine deutliche quantitative Veränderung i. S. einer Zunahme der alkoholassoziierten ZNA-Vorstellungen beobachtet werden.
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Affiliation(s)
| | | | - Georg Juckel
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin der Ruhr-Universität Bochum, LWL-Universitätsklinikum
| | - Martin Schäfer
- Kliniken Essen-Mitte, Abteilung für Psychiatrie, Psychotherapie, Psychosomatik und Suchtmedizin
- Charité-Universitätsmedizin Berlin
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Keenan BT, Kirchner H, Veatch OJ, Borthwick KM, Davenport VA, Gendy M, Pack F, Sirikulvadhana L, Malow BA, Morgenthaler TI, Zee PC, Robishaw JD, Derose SF, Pack AI. 0496 Multi-Site Validation of a Simple EHR-based Algorithm for Obstructive Sleep Apnea. Sleep 2018. [DOI: 10.1093/sleep/zsy061.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B T Keenan
- University of Pennsylvania, Philadelphia, PA
| | | | - O J Veatch
- University of Pennsylvania, Philadelphia, PA
| | | | | | - M Gendy
- Northwestern University, Chicago, IL
| | - F Pack
- University of Pennsylvania, Philadelphia, PA
| | | | - B A Malow
- Vanderbilt University Medical Center, Nashville, TN
| | | | - P C Zee
- Northwestern University, Chicago, IL
| | | | - S F Derose
- Kaiser Permanente Southern California, Pasadena, CA
| | - A I Pack
- University of Pennsylvania, Philadelphia, PA
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Geißler C, Krause C, Kähler M, Cascorbi I, Kirchner H. Longitudinal analysis of the development of hepatic insulin resistance in diet-induced obese mice. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641822] [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)
- C Geißler
- Medical Department I, University of Lübeck, Lübeck, Germany
| | - C Krause
- Medical Department I, University of Lübeck, Lübeck, Germany
| | - M Kähler
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - I Cascorbi
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - H Kirchner
- Medical Department I, University of Lübeck, Lübeck, Germany
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10
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Krause C, Sievert H, Grohs M, Geißler C, El Gammal AT, Wolter S, Lill CM, Krämer UM, Kasten M, Klein C, Brabant G, Mann O, Lehnert H, Kirchner H. Critical evaluation of DNA methylation markers for type-2-diabetes risk prediction. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641819] [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)
- C Krause
- University of Lübeck, Medical Department I, Lübeck, Germany
| | - H Sievert
- University of Lübeck, Medical Department I, Lübeck, Germany
| | - M Grohs
- University of Lübeck, Medical Department I, Lübeck, Germany
| | - C Geißler
- University of Lübeck, Medical Department I, Lübeck, Germany
| | - AT El Gammal
- University Medical Center Hamburg-Eppendorf, Department of General, Visceral and Thoracic Surgery, Hamburg, Germany
| | - S Wolter
- University Medical Center Hamburg-Eppendorf, Department of General, Visceral and Thoracic Surgery, Hamburg, Germany
| | - CM Lill
- University of Lübeck, Institute of Neurogenetics, Lübeck, Germany
| | - UM Krämer
- University of Lübeck, Department of Neurology, Lübeck, Germany
- University of Lübeck, Institute of Psychology II, Lübeck, Germany
| | - M Kasten
- University of Lübeck, Institute of Neurogenetics, Lübeck, Germany
- University of Lübeck, Dept. of Psychiatry and Psychotherapy, Lübeck, Germany
| | - C Klein
- University of Lübeck, Institute of Neurogenetics, Lübeck, Germany
| | - G Brabant
- University of Lübeck, Medical Department I, Lübeck, Germany
| | - O Mann
- University Medical Center Hamburg-Eppendorf, Department of General, Visceral and Thoracic Surgery, Hamburg, Germany
| | - H Lehnert
- University of Lübeck, Medical Department I, Lübeck, Germany
| | - H Kirchner
- University of Lübeck, Medical Department I, Lübeck, Germany
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Schlenke P, Hennig H, Kirchner H, Klüter H, Hagenström H. Quantification of Platelet-associated IgG for Differential Diagnosis of Patients with Thrombocytopenia. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614115] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryImmune thrombocytopenia is due to platelet destruction by circulating glycoprotein-specific antibodies and is found in various disorders. Methods for the detection of platelet-associated IgG (PAIgG) are generally sensitive but unspecific, whereas glycoprotein-specific assays are highly specific but less sensitive. Usefully, a sensitive screening method for PAIgG detection would also provide information for differential diagnosis. We developed a quantitative direct Platelet Immunofluorescence Test (PIFT) by flow cytometry and studied 79 thrombocytopenic patients with immune thrombocytopenia and other disorders. The sensitivity of the assay was 94%, its specificity 66% for the detection of a clinically obvious immune thrombocytopenia. PAIgG levels of patients with immune thrombocytopenia differed significantly from those of other patients with low platelet counts (p <0.001). The quantitative PIFT proved to be a sensitive method for PAIgG detection and should therefore be used as a screening method. In addition, it could be helpful for differential diagnosis in marked thrombocytopenia where a MAIPA is not feasible.
