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Schuster L, Valor-Méndez L, Wacker J, Dannhardt-Thiem V, Schmidt A, Knitza J, Simon D, Manger B, Schett G, Kleyer A. ["Rheuma (be-)greifen"- A multimodal teaching concept to improve rheumatology education for medical students]. Z Rheumatol 2024; 83:186-193. [PMID: 37505294 PMCID: PMC10973034 DOI: 10.1007/s00393-023-01391-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND The German Society for Rheumatology, through its campaign Rheuma2025, aims to improve student teaching in order to ensure patient care for rheumatological patients in the future. OBJECTIVE To assess whether a combination of traditional and innovative educational methods provide both an improvement in the quality of teaching and an increase in the attractiveness of rheumatology as a discipline. MATERIAL AND METHODS Establishment of the teaching concept "Rheuma (be-)greifen" consisting of five modules on patient history taking with acting patients, musculoskeletal ultrasound, arthrocentesis, 3D printing of pathological joints and virtual reality applications based on real patient cases in the curricular teaching of medical students. RESULTS The evaluation of the teaching concept with 93 students of medicine showed a consistently high acceptance of all modules, which were rated as very effective or rather effective. Direct patient-related modules, such as history taking with acting patients, musculoskeletal ultrasound and arthrocentesis, received even higher acceptance than the visualization methods utilizing 3D printing and virtual reality. CONCLUSION Innovative teaching methods can help to improve the acceptance of teaching in the field of rheumatology, especially when combined with classical teaching contents.
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Affiliation(s)
- L Schuster
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland.
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland.
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland.
| | - L Valor-Méndez
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - J Wacker
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - V Dannhardt-Thiem
- Medizinische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - A Schmidt
- Medizinische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - J Knitza
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - D Simon
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - B Manger
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - G Schett
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Kleyer
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
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Wacker J, Joye R, McLin V, Wildhaber B, Toso C, Genecand L, Lador F, Beghetti M. Liver Transplantation for Pediatric Portopulmonary Hypertension. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1356] [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: 04/05/2023] Open
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van Zanten HHE, Simon W, van Selm B, Wacker J, Maindl TI, Frehner A, Hijbeek R, van Ittersum MK, Herrero M. Circularity in Europe strengthens the sustainability of the global food system. Nat Food 2023; 4:320-330. [PMID: 37117548 PMCID: PMC10154194 DOI: 10.1038/s43016-023-00734-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/10/2023] [Indexed: 04/30/2023]
Abstract
Redesigning the European food system on the basis of circularity principles could bring environmental benefits for Europe and the world. Here we deploy a biophysical optimization model to explore the effects of adopting three circularity scenarios in the European Union (EU)27 + UK. We calculate a potential reduction of 71% in agricultural land use and 29% per capita in agricultural greenhouse gas emissions, while producing enough healthy food within a self-sufficient European food system. Under global food shortages, savings in agricultural land could be used to feed an additional 767 million people outside the EU (+149%), while reducing per capita greenhouse gas emissions by 38% but increasing overall emissions by 55% due to the increased population served. Transitioning the EU's food system towards circularity implies sequential changes among all its components and has great potential to safeguard human and planetary health.
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Affiliation(s)
- H H E van Zanten
- Farming Systems Ecology Group, Wageningen University & Research, Wageningen, the Netherlands.
- Department of Global Development, College of Agriculture and Life Sciences, and Cornell Atkinson Center for Sustainability, Cornell University, Ithaca, NY, USA.
| | - W Simon
- Farming Systems Ecology Group, Wageningen University & Research, Wageningen, the Netherlands
- Plant Production Systems Group, Wageningen University & Research, Wageningen, the Netherlands
| | - B van Selm
- Plant Production Systems Group, Wageningen University & Research, Wageningen, the Netherlands
- Animal Production Systems Group, Wageningen University & Research, Wageningen, the Netherlands
| | - J Wacker
- Farming Systems Ecology Group, Wageningen University & Research, Wageningen, the Netherlands
| | - T I Maindl
- SDB Science-driven Business Ltd, Larnaca, Cyprus
| | - A Frehner
- Department of Food System Sciences, Research Institute of Organic Agriculture FiBL, Frick, Switzerland
| | - R Hijbeek
- Plant Production Systems Group, Wageningen University & Research, Wageningen, the Netherlands
| | - M K van Ittersum
- Plant Production Systems Group, Wageningen University & Research, Wageningen, the Netherlands
| | - M Herrero
- Department of Global Development, College of Agriculture and Life Sciences, and Cornell Atkinson Center for Sustainability, Cornell University, Ithaca, NY, USA
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Bagnall R, Singer E, Wacker J, Nowak N, Ingles J, King I, Macciocca I, Crowe J, Ronan A, Weintraub R, Semsarian C. Genetic Basis of Childhood Cardiomyopathy. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bagnall R, Singer E, Wacker J, Nowak N, Ingles J, King I, Macciocca I, Crowe J, Ronan A, Weintraub R, Semsarian C. Genetic Basis of Childhood Cardiomyopathy. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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D'Alto M, Chessa M, Santoro G, Giordano M, Gaio G, Romeo E, Argiento P, Wacker J, D'Aiello F, Sarubbi B, Russo MG, Golino P, Costantine A, Naeije R, Dimopoulos K. The adding value of fluid challenge and balloon occlusion tests in patients with atrial septal defect. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Careful, step-wise assessment is required in all patients with an atrial septal defect (ASD) to exclude pre-existing pulmonary vascular disease or left ventricular disease. Fluid challenge test (FCT) and balloon occlusion testing (BOT) may unmask left ventricular disease and challenge the pulmonary circulation, but their complementary role in the evaluation of patients with “operable” ASD is not well established.
