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Rohmann N, Stürmer P, Geisler C, Schlicht K, Knappe C, Hartmann K, Türk K, Hollstein T, Beckmann A, Seoudy AK, Becker U, Wietzke-Braun P, Settgast U, Tran F, Rosenstiel P, Beckmann JH, von Schönfels W, Seifert S, Heyckendorf J, Franke A, Schreiber S, Schulte DM, Laudes M. Effects of lifestyle and associated diseases on serum CC16 suggest complex interactions among metabolism, heart and lungs. J Adv Res 2024; 59:161-171. [PMID: 37330047 DOI: 10.1016/j.jare.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/10/2023] [Accepted: 06/11/2023] [Indexed: 06/19/2023] Open
Abstract
INTRODUCTION Clara cell 16-kDa protein (CC16) is an anti-inflammatory, immunomodulatory secreted pulmonary protein with reduced serum concentrations in obesity according to recent data. OBJECTIVE Studies focused solely on bodyweight, which does not properly reflect obesity-associated implications of the metabolic and reno-cardio-vascular system. The purpose of this study was therefore to examine CC16 in a broad physiological context considering cardio-metabolic comorbidities of primary pulmonary diseases. METHODS CC16 was quantified in serum samples in a subset of the FoCus (N = 497) and two weight loss intervention cohorts (N = 99) using ELISA. Correlation and general linear regression analyses were applied to assess CC16 effects of lifestyle, gut microbiota, disease occurrence and treatment strategies. Importance and intercorrelation of determinants were validated using random forest algorithms. RESULTS CC16 A38G gene mutation, smoking and low microbial diversity significantly decreased CC16. Pre-menopausal female displayed lower CC16 compared to post-menopausal female and male participants. Biological age and uricosuric medications increased CC16 (all p < 0.01). Adjusted linear regression revealed CC16 lowering effects of high waist-to-hip ratio (est. -11.19 [-19.4; -2.97], p = 7.99 × 10-3), severe obesity (est. -2.58 [-4.33; -0.82], p = 4.14 × 10-3) and hypertension (est. -4.31 [-7.5; -1.12], p = 8.48 × 10-3). ACEi/ARB medication (p = 2.5 × 10-2) and chronic heart failure (est. 4.69 [1.37; 8.02], p = 5.91 × 10-3) presented increasing effects on CC16. Mild associations of CC16 were observed with blood pressure, HOMA-IR and NT-proBNP, but not manifest hyperlipidemia, type 2 diabetes, diet quality and dietary weight loss intervention. CONCLUSION A role of metabolic and cardiovascular abnormalities in the regulation of CC16 and its modifiability by behavioral and pharmacological interventions is indicated. Alterations by ACEi/ARB and uricosurics could point towards regulatory axes comprising the renin-angiotensin-aldosterone system and purine metabolism. Findings altogether strengthen the importance of interactions among metabolism, heart and lungs.
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Affiliation(s)
- Nathalie Rohmann
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Paula Stürmer
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Corinna Geisler
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Kristina Schlicht
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Carina Knappe
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Katharina Hartmann
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Kathrin Türk
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Tim Hollstein
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Alexia Beckmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Anna K Seoudy
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Ulla Becker
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Perdita Wietzke-Braun
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Ute Settgast
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Florian Tran
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany; Department of Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Jan H Beckmann
- Department of General, Visceral, Thoracic, Transplantation, and Pediatric Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Witigo von Schönfels
- Department of General, Visceral, Thoracic, Transplantation, and Pediatric Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Stephan Seifert
- Institute of Food Chemistry, University of Hamburg, Hamburg School of Food Science, Hamburg, Germany
| | - Jan Heyckendorf
- Division of Pneumology, Department of Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Dominik M Schulte
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany; Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Matthias Laudes
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany; Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany.