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Huhn S, Weinhold N, Nickel J, Pritsch M, Hielscher T, Hummel M, Bertsch U, Huegle-Doerr B, Vogel M, Angermund R, Hänel M, Salwender HJ, Weisel K, Dürig J, Görner M, Kirchner H, Peter N, Graeven U, Lordick F, Hoffmann M, Reimer P, Blau IW, Jauch A, Dembowsky K, Möhler T, Wuchter P, Goldschmidt H. Circulating tumor cells as a biomarker for response to therapy in multiple myeloma patients treated within the GMMG-MM5 trial. Bone Marrow Transplant 2017; 52:1194-1198. [PMID: 28504661 PMCID: PMC5543255 DOI: 10.1038/bmt.2017.91] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- S Huhn
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - N Weinhold
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J Nickel
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - M Pritsch
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - T Hielscher
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - M Hummel
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - U Bertsch
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases Heidelberg, Heidelberg, Germany
| | - B Huegle-Doerr
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - M Vogel
- Janssen-Cilag, Neuss, Germany
| | | | - M Hänel
- Department of Internal Medicine III, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - H J Salwender
- Department of Hematology/Oncology, Asklepios Klinik Altona, Hamburg, Germany
| | - K Weisel
- Department of Internal Medicine II-Hematology and Oncology, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - J Dürig
- Department of Hematology, University Hospital Essen, Essen, Germany
| | - M Görner
- Department of Hematology, Oncology and Palliative Care, Community Hospital Bielefeld, Bielefeld, Germany
| | - H Kirchner
- Medical Clinic III Hematology and Oncology, Städt. Krankenhaus Siloah, Hannover, Germany
| | - N Peter
- 2nd Medical Department, Academic Teaching Hospital of the Charité, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | - U Graeven
- Hematology, Oncology and Gastroenterology, Maria-Hilf-Krankenhaus, Mönchengladbach, Germany
| | - F Lordick
- 3rd Medical Department, Haematology and Oncology, Klinikum Braunschweig, Braunschweig, Germany.,University Cancer Center Leipzig (UCCL), University Medical Center Leipzig, Leipzig, Germany
| | - M Hoffmann
- Medical Clinic A, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen am Rhein, Germany
| | - P Reimer
- Hematology, Oncology and Stem Cell Transplantation, Evangelisches Krankenhaus Essen-Werden gGmbH, Essen, Germany
| | - I W Blau
- Medical Clinic III Hematology and Oncology, Charité University Medicine Berlin, Berlin, Germany
| | - A Jauch
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | | | - T Möhler
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,inVentiv Health, Boston, MA, USA
| | - P Wuchter
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Institute of Transfusion Medicine and Immunology, German Red Cross Blood Service Baden-Württemberg-Hessen, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - H Goldschmidt
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases Heidelberg, Heidelberg, Germany
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Krause C, Tackenberg H, Geißler C, El Gammal AT, Wolter S, Mann O, Lehnert H, Kirchner H. Altered hepatic DNA methylation and gene expression of metabolic genes in non-diabetic obese and type-2-diabetic obese subjects. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601581] [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: 10/19/2022]
Affiliation(s)
- C Krause
- University of Lübeck, Medical Department I, Lübeck, Germany
| | - H Tackenberg
- University of Lübeck, Medical Department I, Lübeck, Germany
| | - C Geißler
- University of Lübeck, Medical Department I, Lübeck, Germany
| | - AT El Gammal
- University Medical Center Hamburg-Eppendorf, Department of General, Visceral and Thoracic Surgery, Hamburg, Germany
| | - S Wolter
- University Medical Center Hamburg-Eppendorf, Department of General, Visceral and Thoracic Surgery, Hamburg, Germany
| | - O Mann
- University Medical Center Hamburg-Eppendorf, Department of General, Visceral and Thoracic Surgery, Hamburg, Germany
| | - H Lehnert
- University of Lübeck, Medical Department I, Lübeck, Germany
| | - H Kirchner
- University of Lübeck, Medical Department I, Lübeck, Germany
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Thol F, Klesse S, Köhler L, Gabdoulline R, Kloos A, Liebich A, Wichmann M, Chaturvedi A, Fabisch J, Gaidzik VI, Paschka P, Bullinger L, Bug G, Serve H, Göhring G, Schlegelberger B, Lübbert M, Kirchner H, Wattad M, Kraemer D, Hertenstein B, Heil G, Fiedler W, Krauter J, Schlenk RF, Döhner K, Döhner H, Ganser A, Heuser M. Acute myeloid leukemia derived from lympho-myeloid clonal hematopoiesis. Leukemia 2016; 31:1286-1295. [PMID: 27881874 DOI: 10.1038/leu.2016.345] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/05/2016] [Accepted: 10/31/2016] [Indexed: 12/12/2022]
Abstract
We studied acute myeloid leukemia (AML) patients with lympho-myeloid clonal hematopoiesis (LM-CH), defined by the presence of DNA methyltransferase 3A (DNMT3A) mutations in both the myeloid and lymphoid T-cell compartment. Diagnostic, complete remission (CR) and relapse samples were sequenced for 34 leukemia-related genes in 171 DNMT3A mutated adult AML patients. AML with LM-CH was found in 40 patients (23%) and was associated with clonal hematopoiesis of indeterminate potential years before AML, older age, secondary AML and more frequent MDS-type co-mutations (TET2, RUNX1 and EZH2). In 82% of AML patients with LM-CH, the preleukemic clone was refractory to chemotherapy and was the founding clone for relapse. Both LM-CH and non-LM-CH MRD-positive AML patients who achieved CR had a high risk of relapse after 10 years (75% and 75%, respectively) compared with patients without clonal hematopoiesis in CR with negative MRD (27% relapse rate). Long-term survival of patients with LM-CH was only seen after allogeneic hematopoietic stem cell transplantation (HSCT). We define AML patients with LM-CH as a distinct high-risk group of AML patients that can be identified at diagnosis through mutation analysis in T cells and should be considered for HSCT.
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Affiliation(s)
- F Thol
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - S Klesse
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - L Köhler
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - R Gabdoulline
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - A Kloos
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - A Liebich
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - M Wichmann
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - A Chaturvedi
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - J Fabisch
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - V I Gaidzik
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - P Paschka
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - L Bullinger
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - G Bug
- Department of Internal Medicine III, University of Frankfurt, Frankfurt, Germany
| | - H Serve
- Department of Internal Medicine III, University of Frankfurt, Frankfurt, Germany
| | - G Göhring
- Institute of Cell and Molecular Pathology, Hannover Medical School, Hannover, Germany
| | - B Schlegelberger
- Institute of Cell and Molecular Pathology, Hannover Medical School, Hannover, Germany
| | - M Lübbert
- Department of Hematology-Oncology, University of Freiburg Medical Center, Freiburg, Germany
| | - H Kirchner
- Department of Internal Medicine III, Krankenhaus Siloah, Hannover, Germany
| | - M Wattad
- Evangelisches Krankenhaus Essen-Werden, Essen, Germany
| | - D Kraemer
- Klinikum Oldenburg, Oldenburg, Germany
| | | | - G Heil
- Department of Internal Medicine V, Klinikum Lüdenscheid, Germany
| | - W Fiedler
- Department of Medicine II, Oncological Center, Hubertus Wald University Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - J Krauter
- Department of Hematology and Oncology, Klinikum Braunschweig, Braunschweig, Germany
| | - R F Schlenk
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - K Döhner
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - H Döhner
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - A Ganser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - M Heuser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
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Slim A, Fentanes E, Thomas D, Slim J, Triana T, Ahmadian H, McDonough R, Saucedo J, Suarez N, Pearce-Moore D, Kirchner H, Hulten E, Cury R, Branch K. ASpirin and Plavix Following Coronary Artery Bypass Grafting (ASAP-CABG): A Randomized, Double-Blind, Placebo-Controlled Pilot Trial. ACTA ACUST UNITED AC 2016. [DOI: 10.9734/bjmmr/2016/24386] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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Müller TD, Nogueiras R, Andermann ML, Andrews ZB, Anker SD, Argente J, Batterham RL, Benoit SC, Bowers CY, Broglio F, Casanueva FF, D'Alessio D, Depoortere I, Geliebter A, Ghigo E, Cole PA, Cowley M, Cummings DE, Dagher A, Diano S, Dickson SL, Diéguez C, Granata R, Grill HJ, Grove K, Habegger KM, Heppner K, Heiman ML, Holsen L, Holst B, Inui A, Jansson JO, Kirchner H, Korbonits M, Laferrère B, LeRoux CW, Lopez M, Morin S, Nakazato M, Nass R, Perez-Tilve D, Pfluger PT, Schwartz TW, Seeley RJ, Sleeman M, Sun Y, Sussel L, Tong J, Thorner MO, van der Lely AJ, van der Ploeg LHT, Zigman JM, Kojima M, Kangawa K, Smith RG, Horvath T, Tschöp MH. Ghrelin. Mol Metab 2015; 4:437-60. [PMID: 26042199 PMCID: PMC4443295 DOI: 10.1016/j.molmet.2015.03.005] [Citation(s) in RCA: 680] [Impact Index Per Article: 75.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/11/2015] [Accepted: 03/11/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The gastrointestinal peptide hormone ghrelin was discovered in 1999 as the endogenous ligand of the growth hormone secretagogue receptor. Increasing evidence supports more complicated and nuanced roles for the hormone, which go beyond the regulation of systemic energy metabolism. SCOPE OF REVIEW In this review, we discuss the diverse biological functions of ghrelin, the regulation of its secretion, and address questions that still remain 15 years after its discovery. MAJOR CONCLUSIONS In recent years, ghrelin has been found to have a plethora of central and peripheral actions in distinct areas including learning and memory, gut motility and gastric acid secretion, sleep/wake rhythm, reward seeking behavior, taste sensation and glucose metabolism.