Aim
To evaluate the haemodynamic changes of the pulmonary circulation by FCT and BOT in ASD patients undergoing percutaneous closure according to the current guidelines.
Methods
Consecutive patients selected for percutaneous ASD closure underwent invasive hemodynamic assessment at baseline and after BOT, FCT and both.
Results
Fifty patients (mean age 47.3±11.7 years, 72% female) were included. All patients had a pulmonary-to-systemic flow ratio (QP/QS) ≥1.5, pulmonary vascular resistance (PVR) <5 WU and pulmonary arterial wedge pressure (PAWP) <15 mmHg. Individuals with a PVR ≥2 WU at baseline were older, more symptomatic, with a higher baseline systemic vascular resistance compared to the lower PVR group (PVR <2 WU; p<0.0001). The response of Qp/Qs to FCT was different between groups (p<0.0001, Figure 1). Patients with a lower baseline PVR experienced an increase in Qp/Qs, which remained above 1.5 in all patients, whereas in almost all (90%) patients with a higher baseline PVR, the Qp/Qs fell to below 1.5.
FCT caused a marked increase in pulmonary blood flow of almost 2 liters (p<0.0001) accompanied by increases in PAWP (p<0.0001). BOT led to a modest increase in PAWP (Δ1.5 [−1.0–7.0] mmHg, p<0.0001). FCT added to BOT caused a further increase in PAWP and Qs (both p<0.0001), while PVR was unchanged (p>0.1).
No difference was observed in the PAWP response to FCT, BOT or both between groups; no patients reached a PAWP ≥18 mmHg following FCT or BOT alone, but 4 (8%) patients did following the addition of FCT to BOT. No acute clinical adverse events were experienced by any patients.
Conclusions
None of the reported ASD patients presented with FCT criteria of post-capillary PH (that is a PAWP >18 mmHg). Even small rises in PVR may have significant implications on cardiovascular haemodynamics. In fact, patients with PVR <2 WU showed an increase in Qp/Qs, which remained above 1.5 in all patients, suggesting that they still had a distensible pulmonary circulation, whereas in almost all patients with a PVR ≥2 WU, the Qp/Qs fell to below 1.5.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- M D'Alto
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - M Chessa
- IRCCS Policlinico San Donato, GUCH Unit, San Donato Milanese, Italy
| | - G Santoro
- G. Pasquinucci Hospital, Paediatric Cardiology, Massa, Italy
| | - M Giordano
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - G Gaio
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - E Romeo
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - P Argiento
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - J Wacker
- IRCCS Policlinico San Donato, GUCH Unit, San Donato Milanese, Italy
| | - F D'Aiello
- IRCCS Policlinico San Donato, GUCH Unit, San Donato Milanese, Italy
| | - B Sarubbi
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - M G Russo
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - P Golino
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - A Costantine
- Royal Brompton Hospital Imperial College London, GUCH Unit, London, United Kingdom
| | - R Naeije
- Erasme Hospital, Department of Pathophysiology, Bruxelles, Belgium
| | - K Dimopoulos
- Royal Brompton Hospital Imperial College London, GUCH Unit, London, United Kingdom
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Schmidt M, KÜmmel S, Ruf-Doerdelmann A, Distelrath A, Wacker JÜ, Schmatloch S, Busch-Liles S, LÜdtke-Heckenkamp K. Neo-adjuvant and/or Adjuvant Subcutaneous Trastuzumab (Herceptin ®) in Patients With Early HER2-positive Breast Cancer: Real World Data from a German Observational Study - (NIS HerSCin). Anticancer Res 2021; 41:485-496. [PMID: 33419847 DOI: 10.21873/anticanres.14799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/15/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Subcutaneous Herceptin (HER SC) has been shown to be equally effective and safe compared to intravenous Herceptin (HER i.v.) application in early HER2-positive breast cancer (HER2+ BC). However, real-world data from the subcutaneous application are currently limited. PATIENTS AND METHODS Based on a non-interventional study (NIS), data from routine clinical use of HER SC have been gathered between 2013 and 2018 in 135 hospitals and open-care practices throughout Germany. RESULTS A total of 265 patients were recruited in the neo-adjuvant and 605 patients in the adjuvant setting. Primary effectiveness endpoint in the neoadjuvant treatment setting was pathological complete response rate, which was achieved in 41.5%. Primary endpoint in the adjuvant setting was disease free survival rate after 2 years (94.9%). Safety results from the study were comparable to the well-known safety profile of HER i.v. including preferred terms, incidence, severity, including cardiac events. No new safety signals were detected. CONCLUSION Effectiveness and safety of HER SC were comparable to data from HER i.v. in early HER2+ BC.