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Chandler RE, Balakrishnan MR, Brasseur D, Bryan P, Espie E, Hartmann K, Jouquelet-Royer C, Milligan J, Nesbitt L, Pal S, Precioso A, Takey P, Chen RT. Collaboration within the global vaccine safety surveillance ecosystem during the COVID-19 pandemic: lessons learnt and key recommendations from the COVAX Vaccine Safety Working Group. BMJ Glob Health 2024; 9:e014544. [PMID: 38453518 PMCID: PMC10921508 DOI: 10.1136/bmjgh-2023-014544] [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: 11/14/2023] [Accepted: 01/01/2024] [Indexed: 03/09/2024] Open
Abstract
This analysis describes the successes, challenges and opportunities to improve global vaccine safety surveillance as observed by the Vaccine Safety Working Group from its role as a platform of exchange for stakeholders responsible for monitoring the safety of vaccines distributed through the COVAX mechanism. Three key elements considered to be essential for ongoing and future pandemic preparedness for vaccine developers in their interaction with other members of the vaccine safety ecosystem are (1) the availability of infrastructure and capacity for active vaccine safety surveillance in low-income and middle-income countries (LMICs), including the advancement of concepts of safety surveillance and risk management to vaccine developers and manufacturers from LMICs; (2) more comprehensive mechanisms to ensure timely exchange of vaccine safety data and/or knowledge gaps between public health authorities and vaccine developers and manufacturers; and (3) further implementation of the concept of regulatory reliance in pharmacovigilance. These aims would both conserve valuable resources and allow for more equitable access to vaccine safety information and for benefit/risk decision-making.
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Affiliation(s)
| | | | | | - Philip Bryan
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | | | | | | | - Linda Nesbitt
- Biovac Institute, Pinelands, Cape Town, South Africa
| | | | | | | | - Robert T Chen
- The Task Force for Global Health, Decatur, Georgia, USA
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3
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Horsch A, Garthus-Niegel S, Ayers S, Chandra P, Hartmann K, Vaisbuch E, Lalor J. Childbirth-related posttraumatic stress disorder: definition, risk factors, pathophysiology, diagnosis, prevention, and treatment. Am J Obstet Gynecol 2024; 230:S1116-S1127. [PMID: 38233316 DOI: 10.1016/j.ajog.2023.09.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 01/19/2024]
Abstract
Psychological birth trauma and childbirth-related posttraumatic stress disorder represent a substantial burden of disease with 6.6 million mothers and 1.7 million fathers or co-parents affected by childbirth-related posttraumatic stress disorder worldwide each year. There is mounting evidence to indicate that parents who develop childbirth-related posttraumatic stress disorder do so as a direct consequence of a traumatic childbirth experience. High-risk groups, such as those who experience preterm birth, stillbirth, or preeclampsia, have higher prevalence rates. The main risks include antenatal factors (eg, depression in pregnancy, fear of childbirth, poor health or complications in pregnancy, history of trauma or sexual abuse, or mental health problems), perinatal factors (eg, negative subjective birth experience, operative birth, obstetrical complications, and severe maternal morbidity, as well as maternal near misses, lack of support, dissociation), and postpartum factors (eg, depression, postpartum physical complications, and poor coping and stress). The link between birth events and childbirth-related posttraumatic stress disorder provides a valuable opportunity to prevent traumatic childbirths and childbirth-related posttraumatic stress disorder from occurring in the first place. Childbirth-related posttraumatic stress disorder is an extremely distressing mental disorder and has a substantial negative impact on those who give birth, fathers or co-parents, and, potentially, the whole family. Still, a traumatic childbirth experience and childbirth-related posttraumatic stress disorder remain largely unrecognized in maternity services and are not routinely screened for during pregnancy and the postpartum period. In fact, there are gaps in the evidence on how, when, and who to screen. Similarly, there is a lack of evidence on how best to treat those affected. Primary prevention efforts (eg, screening for antenatal risk factors, use of trauma-informed care) are aimed at preventing a traumatic childbirth experience and childbirth-related posttraumatic stress disorder in the first place by eliminating or reducing risk factors for childbirth-related posttraumatic stress disorder. Secondary prevention approaches (eg, trauma-focused psychological therapies, early psychological interventions) aim to identify those who have had a traumatic childbirth experience and to intervene to prevent the development of childbirth-related posttraumatic stress disorder. Tertiary prevention (eg, trauma-focused cognitive behavioural therapy and eye movement desensitization and reprocessing) seeks to ensure that people with childbirth-related posttraumatic stress disorder are identified and treated to recovery so that childbirth-related posttraumatic stress disorder does not become chronic. Adequate prevention, screening, and intervention could alleviate a considerable amount of suffering in affected families. In light of the available research on the impact of childbirth-related posttraumatic stress disorder on families, it is important to develop and evaluate assessment, prevention, and treatment interventions that target the birthing person, the couple dyad, the parent-infant dyad, and the family as a whole. Further research should focus on the inclusion of couples in different constellations and, more generally, on the inclusion of more diverse populations in diverse settings. The paucity of national and international policy guidance on the prevention, care, and treatment of psychological birth trauma and the lack of formal psychological birth trauma services and training, highlight the need to engage with service managers and policy makers.