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Affiliation(s)
- T D Müller
- Institute for Diabetes and Obesity, Helmholtz Zentrum München, München, Germany
| | - R Nogueiras
- Department of Physiology, Centro de Investigación en Medicina Molecular y Enfermedades Crónicas, University of Santiago de Compostela (CIMUS)-Instituto de Investigación Sanitaria (IDIS)-CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Santiago de Compostela, Spain
| | - M L Andermann
- Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Z B Andrews
- Department of Physiology, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - S D Anker
- Applied Cachexia Research, Department of Cardiology, Charité Universitätsmedizin Berlin, Germany
| | - J Argente
- Department of Pediatrics and Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Madrid, Spain ; Department of Pediatrics, Universidad Autónoma de Madrid and CIBER Fisiopatología de la obesidad y nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - R L Batterham
- Centre for Obesity Research, University College London, London, United Kingdom
| | - S C Benoit
- Metabolic Disease Institute, Division of Endocrinology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - C Y Bowers
- Tulane University Health Sciences Center, Endocrinology and Metabolism Section, Peptide Research Section, New Orleans, LA, USA
| | - F Broglio
- Division of Endocrinology, Diabetes and Metabolism, Dept. of Medical Sciences, University of Torino, Torino, Italy
| | - F F Casanueva
- Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (CHUS), CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, Santiago de Compostela, Spain
| | - D D'Alessio
- Duke Molecular Physiology Institute, Duke University, Durham, NC, USA
| | - I Depoortere
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - A Geliebter
- New York Obesity Nutrition Research Center, Department of Medicine, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - E Ghigo
- Department of Pharmacology & Molecular Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P A Cole
- Monash Obesity & Diabetes Institute, Monash University, Clayton, Victoria, Australia
| | - M Cowley
- Department of Physiology, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia ; Monash Obesity & Diabetes Institute, Monash University, Clayton, Victoria, Australia
| | - D E Cummings
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - A Dagher
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - S Diano
- Dept of Neurobiology, Yale University School of Medicine, New Haven, CT, USA
| | - S L Dickson
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - C Diéguez
- Department of Physiology, School of Medicine, Instituto de Investigacion Sanitaria (IDIS), University of Santiago de Compostela, Spain
| | - R Granata
- Division of Endocrinology, Diabetes and Metabolism, Dept. of Medical Sciences, University of Torino, Torino, Italy
| | - H J Grill
- Department of Psychology, Institute of Diabetes, Obesity and Metabolism, University of Pennsylvania, Philadelphia, PA, USA
| | - K Grove
- Department of Diabetes, Obesity and Metabolism, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - K M Habegger
- Comprehensive Diabetes Center, University of Alabama School of Medicine, Birmingham, AL, USA
| | - K Heppner
- Division of Diabetes, Obesity, and Metabolism, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR 97006, USA
| | - M L Heiman
- NuMe Health, 1441 Canal Street, New Orleans, LA 70112, USA
| | - L Holsen
- Departments of Psychiatry and Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - B Holst
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen N, Denmark
| | - A Inui
- Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - J O Jansson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - H Kirchner
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - M Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London, Queen Mary University of London, London, UK
| | - B Laferrère
- New York Obesity Research Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - C W LeRoux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Ireland
| | - M Lopez
- Department of Physiology, Centro de Investigación en Medicina Molecular y Enfermedades Crónicas, University of Santiago de Compostela (CIMUS)-Instituto de Investigación Sanitaria (IDIS)-CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Santiago de Compostela, Spain
| | - S Morin
- Institute for Diabetes and Obesity, Helmholtz Zentrum München, München, Germany
| | - M Nakazato
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - R Nass
- Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA, USA
| | - D Perez-Tilve
- Department of Internal Medicine, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - P T Pfluger
- Institute for Diabetes and Obesity, Helmholtz Zentrum München, München, Germany
| | - T W Schwartz
- Department of Neuroscience and Pharmacology, Laboratory for Molecular Pharmacology, The Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - R J Seeley
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - M Sleeman
- Department of Physiology, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Y Sun
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - L Sussel
- Department of Genetics and Development, Columbia University, New York, NY, USA
| | - J Tong
- Duke Molecular Physiology Institute, Duke University, Durham, NC, USA
| | - M O Thorner
- Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA, USA
| | - A J van der Lely
- Department of Medicine, Erasmus University MC, Rotterdam, The Netherlands
| | | | - J M Zigman
- Departments of Internal Medicine and Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - M Kojima
- Molecular Genetics, Institute of Life Science, Kurume University, Kurume, Japan
| | - K Kangawa
- National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - R G Smith
- The Scripps Research Institute, Florida Department of Metabolism & Aging, Jupiter, FL, USA
| | - T Horvath
- Program in Integrative Cell Signaling and Neurobiology of Metabolism, Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - M H Tschöp
- Institute for Diabetes and Obesity, Helmholtz Zentrum München, München, Germany ; Division of Metabolic Diseases, Department of Medicine, Technical University Munich, Munich, Germany
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Kirchner H, Sinha I, Naslund E, Zierath J. Altered DNA methylation of glycolytic and lipogenic genes in liver of obese and type 2 diabetic patients. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kirchner H, Siegmund A, Arolt V. NMDAR-Enzephalitis nach ovarieller Zystektomie mit den Symptomen einer akut polymorph psychotischen Störung. Akt Neurol 2013. [DOI: 10.1055/s-0033-1343469] [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: 10/26/2022]
Affiliation(s)
- H. Kirchner
- Euregioklinik Nordhorn, Psychiatrie, Nordhorn
| | - A. Siegmund
- Euregioklinik Nordhorn, Psychiatrie, Nordhorn
| | - V. Arolt
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Münster
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Heppner KM, Müller TD, Kirchner H, Perez-Tilve D, Pfluger PT, Tschöp MH, Hofmann SM. The role of ghrelin-octanoyl-acyl-transferase in thermoregulation. J Endocrinol Invest 2013; 36:180-4. [PMID: 22526011 DOI: 10.3275/8388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ghrelin is a gastrointestinal peptide that promotes a positive energy balance. The enzyme ghrelin O-acyltransferase (GOAT) esterifies an n-octanoic acid to the peptide, thereby enabling ghrelin to bind and activate the ghrelin receptor. Although ghrelin has previously been implicated in the control and maintenance of body core temperature (BCT), the role that this acylation may play in thermoregulation has not been examined. AIM We aimed to investigate the endogenous role of ghrelin acylation in thermoregulation. METHODS In this study, we exposed mice lacking the enzyme GOAT as well as wild-type (WT) control mice to cold temperatures under ad libitum and fasting conditions. Additionally, we investigated the role of GOAT in metabolic adaptation to cold temperatures by analyzing BCT and energy metabolism in mice with and without GOAT that were progressively exposed to low ambient temperatures (31-7 C). RESULTS We find that regardless of nutritional status, mice lacking GOAT maintain a similar BCT as their WT counterparts during an 8 h cold exposure. Furthermore, mice lacking GOAT maintain a similar BCT and metabolic adaptation asWT controls during acclimatization to low ambient temperatures. CONCLUSIONS We conclude that the absence of the enzyme GOAT does not play a significant role in maintenance of BCT or metabolic adaptation during exposure to low external temperatures.