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Affiliation(s)
- Marcus Schmidt
- Department of Obstetrics and Gynecology, University Medical Center, Mainz, Germany;
| | - Sherko KÜmmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology with Breast Unit, Charité Hospital Berlin, Berlin, Germany
| | | | - Andrea Distelrath
- Joint Practices for Urology and Oncology, Wilhelmshaven, previously, MVZ Osthessen GmbH, Fulda, Germany
| | - JÜrgen Wacker
- Bruchsaler Brustzentrum, Fürst-Stirum-Klinik, Bruchsal, Germany
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D'Alto M, Chessa M, Gaio G, Santoro G, Giordano M, Romeo E, Argiento P, Wacker J, D'Aiello F, Sarubbi B, Russo M, Naeije R, Golino P. Response to fluid challenge in patients with atrial septal defect. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
A fluid challenge test (FCT) with a rapid infusion of saline allows for discrimination between pre- and post-capillary pulmonary hypertension (PH) and may unmask hidden post-capillary PH. Patients with atrial septal defect (ASD) may develop pre- or post-capillary PH after shunt closure respectively in case of pulmonary vascular disease or left ventricular disease.
Aim
To evaluate the haemodynamic changes of the pulmonary circulation in ASD patients undergoing percutaneous closure with indicated according to the current ESC guidelines.
Methods
Twenty-three patients (mean age 42.9±12.4 years; 15 female) underwent right heart catheterization in basal conditions and after FCT (volume loading with rapid saline infusion of 7 ml/kg in 10 min) before percutaneous closure of the ASD.
Right atrial pressure (RAP), systolic, mean and diastolic pulmonary arterial pressure (sPAP, mPAP and dPAP), pulmonary arterial wedge pressure (PAWP), cardiac output (CO), pulmonary vascular resistance (PVR), systemic vascular resistance (SVR) and the ratio between pulmonary and systemic flow (QP/QS) were calculated four times: before and after inflating the sizing balloon both at baseline and immediately after FCT (Fig. 1).
Results
The patients had an increase in pressures and flows after FCT with open ASD: mPAP (18.7±4.4 vs 16.7±4.6 mmHg, p<0.001), PAWP (11.3±3.1 vs 9.2±3.0 mmHg, p<0.001), QP (12.5±2.3 vs 10.3±2.0 l/min, p<0.001), and QS (6.6±1.4 vs 5.9±1.2 l/min, p<0.001) but RAP remained unchanged (8.7±3.0 vs 8.3±2.4 mmHg, p=0.35). PVR (0.2±0.4 vs 0.8±0.3 Wood Units, p<0.001) and SVR (11.2±3.2 vs 12.5±3.2 Wood Units, p=0.02) decreased, and PVR/SVR (0.06±0.02 vs 0.06±0.3, p=0.25) remained unchanged. QP/QS increased in all patients after FCT (mean±SD: 2.0±0.4 vs 1.8±0.4, p<0.001).
During a temporary ASD closure by sizing balloon, the patients had increases of RAP (9.0±2.6 vs 7.6±2.6 mmHg, p<0.001) mPAP (19.5±4.0 vs 17.4±3.7 mmHg, p<0.001), PAWP (13.2±2.1 vs 11.2±2.9 mmHg, p<0.001), and CO (7.7±2.7 vs 6.8±2.3 l/min, p<0.001) after FCT. PVR remained unchanged (0.9±0.4 vs 1.1±0.6, p=0.12) and SVR reduced (9.8±2.7 vs 11.3±2.9, p<0.001) after FCT.
Conclusions
None of the reported ASD patients presented with FCT criteria of post-capillary PH (that is a PAWP >18 mmHg). The FCT was associated with an increase in QP/QS suggesting that the patients still had a distensible pulmonary circulation. Further studies are needed to explore the relevance of a FCT in ASD patients, particularly those with higher PVR values.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M D'Alto
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - M Chessa
- IRCCS Policlinico San Donato, GUCH Unit, San Donato Milanese, Italy
| | - G Gaio
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - G Santoro
- G. Pasquinucci Hospital, Paediatric Cardiology, Massa, Italy
| | - M Giordano
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - E Romeo
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - P Argiento
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - J Wacker
- IRCCS Policlinico San Donato, GUCH Unit, San Donato Milanese, Italy
| | - F D'Aiello
- IRCCS Policlinico San Donato, GUCH Unit, San Donato Milanese, Italy
| | - B Sarubbi
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - M.G Russo
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - R Naeije
- Erasme Hospital, Department of Pathophysiology, Bruxelles, Belgium
| | - P Golino
- AO dei Colli-Monaldi Hospital, Naples, Italy
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Wacker J, Shipp A, Konstantinov I, Brink J, Weintraub R, Mathew J. Donor Utilization in the Australian National Paediatric Heart Transplant Program: Stretching the Limits. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Rapin M, Ferrario D, Haenni E, Wacker J, Falhi A, Meier C, Porchet JA, Chetelat O. Electromagnetic disturbances rejection with single skin contact in the context of ECG measurements with cooperative sensors. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2017:4427-4430. [PMID: 29060879 DOI: 10.1109/embc.2017.8037838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Classical approaches to make high-quality measurements of biopotential signals require the use of shielded or multi-wire cables connecting the electrodes to a central unit in a star arrangement. Consequently, increasing the number of leads increases cabling and connector complexity which is not only limiting patient comfort but also anticipated as the main limiting factor for future miniaturization and cost reduction of tomorrow's wearables. We have recently introduced a novel sensing architecture that significantly reduces cabling complexity by eliminating shielded or multi-wire cables as well as by allowing simple connectors thanks to a bus arrangement. In this architecture, electrodes are replaced by so-called cooperative sensors. However, in this design, one of the cooperative sensors needs to be equipped with two contacts with the skin for proper common mode rejection, thus making its miniaturization problematic. This paper presents a novel common mode rejection principle which overcomes this limitation. When compared to others, the suggested approach is advantageous as it keeps the cabling complexity to its minimum. First measurements demonstrated in a real-life scenario the feasibility of this common mode rejection principle for a wearable 12-lead electrocardiogram monitoring system.