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Affiliation(s)
- Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland; Department Woman-mother-child, Lausanne University Hospital, Lausanne.
| | - Susan Garthus-Niegel
- Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, Hamburg, Germany; Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Prabha Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Edi Vaisbuch
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joan Lalor
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
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4
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Ayers S, Horsch A, Garthus-Niegel S, Nieuwenhuijze M, Bogaerts A, Hartmann K, Karlsdottir SI, Oosterman M, Tecirli G, Turner JD, Lalor J. Traumatic birth and childbirth-related post-traumatic stress disorder: International expert consensus recommendations for practice, policy, and research. Women Birth 2024; 37:362-367. [PMID: 38071102 DOI: 10.1016/j.wombi.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Research suggests 1 in 3 births are experienced as psychologically traumatic and about 4% of women and 1% of their partners develop post-traumatic stress disorder (PTSD) as a result. AIM To provide expert consensus recommendations for practice, policy, and research and theory. METHOD Two consultations (n = 65 and n = 43) with an international group of expert researchers and clinicians from 33 countries involved in COST Action CA18211; three meetings with CA18211 group leaders and stakeholders; followed by review and feedback from people with lived experience and CA18211 members (n = 238). FINDINGS Recommendations for practice include that care for women and birth partners must be given in ways that minimise negative birth experiences. This includes respecting women's rights before, during, and after childbirth; and preventing maltreatment and obstetric violence. Principles of trauma-informed care need to be integrated across maternity settings. Recommendations for policy include that national and international guidelines are needed to increase awareness of perinatal mental health problems, including traumatic birth and childbirth-related PTSD, and outline evidence-based, practical strategies for detection, prevention, and treatment. Recommendations for research and theory include that birth needs to be understood through a neuro-biopsychosocial framework. Longitudinal studies with representative and global samples are warranted; and research on prevention, intervention and cost to society is essential. CONCLUSION Implementation of these recommendations could potentially reduce traumatic births and childbirth-related PTSD worldwide and improve outcomes for women and families. Recommendations should ideally be incorporated into a comprehensive, holistic approach to mental health support for all involved in the childbirth process.
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Affiliation(s)
- Susan Ayers
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, EC1V 0HB, UK.