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Affiliation(s)
- K M Heppner
- Metabolic Diseases Institute, Division of Endocrinology, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
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Davis JF, Perello M, Choi DL, Magrisso IJ, Kirchner H, Pfluger PT, Tschoep M, Zigman JM, Benoit SC. GOAT induced ghrelin acylation regulates hedonic feeding. Horm Behav 2012; 62:598-604. [PMID: 22982020 PMCID: PMC3489978 DOI: 10.1016/j.yhbeh.2012.08.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 07/10/2012] [Accepted: 08/29/2012] [Indexed: 11/21/2022]
Abstract
Ghrelin is an orexigenic hormone that regulates homeostatic and reward-related feeding behavior. Recent evidence indicates that acylation of ghrelin by the gut enzyme ghrelin O-acyl transferase (GOAT) is necessary to render ghrelin maximally active within its target tissues. Here we tested the hypothesis that GOAT activity modulates food motivation and food hedonics using behavioral pharmacology and mutant mice deficient for GOAT and the ghrelin receptor (GHSR). We evaluated operant responding following pharmacological administration of acyl-ghrelin and assessed the necessity of endogenous GOAT activity for operant responding in GOAT and GHSR-null mice. Hedonic-based feeding behavior also was examined in GOAT-KO and GHSR-null mice using a "Dessert Effect" protocol in which the intake of a palatable high fat diet "dessert" was assessed in calorically-sated mice. Pharmacological administration of acyl-ghrelin augmented operant responding; notably, this effect was dependent on intact GHSR signaling. GOAT-KO mice displayed attenuated operant responding and decreased hedonic feeding relative to controls. These behavioral results correlated with decreased expression of the orexin-1 receptor in reward-related brain regions in GOAT-KO mice. In summary, the ability of ghrelin to stimulate food motivation is dependent on intact GHSR signaling and modified by endogenous GOAT activity. Furthermore, GOAT activity is required for hedonic feeding behavior, an effect potentially mediated by forebrain orexin signaling. These data highlight the significance of the GOAT-ghrelin system for the mediation of food motivation and hedonic feeding.
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Affiliation(s)
- J F Davis
- Department of Psychiatry, Metabolic Diseases Institute, University of Cincinnati, OH, USA.
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Barbeau E, Fize D, Kirchner H, Liegeois-Chauvel C, Regis J, Fabre-Thorpe M. Electrophysiological evidence for early visual categorisation at 80 MS. J Vis 2010. [DOI: 10.1167/10.7.999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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24
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Kirchner H, Vuong Q, Thorpe SJ, Thornton IM. Knowing where it goes: Different saccadic responses to dynamic versus static targets. J Vis 2010. [DOI: 10.1167/6.6.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Juhl D, Mosel C, Nawroth F, Funke AM, Dadgar SM, Hagenström H, Kirchner H, Hennig H. Detection of herpes simplex virus DNA in plasma of patients with primary but not with recurrent infection: implications for transfusion medicine? Transfus Med 2010; 20:38-47. [DOI: 10.1111/j.1365-3148.2009.00951.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [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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Honey C, Kirchner H, VanRullen R. Faces in the cloud: Fourier power spectrum biases ultrarapid face detection. J Vis 2008; 8:9.1-13. [DOI: 10.1167/8.12.9] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 07/31/2008] [Indexed: 11/24/2022] Open
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Gluz O, Nitz U, Harbeck N, Ting E, Kates R, Herr A, Lindemann W, Jackisch C, Berdel W, Kirchner H, Metzner B, Werner F, Schütt G, Frick M, Poremba C, Diallo-Danebrock R, Mohrmann S. Triple-negative high-risk breast cancer derives particular benefit from dose intensification of adjuvant chemotherapy: results of WSG AM-01 trial. Ann Oncol 2008; 19:861-70. [DOI: 10.1093/annonc/mdm551] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [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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Chen J, Rothermundt M, Karoutzou G, Zhang Y, Ebmeyer EC, Peters M, Kirchner H, Arolt V, Emrich HM, Dietrich DE. Preliminary investigations on immune parameters in remitted patients with an affective disorder after amantadine treatment. Pharmacopsychiatry 2007. [DOI: 10.1055/s-2007-991697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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Faust KB, Finke D, Klempt-Giessing K, Randers K, Zachrau B, Schlenke P, Kirchner H, Goerg S. Antigen-induced B cell apoptosis is independent of complement C4. Clin Exp Immunol 2007; 150:132-9. [PMID: 17645767 PMCID: PMC2219293 DOI: 10.1111/j.1365-2249.2007.03456.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Deficiencies in early complement components are associated with the development of systemic lupus erythematosus (SLE) and therefore early complement components have been proposed to influence B lymphocyte activation and tolerance induction. A defect in apoptosis is a potential mechanism for breaking of peripheral B cell tolerance, and we hypothesized that the lack of the early complement component C4 could initiate autoimmunity through a defect in peripheral B lymphocyte apoptosis. Previous studies have shown that injection of a high dose of soluble antigen, during an established primary immune response, induces massive apoptotic death in germinal centre B cells. Here, we tested if the antigen-induced apoptosis within germinal centres is influenced by early complement components by comparing complement C4-deficient mice with C57BL/6 wild-type mice. We demonstrate that after the application of a high dose of soluble antigen in wild-type mice, antibody levels declined temporarily but were restored almost completely after a week. However, after antigen-induced apoptosis, B cell memory was severely limited. Interestingly, no difference was observed between wild-type and complement C4-deficient animals in the number of apoptotic cells, restoration of antibody levels and memory response.