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Lüdtke-Heckenkamp K, Kümmel S, Ruf-Dördelmann A, Distelrath A, Wacker J, Schmatloch S, Busch-Liles S, Schmidt M. Second interim analysis of HerSCin, a German non-interventional study of subcutaneous trastuzumab for HER2-positive early breast cancer in routine clinical practice. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Joye R, Wacker J, McLin V, Giostra E, Aggoun Y, Wildhaber B, Beghetti M, Lador F. P210 Modern management of portopulmonary hypertension in children : experience of an expert center. Chest 2017. [DOI: 10.1016/j.chest.2017.04.115] [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: 11/25/2022] Open
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13
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Hatzipanagiotou M, Runge I, Holzinger D, Millogo F, Pawlita M, Wacker J. Humane Papillomviren: Prävalenzen und Risikofaktoren in Ouagadougou, Burkina Faso. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1602300] [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] Open
Affiliation(s)
- M Hatzipanagiotou
- Caritas-Krankenhaus St. Josef Regensburg, Klinik für Frauenheilkunde und Geburtshilfe
| | - I Runge
- Caritas-Krankenhaus St. Josef Regensburg, Klinik für Frauenheilkunde und Geburtshilfe
| | - D Holzinger
- Caritas-Krankenhaus St. Josef Regensburg, Klinik für Frauenheilkunde und Geburtshilfe
| | - F Millogo
- Caritas-Krankenhaus St. Josef Regensburg, Klinik für Frauenheilkunde und Geburtshilfe
| | - M Pawlita
- Caritas-Krankenhaus St. Josef Regensburg, Klinik für Frauenheilkunde und Geburtshilfe
| | - J Wacker
- Caritas-Krankenhaus St. Josef Regensburg, Klinik für Frauenheilkunde und Geburtshilfe
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Abstract
Giant cell arteritis is one of the most frequent causes of pyrexia of unknown origin after infectious or malignant causes have been ruled out. In this case report we describe a 66-year old female patient, who after five weeks of remitting fever developed a life-threatening, painless severe aortic dissection. The timely use of modern imaging technologies such as magnetic resonance angiography or positron emission computed tomography could in the future be of help to recognize aortic involvement early and to avoid this devastating complication in patients with fever of unknown origin.
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Affiliation(s)
- K Hofheinz
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - S Bertz
- Institute for Pathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - J Wacker
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - G Schett
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - B Manger
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
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Nabhani S, Siva R, Kayyali R, Yagambrun C, Robinson P, Spruit M, Vaes A, Wacker J, Caldani L, Paradiso R, Chang J. M23 The use of Wearables for COPD patients: A Qualitative study. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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El-Shazly I, Wacker J, Schlembach D. Management hypertensiver Schwangerschaftserkrankungen in Deutschland: Ergebnisse einer Umfrage an deutschen Geburtskliniken. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Görtz RS, Wacker J, Agaimy A, Neurath MF, Siebler J. [Weakness, dizziness, cough, and dyspnea in a previously healthy woman]. Med Klin Intensivmed Notfmed 2014; 109:625-6. [PMID: 25256149 DOI: 10.1007/s00063-014-0422-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 08/25/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
Affiliation(s)
- R S Görtz
- Innere Medizin 1 - Gastroenterologie, Pneumologie, Endokrinologie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland,
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Schäfer V, Agaimy A, Wachter D, Wacker J, Anders K, Schett G, Manger B. Multi-organ Involvement in Refractory IgG4-related Disease. AKTUEL RHEUMATOL 2014. [DOI: 10.1055/s-0034-1383585] [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: 10/25/2022]
Affiliation(s)
- V. Schäfer
- Department of Rheumatology and Clinical Immunology, Asklepios Medical Center Bad Abbach, Bad Abbach, Germany
| | - A. Agaimy
- Department of Pathology, University Hospital of Erlangen, Erlangen, Germany
| | - D. Wachter
- Department of Pathology, University Hospital of Erlangen, Erlangen, Germany
| | - J. Wacker
- Department of Medicine III, University Hospital of Erlangen, Erlangen, Germany
| | - K. Anders
- Department of Radiology, University Hospital of Erlangen, Erlangen, Germany
| | - G. Schett
- Department of Medicine III, University Hospital of Erlangen, Erlangen, Germany
| | - B. Manger
- Department of Medicine III, University Hospital of Erlangen, Erlangen, Germany