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland; Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Susan Garthus-Niegel
- Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, Hamburg, Germany; Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands; CAPHRI, Maastricht University, 6229 ER Maastricht, the Netherlands
| | - Annick Bogaerts
- REALIFE research group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | | | | | - Mirjam Oosterman
- Faculty of Behavioral and Movement Sciences, Department of Clinical Child & Family Studies, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute, the Netherlands
| | - Gulcan Tecirli
- Health Technology Assessment Department, Republic of Turkiye Ministry of Health, Bilkent, Çankaya, Ankara, Turkiye
| | - Jonathan D Turner
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Joan Lalor
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
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5
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Nieuwenhuijze M, Leahy-Warren P, Healy M, Aktaş S, Aydin R, Calleja-Agius J, Goberna-Tricas J, Hadjigeorgiou E, Hartmann K, Henriksen L, Horsch A, Lange U, Murphy M, Pierron A, Schäfers R, Pajalic Z, Verhoeven C, Berdun DR, Hossain S. The impact of severe perinatal events on maternity care providers: a scoping review. BMC Health Serv Res 2024; 24:171. [PMID: 38326880 PMCID: PMC10848539 DOI: 10.1186/s12913-024-10595-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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Severe events during the perinatal period can be experienced as traumatic by pregnant women, their partners or others who are closely involved. This includes maternity care providers who can be affected by being involved in or observing these events. This may have an impact on their personal well-being and professional practice, influencing quality of care. The aim of this study is to map research investigating the impact of severe events during the perinatal period on maternity care providers, and how these experiences affect their well-being and professional practice. METHOD A scoping review following the manual of the Joanna Briggs Institute was undertaken. The electronic bibliographic databases included PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, SocINDEX, Cochrane, Scopus, Web of Science and databases for grey literature. Records passing the two-stage screening process were assessed, and their reference lists hand searched. We included primary research papers that presented data from maternity care professionals on the impact of severe perinatal traumatic events. A descriptive content analysis and synthesis was undertaken. RESULTS Following a detailed systematic search and screening of 1,611 records, 57 papers were included in the scoping review. Results of the analysis identified four categories, which highlighted the impact of traumatic perinatal events on maternity care providers, mainly midwives, obstetricians and nurses: Traumatic events, Impact of traumatic events on care providers, Changes in care providers' practice and Support for care providers; each including several subcategories. CONCLUSION The impact of traumatic perinatal events on maternity care providers ranged from severe negative responses where care providers moved position or resigned from their employment in maternity care, to responses where they felt they became a better clinician. However, a substantial number appeared to be negatively affected by traumatic events without getting adequate support. Given the shortage of maternity staff and the importance of a sustainable workforce for effective maternity care, the impact of traumatic perinatal events requires serious consideration in maintaining their wellbeing and positive engagement when conducting their profession. Future research should explore which maternity care providers are mostly at risk for the impact of traumatic events and which interventions can contribute to prevention.
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Affiliation(s)
- Marianne Nieuwenhuijze
- CAPHRI, Maastricht University, Universiteitssingel 60, 6229 ER, Maastricht, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | - Ute Lange
- University of Applied Sciences Bochum, Bochum, Germany
| | | | | | | | | | - Corine Verhoeven
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
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6
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Hartmann K, Bamberg M, Seum S, Amendt J, Verhoff MA, Zehner R. Establishment of a multiplex PCR-CE assay for the simultaneous and rapid analysis of age markers for Calliphora vicina pupae. Int J Legal Med 2024; 138:187-196. [PMID: 37221328 PMCID: PMC10771996 DOI: 10.1007/s00414-023-03013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/14/2023] [Indexed: 05/25/2023]
Abstract
Insects, especially blow flies, are forensically relevant to determine the minimal postmortem interval (PMImin), based on the fact that they are usually the first colonisers of a body. By estimating the age of immature blow flies, interferences can be made about the time since death. Whilst morphological parameters are valuable for age estimation of blow fly larvae, gene expression profiling is more applicable for blow fly pupae. Here, the age-dependent changes in the gene expression levels during the development are analysed. 28 temperature-independent markers have already been described for the age estimation of pupae of the forensically important blow fly Calliphora vicina and are analysed by RT-qPCR. To allow simultaneous analysis of these age markers, a multiplex assay was developed in the present study. After reverse transcription, the markers are analysed simultaneously in an endpoint PCR and subsequently separated by capillary electrophoresis (CE). This method is highly attractive due to its quick and easy procedure and interpretation. The present age prediction tool was adapted and validated. The multiplex PCR assay reproduced the same expression profiles as the RT-qPCR assay based on the same markers. The statistical evaluation shows that the new assay has a lower precision but a better trueness for age determination compared to the RT-qPCR assay. Since the new assay is also qualified to estimate the age of C. vicina pupae and is practical, cost-effective and, even more importantly, time-saving, it is attractive for use in forensic casework.
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Affiliation(s)
- Katharina Hartmann
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany.