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Affiliation(s)
- K B Faust
- Institute of Immunology and Transfusion Medicine, University of Luebeck, Luebeck, Germany
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Atzpodien J, Kirchner H, Rebmann U, Soder M, Gertenbach U, Siebels M, Roigas J, Raschke R, Salm S, Schwindl B, Müller SC, Hauser S, Leiber C, Huland E, Heinzer H, Siemer S, Metzner B, Heynemann H, Fornara P, Reitz M. Interleukin-2/interferon-alpha2a/13-retinoic acid-based chemoimmunotherapy in advanced renal cell carcinoma: results of a prospectively randomised trial of the German Cooperative Renal Carcinoma Chemoimmunotherapy Group (DGCIN). Br J Cancer 2006; 95:463-9. [PMID: 16909131 PMCID: PMC2360667 DOI: 10.1038/sj.bjc.6603271] [Citation(s) in RCA: 30] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We performed a prospectively randomised clinical trial to compare the efficacy of four subcutaneous interleukin-2-(sc-IL-2) and sc interferon-alpha2a (sc-IFN-alpha2a)-based outpatient regimens in 379 patients with progressive metastatic renal cell carcinoma. Patients with lung metastases, an erythrocyte sedimentation rate < or =70 mm h(-1) and neutrophil counts < or =6000 microl(-1) (group I) were randomised to arm A: sc-IL-2, sc-IFN-alpha2a, peroral 13-cis-retinoic acid (po-13cRA) (n=78), or arm B: arm A plus inhaled-IL-2 (n=65). All others (group II) were randomised to arm C: arm A plus intravenous 5-fluorouracil (iv-5-FU) (n=116), or arm D: arm A plus po-Capecitabine (n=120). Median overall survival (OS) was 22 months (arm A; 3-year OS: 29.7%) and 18 months (arm B; 3-year OS: 29.2%) in group I, and 18 months (arm C; 3-year OS: 25.7%) and 16 months (arm D; 3-year OS: 32.6%) in group II. There were no statistically significant differences in OS, progression-free survival, and objective response between arms A and B, and between arms C and D, respectively. Given the known therapeutic efficacy of sc-IL-2/sc-INF-alpha2a/po-13cRA-based outpatient chemoimmunotherapies, our results did not establish survival advantages in favour of po-Capecitabine vs iv-5-FU, and in favour of short-term inhaled-IL-2 in patients with advanced renal cell carcinoma receiving systemic cytokines.
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Affiliation(s)
- J Atzpodien
- Fachklinik Hornheide an der Universität Münster, Internistische Onkologie, Dorbaumstrasse 300, Münster 48157, Germany.
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Brand JM, Meller B, Von Hof K, Luhm J, Bähre M, Kirchner H, Frohn C. Kinetics and organ distribution of allogeneic natural killer lymphocytes transfused into patients suffering from renal cell carcinoma. Stem Cells Dev 2006; 13:307-14. [PMID: 15186726 DOI: 10.1089/154732804323099235] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The transfusion of natural killer (NK) lymphocytes into patients suffering from malignant diseases is an approach of current interest in the field of immunotherapy. Little is known about the organ distribution, survival, and clearance of donor immune effector cells in cellular therapy, and no reports exist on these important parameters considering NK cells in particular or any other type of allogeneic lymphocytes in humans. In the context of a clinical Phase I/II study we examined the distribution of transfused allogeneic NK cells in patients suffering from renal cell carcinoma. The NK cells were ex vivo cultivated and activated before transfusion. To assess the circulation of the transfused cells in the peripheral blood, we used a nested PCR technique to detect HLA DRB1 alleles of the NK cell donors. Post-transfusion, all patients showed evidence of circulating donor cells for up to 3 days. After 7 days, all donor cells were cleared from the blood to undetectable levels. To assess organ distribution, (111)In-labeled NK cells were injected and monitored by whole-body scintiscans. A distribution to the whole body, with preference for liver, spleen, and bone marrow, was observed after a short initial uptake in the lungs. No activity was observed in lymphatic nodes. A total of 2/4 evaluable metastases showed a clear accumulation of transfused NK cells. The half-life corrected activity in all body compartments remained almost constant over the 6-day observation period in concordance with the absence of any excretion of radioactivity. This may indicate an extended survival of the transfused cells, despite their foreign nature, in the host organism.
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Affiliation(s)
- J-M Brand
- Institute of Immunology and Transfusion Medicine, University of Lübeck School of Medicine, 23538 Lübeck, Germany
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Steiner T, Roigas J, Kirchner H, Doehn C, Heynemann H, Siebels M, Loening S, Jocham D, Fornara P, Rohde D, Stieff CG. Clinical course of patients with metastatic papillary renal cell carcinoma. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14591 Background: For a long time it has been discussed, whether patients (pts.) with metastatic papillary renal cell carcinoma (mRCC pap) demonstrate different behaviour compared to those with clear cell mRCC. Methods: Clinical data of 61 pts. with mRCC pap were retrospectively assessed at 8 treatment centres. Results: Median follow-up was 20 (1–114) months, median age at time of diagnosis was 62 (24–85) years. Men were affected predominantly (50/61 pts.; 82%). 21 pts. (34%) showed metastases at time of diagnosis. The remaining 40 pts. had metachroneous metastatic disease. Mean time to metastases development was 30.4 (3–143; median 16.5) months. Metastatic sites were: lung (37; 61%), bone (24; 38%), liver (20; 33%), lymph nodes (24; 38%). Local recurrences occurred in 17 pts. (28%). Others sites of metastatic disease were brain in 6 pts. (10%), peritoneal carcinosis in 5 pts. (8%) and others. A surgical approach was performed primarily in 11 pts. (18%): lung 2; local recurrence and lymphomas 7; liver 1; brain 1. 26/61 pts. with metastatic disease received an immuno- (interferon-a ± interleukin-2) or immunochemotherapy (in combination with vinblastine or 5-fluorouracile) as first line treatment. In total, 42/61 pts. (69%) received an interferon- or interleukin-based immunotherapy. No treatment at all was performed in 12 pts. (20%) because of poor performance status. 5/42 pts. (11.4%) achieved an objective response to immuno(chemo)therapy. In the Kaplan-Meier-analysis, median overall survival after diagnosis of metastatic disease was estimated to be 13 ± 1.5 (95% CI 9.9–16) months for the entire study group and 12 ± 2.5 (95% CI 7.1–16.3) from the beginning of systemic treatment. Conclusions: Clinical data of a large population of pts. with mRCC pap have been assessed in this retrospective analysis for the first time. Compared to pts. with clear cell mRCC, these patients are characterized by: I) more frequent local recurrences; II) lower remission rates to immuno(chemo)therapeutic approaches; III) poorer prognosis with regard to overall survival. These findings should be taken into account when planning future studies. No significant financial relationships to disclose.