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Wacker J, Mueller E, Hennig J, Hofmann A, Stemmler G. Brain dopamine and individual differences in a behavioural measure of reward responsiveness: A pharmacogenetic study. Personality and Individual Differences 2014. [DOI: 10.1016/j.paid.2013.07.363] [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: 11/28/2022]
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Lindert J, Sieben G, Breitbach R, Wacker J. O400 PERINATAL HEALTH IN RURAL BURKINA FASO - A STUDY OF 452 BIRTHS IN THE REGIONAL HOSPITAL IN DORI, BURKINA FASO. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60830-3] [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: 11/27/2022]
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Reder E, Wacker J. O567 INCIDENCE AND MANAGEMENT OF CANCER IN LOW-RESOURCE COUNTRIES, USING THE EXAMPLE OF BREAST CANCER IN ZANZIBAR/TANZANIA. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60997-7] [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] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Elsen C, Rivas-Echeverría C, Sahland K, Sánchez R, Molma L, Pahl L, Wallinger R, Volz J, Wacker J, Frühauf J. Vitamins E, A and B 2 as Possible Risk Factors for Preeclampsia - under Consideration of the PROPER Study ("Prevention of Preeclampsia by High-Dose Riboflavin Supplementation"). Geburtshilfe Frauenheilkd 2012; 72:846-852. [PMID: 25308984 PMCID: PMC4168367 DOI: 10.1055/s-0032-1315365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 08/12/2012] [Accepted: 08/16/2012] [Indexed: 10/27/2022] Open
Abstract
In the course of the prospective, randomized, double-blind trial the influence of a high-dose riboflavin substitution on the risk for preeclampsia was studied in a high-risk collective 1. The present contribution evaluates supplementary data from the already published PROPER trial. The patients were from the two study centers Mérida, Venezuela, and Moshi, Tanzania, they were randomized from the 20th week of pregnancy and received either 15 mg riboflavin daily or placebo. Clinical and laboratory checks were carried out at four-week intervals up to childbirth. Concerning the question of whether there is a relationship between the serum levels of antioxidative vitamins and the risk of developing preeclampsia, it was found that no relationship could be detected between the measured laboratory values of vitamins E, A and B2 and the total risk of developing a hypertensive disease of pregnancy. On comparisons between patients with severe preeclampsia, those with a mild form, and the general healthy population, however, significant differences in the levels of antioxidative vitamins E and A as well as the FAD level were seen. The patients from Tanzania showed on the whole significantly lower vitamin levels than those from Venezuela, possibly due to the better nutritional situation in Venezuela. Considering the results altogether, the role of antioxidative parameters in the pathophysiology of preeclampsia remains unclear. However, the collected data provide valuable hints for future preventative strategies.
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Affiliation(s)
- C. Elsen
- Frauenklinik, St. Josefs-Hospital Wiesbaden, Wiesbaden
| | | | - K. Sahland
- Programa de Prevención de Preeclampsia (PPP), Mérida, Venezuela
| | - R. Sánchez
- Programa de Prevención de Preeclampsia (PPP), Mérida, Venezuela
| | - L. Molma
- Programa de Prevención de Preeclampsia (PPP), Mérida, Venezuela
| | - L. Pahl
- Kilimanjaro Christian Medical Center (KCMC), Moshi, United Republic of Tanzania
| | - R. Wallinger
- Kilimanjaro Christian Medical Center (KCMC), Moshi, United Republic of Tanzania
| | - J. Volz
- Frauenklinik, Klinikum Bielefeld, Bielefeld
| | - J. Wacker
- Frauenklinik, Fürst-Stirum-Klinik Bruchsal, Bruchsal
| | - J. Frühauf
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
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Abstract
Hypertrophic osteoarthropathy (HOA) is the classical neoplastic disease in rheumatology characterized by a combination of digital clubbing, joint and bone pain, and proliferative periostitis. This combination of symptoms should initiate an intensive search for an underlying malignant disease usually of thoracic organs. Here we report the case of a patient with HOA and neuroendocrine carcinoma of the esophagus. Other non-malignant disorders of the lungs, heart and other organs should be considered in the differential diagnosis. In addition, rare cases of a primary hereditary form of HOA exist and the genetic background has recently been discovered. Thus, new insights into the pathophysiology have improved diagnostic and therapeutic options for this disorder.
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Affiliation(s)
- B Manger
- Medizinische Klinik III, Universitätsklinikum Erlangen, Krankenhausstrasse 12, Erlangen, Germany.