- Department of Aquatic Ecotoxicology, FB Biowissenschaften, Goethe University, Frankfurt Am Main, Germany.
| | - Malte Bamberg
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany
| | - Sandra Seum
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany
| | - Jens Amendt
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany
| | - Marcel A Verhoff
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany
| | - Richard Zehner
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany
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7
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Betrán AP, Torloni MR, Althabe F, Altieri E, Arulkumaran S, Ashraf F, Bailey P, Bonet M, Bucagu M, Clark E, Changizi N, Churchill R, Dominico S, Downe S, Draycott T, Faye A, Feeley C, Geelhoed D, Gherissi A, Gholbzouri K, Grupta G, Hailegebriel TD, Hanson C, Hartmann K, Hassan L, Hofmeyr GJ, Jayathilaka AC, Kabore C, Kidula N, Kingdon C, Kuzmenko O, Lumbiganon P, Mola GDL, Moran A, de Muncio B, Nolens B, Opiyo N, Pattinson RC, Romero M, van Roosmalen J, Siaulys MM, Camelo JS, Smith J, Sobel HL, Sobhy S, Sosa C, Souza JP, ten Hoope-Bender P, Thangaratinam S, Varallo J, Wright A, Yates A, Oladapo OO. A research agenda to improve incidence and outcomes of assisted vaginal birth. Bull World Health Organ 2023; 101:723-729. [PMID: 37961052 PMCID: PMC10630731 DOI: 10.2471/blt.23.290140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/15/2023] [Accepted: 09/13/2023] [Indexed: 11/15/2023] Open
Abstract
Access to emergency obstetric care, including assisted vaginal birth and caesarean birth, is crucial for improving maternal and childbirth outcomes. However, although the proportion of births by caesarean section has increased during the last few decades, the use of assisted vaginal birth has declined. This is particularly the case in low- and middle-income countries, despite an assisted vaginal birth often being less risky than caesarean birth. We therefore conducted a three-step process to identify a research agenda necessary to increase the use of, or reintroduce, assisted vaginal birth: after conducting an evidence synthesis, which informed a consultation with technical experts who proposed an initial research agenda, we sought and incorporated the views of women's representatives of this agenda. This process has allowed us to identify a comprehensive research agenda, with topics categorized as: (i) the need to understand women's perceptions of assisted vaginal birth, and provide appropriate and reliable information; (ii) the importance of training health-care providers in clinical skills but also in respectful care, effective communication, shared decision-making and informed consent; and (iii) the barriers to and facilitators of implementation and sustainability. From women's feedback, we learned of the urgent need to recognize labour, childbirth and postpartum experiences as inherently physiological and dignified human processes, in which interventions should only be implemented if necessary. The promotion and/or reintroduction of assisted vaginal birth in low-resource settings requires governments, policy-makers and hospital administrators to support skilled health-care providers who can, in turn, respectfully support women in labour and childbirth.
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Affiliation(s)
- Ana Pilar Betrán
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
| | - Maria Regina Torloni
- EBH Postgraduate Programme, Department of Medicine, Sao Paulo Federal University-UNIFESP, Sao Paulo, Brazil
| | | | - Elena Altieri
- Behavioural Insights Unit, Department of Communications, World Health Organization, Geneva, Switzerland
| | - Sabaratnam Arulkumaran
- St George's University of London, London, United Kingdom of Great Britain and Northern Ireland
| | - Fatema Ashraf
- Department of Obstetrics & Gynaecology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh
| | - Patricia Bailey
- Reproductive, Maternal, Newborn and Child Health, FHI360, Durham, North Carolina, United States of America
| | - Mercedes Bonet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
| | - Maurice Bucagu
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Emma Clark
- Maternal Child Health and Nutrition, USAID Bureau for Global Health, Arlington, United States
| | - Nasrin Changizi
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Robyn Churchill
- Maternal Child Health and Nutrition, USAID Bureau for Global Health, Arlington, United States
| | | | - Soo Downe
- Department of Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Tim Draycott
- The Chilterns, Southmead Hospital, Bristol, United Kingdom
| | - Arfang Faye
- Reproductive, Maternal, Newborn, Child and Adolescent Health Unit, Ministry of Health, Gambia
| | - Claire Feeley
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | | | - Atf Gherissi
- High School for Health Science and Techniques, University of Tunis El Manar, Tunis, Tunisia
| | | | - Gagan Grupta