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Affiliation(s)
- T. Steiner
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - J. Roigas
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - H. Kirchner
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - C. Doehn
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - H. Heynemann
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - M. Siebels
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - S. Loening
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - D. Jocham
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - P. Fornara
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - D. Rohde
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - C. G. Stieff
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
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Kirchner H. [Modern concepts of medical care--what has been achieved by the implementation of disease management programs?]. ACTA ACUST UNITED AC 2006; 94 Suppl 4:IV/7-11. [PMID: 16416069 DOI: 10.1007/s00392-005-1403-y] [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: 10/25/2022]
Abstract
Since 2003, structured treatment programs for chronically ill patients (disease management programs; DMPs) have been under development in Germany. Virtually nationwide, programs in which physicians and patients can register are being offered for diabetes mellitus types 1 and 2, breast cancer, coronary heart disease and asthma/COPD. The medical content of the programs is determined on the basis of evidence-based medicine. Even though the effectiveness of structured treatment programs is documented for diabetes, adequate studies confirming the overall transferability of results to the German health care system are as yet lacking. Physicians above all strongly criticise the coupling of DMPs with the risk adjustment scheme of the statutory health insurance funds, as well as the large amount of paperwork involved.
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Affiliation(s)
- H Kirchner
- IQWiG--Institut für Qualität- und Wirtschaftlichkeit im Gesundheitswesen, Leiterin des Ressorts Leitlinien, Dillenburger Strasse 27, 51105 Köln
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Hartwig D, Schütte C, Warnecke J, Dorn I, Hennig H, Kirchner H, Schlenke P. The large form of ADAR 1 is responsible for enhanced hepatitis delta virus RNA editing in interferon-alpha-stimulated host cells. J Viral Hepat 2006; 13:150-7. [PMID: 16475990 DOI: 10.1111/j.1365-2893.2005.00663.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Hepatitis delta virus (HDV) RNA editing controls the formation of hepatitis-delta-antigen-S and -L and therefore indirectly regulates HDV replication. Editing is thought to be catalysed by the adenosine deaminase acting on RNA1 (ADAR1) of which two different forms exist, interferon (IFN)-alpha-inducible ADAR1-L and constitutively expressed ADAR1-S. ADAR1-L is hypothesized to be a part of the innate cellular immune system, responsible for deaminating adenosines in viral dsRNAs. We examined the influence of both forms on HDV RNA editing in IFN-alpha-stimulated and unstimulated hepatoma cells. For gene silencing, an antisense oligodeoxyribonucleotide against a common sequence of both forms of ADAR1 and another one specific for ADAR1-L alone were used. IFN-alpha treatment of host cells led to approximately twofold increase of RNA editing compared with unstimulated controls. If ADAR1-L expression was inhibited, this substantial increase in editing could no longer be observed. In unstimulated cells, ADAR1-L suppression had only minor effects on editing. Inhibition of both forms of ADAR1 simultaneously led to a substantial decrease of edited RNA independently of IFN-alpha-stimulation. In conclusion, the two forms of ADAR1 are responsible almost alone for HDV editing. In unstimulated cells, ADAR1-S is the main editing activity. The increase of edited RNA under IFN-alpha-stimulation is because of induction of ADAR1-L, showing for the first time that this IFN-inducible protein is involved in the base modification of replicating HDV RNA. Thus, induction of ADAR1-L may at least partially cause the antiviral effect of IFN-alpha in natural immune response to HDV as well as in case of therapeutic administration of IFN.
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Affiliation(s)
- D Hartwig
- Institut für Immunologie und Transfusionsmedizin, Universität zu Lübeck, Germany.
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Thole H, Kroegel C, Bassler D, Fessler J, Forster J, Franzen D, Geraedts M, Mörike K, Schmitz M, Scholz R, Kirchner H, Ollenschläger G. [The German guideline clearing-project on bronchial asthma - part 2: recommendations and key topics for a national guideline on bronchial asthma]. Pneumologie 2004; 58:165-75. [PMID: 15007789 DOI: 10.1055/s-2003-812524] [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: 10/26/2022]
Abstract
BACKGROUND In order to promote the quality of asthma management in Germany, a national asthma guidelines clearing project was initiated in 2000 by the German Guidelines Clearinghouse (Sponsors: German Medical Association (GMA), National Association of the Statutory Health Insurance Physicians (NASHIP), German Hospital Federation, Federal Association of the Statutory Sickness Funds. This Part shows the key topics which should be dealt with in a German guideline on bronchial asthma. SUMMARY POINTS For quality promotion of bronchial asthma management in Germany, the development of a national evidence-based guideline, using the internationally accepted quality criteria for clinical practice guidelines, was recommended by an expert group of the German Guideline Clearinghouse. The experts identified and peer-reviewed 16 out of 54 guidelines, which might be useful as benchmarks and examples for a German asthma guideline. From the peer review results, the expert group identified 18 key topics for a national asthma guideline.
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Affiliation(s)
- H Thole
- Arztliches Zentrum für Qualität in der Medizin, Köln.
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Rothermundt M, Peters M, Ponath G, Erfurth A, Wiesmann M, Missler U, Rudolf S, Kirchner H, Arolt V. Treatment response in major depression is correlated with an increased concentration of the neuroplasticity marker S100B. Pharmacopsychiatry 2004. [DOI: 10.1055/s-2003-825477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Heil G, Krauter J, Raghavachar A, Bergmann L, Hoelzer D, Fiedler W, Lübbert M, Noens L, Schlimok G, Arnold R, Kirchner H, Ganser A. Risk-adapted induction and consolidation therapy in adults with de novo AML aged =�60�years: results of a prospective multicenter trial. Ann Hematol 2004; 83:336-44. [PMID: 15034758 DOI: 10.1007/s00277-004-0853-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [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: 11/10/2003] [Accepted: 01/20/2004] [Indexed: 11/30/2022]
Abstract
We treated 305 de novo acute myeloid leukemia (AML) patients aged </=60 years with risk-adapted therapy. Patients with CBF leukemias or normal karyotype and good response to induction I [</=5% bone marrow (BM) blasts on day 15] were considered standard risk (SR), all others as high risk (HR). Patients with t(15;17) were excluded. Chemotherapy comprised double induction followed by early consolidation. As late consolidation, SR patients received high-dose cytarabine/daunorubicin (AraC/DNR). SR patients with normal karyotype were allotransplanted from HLA-matched siblings. HR patients were allotransplanted or if no sibling donor was available autotransplanted with peripheral blood progenitor cells (PBSC) harvested after early consolidation. 89% of the SR and 60% of the HR patients achieved CR. The continuous complete remission (CCR) rate at 80 months (median follow-up: 48 months) was 48% for SR and 32% for HR. The CCR rate was 54% for t(8;21), 47% for normal karyotype, and 33% for inv(16) patients. In the HR group, the CCR rate did not differ significantly for patients with bad response to IVA-I, unfavorable karyotype, or both. Forty-five HR patients were autotransplanted (n=20) or allotransplanted (n=25). The probability of CCR was 44% for autotransplantation vs 33% for allotransplantation. In conclusion, our risk-adapted strategy produced encouraging results in SR patients. Early response to therapy is a strong prognostic factor that predicts the probability of CR and long-term outcome.