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Manger B, Lell M, Wacker J, Schett G, Rech J. Detection of periarticular urate deposits with dual energy CT in patients with acute gouty arthritis. Ann Rheum Dis 2011; 71:470-2. [DOI: 10.1136/ard.2011.154054] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Burtscher MJ, Manser T, Kolbe M, Grote G, Grande B, Spahn DR, Wacker J. Adaptation in anaesthesia team coordination in response to a simulated critical event and its relationship to clinical performance. Br J Anaesth 2011; 106:801-6. [PMID: 21429954 DOI: 10.1093/bja/aer039] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent studies in anaesthesia and intensive care indicate that a team's ability to adapt its coordination activities to changing situational demands is crucial for effective teamwork and thus, safe patient care. This study addresses the relationship between adaptation of team coordination and markers of clinical performance in response to a critical event, particularly regarding which types of coordination activities are used and which team member engages in those coordination activities. METHODS Video recordings of 15 two-person anaesthesia teams (anaesthesia trainee plus anaesthesia nurse) performing a simulated induction of general anaesthesia were coded, using a structured observation system for coordination activities. The simulation involved a critical event-asystole during laryngoscopy. Clinical performance was assessed using two separate reaction times related to the critical event. RESULTS Analyses of variance revealed a significant effect of the critical event on team coordination: after the occurrence of the asystole, team members adapted their coordination activities by spending more time on information management-a specific type of coordination activity (F(1,28)=15.17, P=0.001). No significant effect was found for task management. The increase in information management was related to faster decisions regarding how to respond to the critical event, but only for trainees and not for nurses. CONCLUSIONS Our findings support the claim that adaptation of coordination activities is related to improved team performance in healthcare. Moreover, adaptation and its relationship to team performance were found to vary with regard to type of coordination activities and team member.
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Affiliation(s)
- M J Burtscher
- ETH Zurich, Center for Organizational and Occupational Sciences, or Organization, Work, and Technology Group, Kreuzplatz 5, CH-8032 Zurich, Switzerland.
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Wacker J. Geburtshilfe. Kaiserschnitt vs. Natürliche Geburt. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1250563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Maurer K, Wacker J, Vastani N, Seifert B, Spahn DR. Changes in axonal excitability of primary sensory afferents with general anaesthesia in humans. Br J Anaesth 2010; 105:648-56. [PMID: 20729532 DOI: 10.1093/bja/aeq218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intraoperative monitoring of neuronal function is important in a variety of surgeries. The type of general anaesthetic used can affect the interpretation and quality of such recordings. Although the principal effects of general anaesthetics are synaptically mediated, the extent to which they affect excitability of the peripheral afferent nervous system is unclear. METHODS Forty subjects were randomized in a stratified manner into two groups, anaesthetized with either propofol or sevoflurane. The threshold tracking technique (QTRAC(®)) was used to measure nerve excitability parameters of the sensory action potential of the median nerve before and after induction of general anaesthesia. RESULTS Several parameters of peripheral sensory afferent nerve excitability changed after induction of general anaesthesia, which were similar for both propofol and sevoflurane. The maximum amplitude of the sensory nerve action potential decreased in both groups (propofol: 25.3%; sevoflurane: 29.5%; both P<0.01). The relative refractory period [mean (sd)] also decreased similarly in both groups [propofol: -0.6 (0.7) ms; sevoflurane: -0.3 (0.5) ms; both P<0.01]. Skin temperature at the stimulation site increased significantly in both groups [propofol: +1.2 (1.0)°C; sevoflurane: +1.7 (1.4)°C; both P<0.01]. CONCLUSIONS Small changes in excitability of primary sensory afferents after the induction of anaesthesia with propofol or sevoflurane were detected. These effects, which were non-specific and are possibly explained by changes observed in temperature, demonstrate possible anaesthetic effects on intraoperative neuromonitoring.
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Affiliation(s)
- K Maurer
- Pain Research Unit, Institute of Anaesthesiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
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Mueller E, Stemmler G, Wacker J. Single-trial electroencephalogram predicts cardiac acceleration: a time-lagged P-correlation approach for studying neurovisceral connectivity. Neuroscience 2010; 166:491-500. [DOI: 10.1016/j.neuroscience.2009.12.051] [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] [Received: 12/04/2009] [Revised: 12/21/2009] [Accepted: 12/21/2009] [Indexed: 12/30/2022]
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Nath P, Nelson B, Davoudiasl H, Dutta B, Feldman D, Liu Z, Han T, Langacker P, Mohapatra R, Valle J, Pilaftsis A, Zerwas D, AbdusSalam S, Adam-Bourdarios C, Aguilar-Saavedra J, Allanach B, Altunkaynak B, Anchordoqui LA, Baer H, Bajc B, Buchmueller O, Carena M, Cavanaugh R, Chang S, Choi K, Csáki C, Dawson S, de Campos F, De Roeck A, Dührssen M, Éboli O, Ellis J, Flächer H, Goldberg H, Grimus W, Haisch U, Heinemeyer S, Hirsch M, Holmes M, Ibrahim T, Isidori G, Kane G, Kong K, Lafaye R, Landsberg G, Lavoura L, Lee JS, Lee SJ, Lisanti M, Lüst D, Magro M, Mahbubani R, Malinsky M, Maltoni F, Morisi S, Mühlleitner M, Mukhopadhyaya B, Neubert M, Olive K, Perez G, Pérez PF, Plehn T, Pontón E, Porod W, Quevedo F, Rauch M, Restrepo D, Rizzo T, Romão J, Ronga F, Santiago J, Schechter J, Senjanović G, Shao J, Spira M, Stieberger S, Sullivan Z, Tait TM, Tata X, Taylor T, Toharia M, Wacker J, Wagner C, Wang LT, Weiglein G, Zeppenfeld D, Zurek K. The Hunt for New Physics at the Large Hadron Collider. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.nuclphysbps.2010.03.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Neukom L, Wacker J, Spahn D, Maurer K. 193 PROPOFOL CHANGES EXCITABILITY OF PRIMARY SENSORY AFFERENTS. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60196-8] [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: 10/20/2022]
Affiliation(s)
- L. Neukom
- Institute of Anesthesiology University Hospital Zurich, Zurich, Switzerland
| | - J. Wacker
- Institute of Anesthesiology University Hospital Zurich, Zurich, Switzerland
| | - D.R. Spahn
- Institute of Anesthesiology University Hospital Zurich, Zurich, Switzerland
| | - K. Maurer
- Institute of Anesthesiology University Hospital Zurich, Zurich, Switzerland
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Neugebauer J, Felten U, Hardt S, Boos I, Wacker J. Myokardinfarkt unter der Geburt – ein Fallbericht. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1185938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Echle F, Siegele M, Braun R, Pöschl J, Wacker J. Fallbericht einer 31-jährigen Patientin mit akutem fetomaternalen Transfusionssyndrom in der 36+6 SSW. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Neugebauer J, Felten U, Hardt S, Boos I, Wacker J. Myokardinfarkt unter Geburt – ein Fallbericht. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zala-Mezo E, Wacker J, Kunzle B, Bruesch M, Grote G. The influence of standardisation and task load on team coordination patterns during anaesthesia inductions. Qual Saf Health Care 2009; 18:127-30; 1 p following 130. [DOI: 10.1136/qshc.2007.025973] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Schneeweiss A, Ruiz A, Rovira P, Bottini A, Manikhas A, Wacker J, Schumacher T, Wolf M, Segui M, Sinn P, Kennedy L, Mansouri K, Bauknecht T. 0178 Results of clinical endpoints of a randomized phase II trial with doxorubicin + pemetrexed followed by docetaxel versus doxorubicin + cyclophosphamide followed by docetaxel as primary systemic therapy for early breast cancer. Breast 2009. [DOI: 10.1016/s0960-9776(09)70201-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Thaler J, Neugebauer J, Wolf J, Dakouré-Ouedraogo M, Köhler H, Wessel L, Zanré Y, Wacker J. Auswirkungen einer prophylaktischen Gabe von Riboflavin an Schwangere auf die Häufigkeit der Malaria: Ergebnisse einer prospektiven randomisierten Studie. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-924038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Neugebauer J, Zanré Y, Wacker J. Riboflavin supplementation and preeclampsia. Int J Gynaecol Obstet 2006; 93:136-7. [PMID: 16545814 DOI: 10.1016/j.ijgo.2006.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2005] [Revised: 01/06/2006] [Accepted: 01/06/2006] [Indexed: 11/29/2022]
Affiliation(s)
- J Neugebauer
- Department of Gynecology and Obstetrics, Fürst-Stirum-Klinik Bruchsal, Germany
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Abstract
Pyrazinamide (PZA) combined with either ethambutol (EMB) or a fluoroquinolone for 6-12 months is one of the treatments recommended for latent tuberculosis infection (LTBI) in contacts exposed to multidrug-resistant tuberculosis (MDR-TB). The aim of the present study was to describe the side effects related to combined PZA and EMB treatment given for LTBI, in contacts previously exposed to MDR-TB. In total, 12 consecutive contacts, all of African origin and aged 38+/-5 yrs, were treated with daily PZA (23+/-4 mg.kg(-1)) and EMB (17+/-4 mg.kg(-1)) at Geneva University Hospital outpatient clinic (Switzerland), as a result of contact-tracing procedures for two patients with contagious MDR-TB. Clinical status and liver function tests (aspartate aminotransferase (ALAT) and alanine aminotransferase (ASAT)) were monitored monthly. In seven cases (58%) treatment was discontinued after a median of 119 days, due to hepatic toxicity in six cases (ALAT or ASAT elevation more than four times the upper normal limit), and gastrointestinal symptoms in one case. In conclusion, combined pyrazinamide and ethambutol for latent tuberculosis infection may be associated with a high risk of hepatic toxicity, and warrants close monitoring. There is clearly a need for alternative preventive treatments for contacts exposed to multidrug-resistant tuberculosis.
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Affiliation(s)
- A B Younossian
- Centre antituberculeux, Hôpital Cantonal Universitaire, 1211 Geneva 14, Switzerland
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Abstract
Despite the growing evidence for the efficacy of different sympatho-modulatory therapies to lower perioperative cardiac morbidity and mortality, such therapeutic strategies are rather infrequently used in daily clinical practice. Most physicians involved in perioperative medicine are aware of the increasing literature related to this topic, but only few comply with current clinical practice guidelines even in the absence of contraindications. This review discusses possible explanations for this reluctance and again summarizes the basic and clinical principles of current sympatho-modulatory therapies including alpha(2)-agonism, beta-adrenergic antagonism, and regional anesthetic techniques in modern anesthetic practice. In addition, the emerging perioperative concept of a patient-tailored individualized pharmacotherapy based on "gene profiling", particularly the adrenergic polymorphisms, is discussed.