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Affiliation(s)
- G Heil
- Department of Hematology, Hemostaseology and Oncology, Hannover Medical School, University of Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Atzpodien J, Kirchner H, Jonas U, Bergmann L, Schott H, Heynemann H, Fornara P, Loening SA, Roigas J, Müller SC, Bodenstein H, Pomer S, Metzner B, Rebmann U, Oberneder R, Siebels M, Wandert T, Puchberger T, Reitz M. Interleukin-2- and interferon alfa-2a-based immunochemotherapy in advanced renal cell carcinoma: a Prospectively Randomized Trial of the German Cooperative Renal Carcinoma Chemoimmunotherapy Group (DGCIN). J Clin Oncol 2004; 22:1188-94. [PMID: 14981107 DOI: 10.1200/jco.2004.06.155] [Citation(s) in RCA: 177] [Impact Index Per Article: 8.9] [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: 11/20/2022] Open
Abstract
PURPOSE We conducted a prospectively randomized clinical trial to compare the efficacy of three outpatient therapy regimens in 341 patients with progressive metastatic renal cell carcinoma. PATIENTS AND METHODS Patients were stratified according to known clinical predictors and were subsequently randomly assigned. Treatment arms were: arm A (n = 132), subcutaneous interferon alfa-2a (sc-IFN-alpha-2a), subcutaneous interleukin-2 (sc-IL-2), and intravenous (IV) fluorouracil; arm B (n = 146): arm A treatment combined with per oral 13-cis-retinoic acid; and arm C (n = 63), sc-IFN-alpha-2a and IV vinblastine. RESULTS Treatment (according to the standard 8-week Hannover Atzpodien regimen) arms A, B, and C yielded objective response rates of 31%, 26%, and 20%, respectively. Arm B, but not arm A, showed a significantly improved progression-free survival (PFS) compared with arm C (P =.0248). Both arm A (median overall survival, 25 months; P =.0440) and arm B (median overall survival, 27 months; P =.0227) led to significantly improved overall survival (OS) compared with arm C (median OS, 16 months). All three sc-IFN-alpha-2a-based therapies were moderately or well tolerated. CONCLUSION Our results established the safety and improved long-term therapeutic efficacy of sc-IL-2 plus sc-INF-alpha-2a-based outpatient immunochemotherapies, compared with sc-INF-alpha-2a/IV vinblastine.
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Abstract
The importance of guidelines increases continuously on the political level whereas on the user level reservations and uncertainty persist. Consequently guidelines are not considered as they should be. Guidelines will develop their effectiveness only if they are firmly implemented in the delivery process. Acceptance problems spring from problems in development and from aspects of dissemination and implementation not sufficiently considered so far. Therefore a lot of countries have developed quality criteria for guidelines and programmes for quality promotion. To further the use of guidelines in the care process aspects of dissemination and implementation have to be recognized even in the development process. This has not been recognized sufficiently so far. Implementation of guidelines is a systematic approach which has to be connected seamlessly with other activities (e. g. quality management). The implementation process should be accompanied and evaluated so that a continuous adjustment is possible. Most of the existing guideline programmes do not consider this sufficiently. The following contribution gives a survey of results and introduces means and instruments for assessment and implementation of guidelines.
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Affiliation(s)
- H Kirchner
- Arztliches Zentrum für Qualität in der Medizin, Cologne.
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Hoerauf H, Klüter H, Joachimmeyer E, Roider J, Framme C, Schlenke P, Kirchner H, Lagua H. Results of vitrectomy and the no-touch-technique using autologous adjuvants in macular hole treatment. Int Ophthalmol 2003; 24:151-9. [PMID: 12498512 DOI: 10.1023/a:1021566806836] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [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: 11/12/2022]
Abstract
BACKGROUND Anatomic and functional results of macular holes using vitrectomy and platelet-concentrate (PC) or autologous whole blood (WB) were investigated without peeling any epiretinal membrane in order to minimize retinal trauma. METHODS 44 patients with macular holes stage II, III and IV underwent a vitrectomy with removal of posterior cortical vitreous (in stage II and III) and C2F6 gas endotamponade. No peeling of any epiretinal membrane or the ILM was performed. In 14 patients autologous WB was injected and in 30 patients autologous PC. The mean follow-up time was 9.3 months. RESULTS An anatomic closure was observed in 36.4% of patients in the WB-group and in 93.9% of patients in the PC-group. SLO-microperimetry showed a reduction of absolute scotomas in 80% of the WB- and in 75% of the PC-group. In the WB-group 1 retinal detachment and 1 branch vein occlusion occurred; in the PC-group 3 retinal detachments, 1 central artery occlusion, 1 macular pucker, 1 cystoid macular edema, 1 late reopening and 1 secondary glaucoma were observed. In both groups no endophthalmitis occurred. CONCLUSION If autologous platelet concentrate is available, high anatomic success rates can be achieved without aggressive membrane removal, which may cause retinal damage. Autologous whole blood cannot be recommended as an alternative adjunct for the treatment of macular holes without membrane removal.
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Affiliation(s)
- H Hoerauf
- Eye-Hospital, University of Lübeck, Germany.
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Huland E, Burger A, Fleischer J, Fornara P, Hatzmann E, Heidenreich A, Heinzer H, Heynemann H, Hoffmann L, Hofmann R, Huland H, Kämpfer I, Kindler M, Kirchner H, Mehlhorn G, Moniak TH, Rebmann U, Roigas J, Schneider TH, Schnorr D, Schmitz HJ, Wenisch R, Varga Z, Vinke J. Efficacy and safety of inhaled recombinant interleukin-2 in high-risk renal cell cancer patients compared with systemic interleukin-2: an outcome study. Folia Biol (Praha) 2003; 49:183-90. [PMID: 14680292] [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: 04/27/2023]
Abstract
Systemic IL-2 is an effective treatment for low to intermediate risk mRCC patients, its efficacy is marginal in high-risk cases. Therefore, other treatment approaches are required for this population. Ninety-four high-risk patients with RCC and pulmonary metastases were treated with inhaled plus concomitant low-dose subcutaneous rhIL-2. Clinical response, survival and safety were compared with those from IL-2 given systemically at the registered dose and schedule in 103 comparable historical controls. In the rhIL-2 INH group, treatment consisted of 6.5 MIU rhIL-2 nebulized 5x/day and 3.3 MIU rhIL-2 SC once daily. The rhIL-2 SYS group received treatment which consisted of intravenous infusion of 18.0 MIU/m2/day rhIL-2 or SC injection of 3.6-18.0 MIU rhIL-2. Some patients in both groups also received IFNalpha. Mean treatment durations were 43 weeks rhIL-2 INH and 15 weeks rhIL-2 SYS. Significantly longer overall survival and progression-free survival durations were observed in the rhIL-2 INH group. The probability of survival at 5 years was 21% for the rhIL-2 INH group. No patients survived 5 years in the rhIL-2 SYS group. A multivariate analysis of overall survival adjusting for differences in baseline characteristics between the two treatment groups resulted in a risk ratio of 0.43 (95% CI 0.30-0.63; P < 0.0001). The data suggested an association between the response (SD or better) and survival, especially in the rhIL-2 INH group. The inhalation regimen was well tolerated. This outcome study suggests that administration of rhIL-2 by inhalation is efficacious and safe in high-risk mRCC patients with pulmonary metastases, who have no other treatment option available.