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Affiliation(s)
- J Wacker
- Institut für Anästhesiologie, Universitätsspital Zürich
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Wacker J, Schild R, Homuth V. Geburtshilfe. Präeklampsie und Evidence based Medicine (EbM). Geburtshilfe Frauenheilkd 2005. [DOI: 10.1055/s-2005-865706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
Tinea incognito has first been described in 1968. The term describes a tinea infection whose clinical morphology has been modified by the application of topical corticosteroids. The clinical manifestation can masquerade a number of other dermatoses and leads to misdiagnosis of annular eruptions. We describe a patient who showed a bizarre appearance of annular, inflammatory skin lesions at the umbilical region. Mycological culture yielded Microsporum canis.
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Affiliation(s)
- J Wacker
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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Deichmann M, Kahle B, Moser K, Wacker J, Wüst K. Diagnosing melanoma patients entering American Joint Committee on Cancer stage IV, C-reactive protein in serum is superior to lactate dehydrogenase. Br J Cancer 2004; 91:699-702. [PMID: 15280926 PMCID: PMC2364774 DOI: 10.1038/sj.bjc.6602043] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [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: 11/09/2022] Open
Abstract
Lactate dehydrogenase (LDH) in serum has recently been introduced into the American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma because of its prognostic value. We hypothesised LDH to be of value in discriminating melanoma patients entering AJCC stage IV from patients staying in AJCC stages I, II or III. Lactate dehydrogenase was compared to the acute phase protein C-reactive protein (CRP), which we observed to reflect the course of melanoma metastasis in a previous report. In this prospective study, we measured LDH and CRP in the serum of 91 consecutive melanoma patients progressing into AJCC stage IV in comparison to 125 patients staying in AJCC stages I, II or III. Comparing distributions of the parameters by median values and quartiles by Mann-Whitney test, LDH was not significantly elevated in patients entering AJCC stage IV melanoma (P=0.785), whereas CRP was (P<0.001). Analysing the sensitivity and the specificity jointly by the areas under the receiver operating characteristics curves (ROC-AUC), LDH did not discriminate between the defined groups of patients (AUC=0.491; 95% confidence interval, 0.410, 0.581), whereas CRP did (AUC=0.933; 95% confidence interval, 0.900, 0.966; P<0.001). Upon logistic regression analysis to calculate the ROC-AUC values upon the predictive probabilities, LDH provided no additional information to CRP. Choosing a cutoff point of 3.0 mg l(-1), CRP yielded a sensitivity of 0.769 together with a specificity of 0.904 in diagnosing AJCC stage IV entry. Altogether, for first diagnosing AJCC stage IV melanoma, CRP is the superior serum marker when compared to the conventional LDH.
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Affiliation(s)
- M Deichmann
- Department of Dermatology, Heidelberg University Clinics, Vossstrasse 2, 69115 Heidelberg, Germany.
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45
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Affiliation(s)
- M Zaugg
- Institute of Anaesthesiology, University Hospital Zurich, Switzerland.
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46
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Heilmann L, Wacker J, Rath W. Die Diagnostik und Therapie des Schwangerschaftshochdruckes in Deutschland: Ergebnisse einer Umfrage an deutschen Frauenkliniken. Geburtshilfe Frauenheilkd 2004. [DOI: 10.1055/s-2004-820892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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47
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Wacker J, Rach B, Hopp H, Briese V, Heilmann L, Bartz C, Schauf B. Deutsche Multicenterstudie zur Behandlung der Hypertonie bei Schwangeren mit Präeklampsie. Z Geburtshilfe Neonatol 2004. [DOI: 10.1055/s-2003-818252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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48
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Abstract
Several premalignant and malignant neoplasms clinically appear as chronic eczematous lesions of the perianal region and have to be distinguished from benign processes. Anal intraepithelial neoplasia (AIN) presenting as bowenoid papulosis and perianal Bowen disease is a precursor lesion for invasive squamous cell carcinoma. When AIN is widespread, persistent or progressive, an underlying immunosuppression should get excluded. Verrucous carcinoma of the perianal region is a highly differentiated variant of squamous cell carcinoma characterized as a slowly growing but locally invasive tumor. Extramammary Paget disease (EMP) is an intraepithelial adenocarcinoma of the skin with apocrine differentiation. Along with EMP, basal cell carcinoma, Langerhans cell histiocytosis and cutaneous T-cell lymphoma should be included in the differential diagnosis for lesions simulating chronic perianal dermatitis. In such situations, biopsies and histopathologic examination are imperative to avoid delayed diagnosis and assure prompt therapy.
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Affiliation(s)
- J Wacker
- Universitäts-Hautklinik, Heidelberg
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Kurzen H, Manns S, Jess P, Wacker J, Naeher H. Metronome antiangiogene Therapie des malignen Melanoms mit Temozolomid und COX-2-Inhibitoren, mit oder ohne pegyliertes Interferon-α. Akt Dermatol 2003. [DOI: 10.1055/s-2003-822234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Affiliation(s)
- M Schulz
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany.
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