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Affiliation(s)
- E Huland
- Department of Urology, University Hospital Hamburg-Eppendorf, Germany.
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Ollenschläger G, Kirchner H, Berenbeck C, Thole H, Weingart O, Sonntag D, Fiene M, Thomeczek C. [Current initiatives in Germany for translating national guidelines into reality - a survey]. Gesundheitswesen 2002; 64:513-20. [PMID: 12375227 DOI: 10.1055/s-2002-34617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The role of practice guidelines as a tool for quality management in health care is now widely accepted in Germany- not only by health professionals, but also in politics. The physicians' professional associations as well as health care authorities (physicians' self-governmental bodies) and parliament introduced several incentives and regulations, aiming at a regular use of guidelines in health care. Among these the German guideline clearinghouse with the systematic approach towards identification, dissemination, and implementation of best available evidence-based guidelines, as well as the country-wide implementation of disease management guidelines seem to be effective and efficient in quality management as well as in patient care management in the German health care system. The article gives an overview on background, procedures and barriers to country-wide implementation of clinical practice guidelines within a social security health care system.
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Rothermundt M, Peters M, Wiesmann M, Hettich M, Abel S, Rudolf S, Kirchner H, Arolt V. Evidence for neuroplastic activity in acute schizophrenic psychosis. Eur Psychiatry 2002. [DOI: 10.1016/s0924-9338(02)80675-7] [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: 11/26/2022] Open
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Hartwig D, Schläger F, Bucsky P, Kirchner H, Schlenke P. Successful long-term erythrocytapheresis therapy in a patient with symptomatic sickle-cell disease using an arterio-venous fistula. Transfus Med 2002; 12:75-7. [PMID: 11967141 DOI: 10.1046/j.1365-3148.2002.00346.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [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: 11/20/2022]
Abstract
The use of long-term automated erythrocytapheresis via an arterio-venous fistula for the prevention of recurrent ischaemic stroke in a child with sickle-cell disease (SCD) has not been described previously. We report the successful use of this technique in a 13-year-old boy. A procedure was performed every 36 +/- 6 days, transfusing six units of donor packed red blood cells (RBCs) and discarding 1318 +/- 174 mL of exchanged erythrocytes (Hct 60%). After transfusion of 85 units over 17 months, there is no evidence for iron-overload, red cell alloimmunization, transfusion-transmitted infections, or other complications. Until now, no cerebrovascular ischaemia has been observed.
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Affiliation(s)
- D Hartwig
- Institute for Immunology and Transfusion Medicine, Medical University of Lübeck, Germany.
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Kreft B, Fischer A, Krüger S, Sack K, Kirchner H, Rink L. The impaired immune response to diphtheria vaccination in elderly chronic hemodialysis patients is related to zinc deficiency. Biogerontology 2002; 1:61-6. [PMID: 11707922 DOI: 10.1023/a:1010077622172] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [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: 11/12/2022]
Abstract
Zinc deficiency causes abnormalities of the immune response. In chronic hemodialysis therapy abnormalities in zinc metabolism as well as an impaired immune response to vaccination have been reported. Therefore we performed a vaccination study against diphtheria and hypothesized that the response to diphtheria vaccination is related to serum zinc deficiency in hemodialysis patients. Serum zinc concentrations were assayed in 16 chronic hemodialysis patients (10 male, 6 female; mean age 65 years) without a documented vaccination history against diphtheria. Nine of these patients were triple immunized against diphtheria while seven received a single vaccination. The response to diphtheria vaccination was measured by ELISA detecting specific antibodies to diphtheria-toxoid. Seroconversion 6 and 12 months after vaccination was defined as the doubling of antibody titers in patients > or = 0.1 IU/ml prior to vaccination or as titers > 0.1 IU/ml in all other patients. Only 6/16 hemodialysis patients responded to immunization against diphtheria by specific antibody production (> 0.1 IU/ml). Twelve months after the single injection 3/7 patients seroconverted while six months after the triple vaccination 3/9 patients responded to immunization. This was not age-dependent, whereas in non-responders we detected significantly decreased serum zinc levels. In contrast, responders showed similar serum zinc levels as age-matched controls. Furthermore, we measured a decreased alpha 2-macroglobulin concentration only in the responders amongst the hemodialysis patients. Protection against diphtheria and the immune response to diphtheria vaccination in hemodialysis patients is poor. The failure to respond to active diphtheria vaccination is related to a significantly decreased serum zinc concentration in hemodialysis patients.
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Affiliation(s)
- B Kreft
- Department of Internal Medicine, University of Lübeck, School of Medicine, Ratzeburger Allee 160, D-23538 Lübeck, Germany
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Rothermundt M, Arolt V, Fenker J, Gutbrodt H, Peters M, Kirchner H. Different immune patterns in melancholic and non-melancholic major depression. Eur Arch Psychiatry Clin Neurosci 2002; 251:90-7. [PMID: 11407444 DOI: 10.1007/s004060170058] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The search for immune patterns in major depression has thus far resulted in ambiguous findings, probably because patient samples are psychiatrically heterogeneous. We therefore focused on a detailed classification of subtypes of major depression, comparing patients with melancholic and non-melancholic major depression. Inpatients suffering from acute major depression were diagnosed and subclassified according to DSM IV criteria. Cell counts were determined by FACS analysis and morphology. Cytokine production (IL-2, IFN-gamma, IL-10) upon mitogen stimulation was measured by ELISA in a whole blood assay. Non-melancholic patients showed increased counts of leukocytes, lymphocytes and NK-cells in the acute stage of disease and after two and four weeks of treatment. Their lymphokine production was unchanged compared to that of healthy controls. Melancholic patients on the other hand demonstrated normal cell counts but a decreased production of IL-2, IFN-gamma and IL-10 during the acute stage of disease followed by a normalization with clinical improvement. Melancholic and non-melancholic patients showed different immune patterns. Classifying melancholic and non-melancholic patients is helpful towards the identification of immune characteristics typical for these diseases.
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Affiliation(s)
- M Rothermundt
- Institute of Immunology and Transfusion Medicine, University of Luebeck School of Medicine, Germany
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