- United Nations Children's Fund, New York, United States
| | | | - Claudia Hanson
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Katharina Hartmann
- Mother Hood e.V. - Federal Parents' Initiative for the Protection of Mother and Child during Pregnancy, Bonn, Germany
| | - Lubna Hassan
- Women's Health Intervention and Development Initiative, Islamabad, Pakistan
| | - George Justus Hofmeyr
- Department of Obstetrics and Gyneacology, University of Botswana, Gaborone, Botswana
| | | | - Charles Kabore
- Institut de Recherche en Sciences de la Sante, Ouagadougou, Burkina Faso
| | - Nancy Kidula
- WHO Regional Office for Africa, Brazzaville, Congo
| | - Carol Kingdon
- Research in Childbirth and Health Unit, University of Central Lancashire, Preston, United Kingdom
| | - Oleg Kuzmenko
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- EBH Postgraduate Programme, Department of Medicine, Sao Paulo Federal University-UNIFESP, Sao Paulo, Brazil
| | - Pisake Lumbiganon
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Buenos Aires, Argentina
| | - Glen DL Mola
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Behavioural Insights Unit, Department of Communications, World Health Organization, Geneva, Switzerland
| | - Allisyn Moran
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Bremen de Muncio
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- St George's University of London, London, United Kingdom of Great Britain and Northern Ireland
| | - Barbara Nolens
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Department of Obstetrics & Gynaecology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh
| | - Newton Opiyo
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
| | - Robert C Pattinson
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Reproductive, Maternal, Newborn and Child Health, FHI360, Durham, North Carolina, United States of America
| | - Mariana Romero
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Jos van Roosmalen
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Maternal Child Health and Nutrition, USAID Bureau for Global Health, Arlington, United States
| | - Monica M Siaulys
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jose Simon Camelo
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Thamini Uhai (Value Life), United Republic of Tanzania
| | - Jeffrey Smith
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Department of Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Howard L Sobel
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- The Chilterns, Southmead Hospital, Bristol, United Kingdom
| | - Soha Sobhy
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Reproductive, Maternal, Newborn, Child and Adolescent Health Unit, Ministry of Health, Gambia
| | - Claudio Sosa
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Joao Paulo Souza
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Tete, Mozambique
| | - Petra ten Hoope-Bender
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- High School for Health Science and Techniques, University of Tunis El Manar, Tunis, Tunisia
| | - Shakila Thangaratinam
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - John Varallo
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- United Nations Children's Fund, New York, United States
| | - Alison Wright
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Ann Yates
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Mother Hood e.V. - Federal Parents' Initiative for the Protection of Mother and Child during Pregnancy, Bonn, Germany
| | - Olufemi O Oladapo
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
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8
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Seoudy AK, Schlicht K, Kulle A, Demetrowitsch T, Beckmann A, Geisler C, Türk K, Rohmann N, Hartmann K, Brandes J, Schulte DM, Schreiber S, Schwarz K, Holterhus PM, Laudes M. A PROSPECTIVE ANALYSIS OF THE METYRAPONE SHORT TEST USING TARGETED AND UNTARGETED METABOLOMICS. Neuroendocrinology 2023:000529146. [PMID: 36646062 DOI: 10.1159/000529146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/29/2022] [Indexed: 01/17/2023]
Abstract
Introduction The present study aimed to prove the metyrapone short test in a day clinic to be suitable for examining the integrity of the hypothalamic-pituitary-adrenal (HPA) axis in patients with suspected secondary and tertiary adrenal insufficiency and to identify novel effector molecules in acute stress response. Methods 44 patients were prospectively enrolled. Based on stimulated 11-deoxycortisol levels, patients were divided into a physiological (11-deoxycortisol ≥70 µg/l) and a pathological (11-deoxycortisol <70 µg/l) response group. Clinical follow-up examination was performed for validation. Ultra-performance-liquid-chromatography-tandem-mass-spectrometry and a Fourier-transform-ion-cyclotron-resonance-mass-spectrometry were used for targeted and untargeted steroid metabolomics. Results At baseline, lower levels of cortisone (42 vs. 50 nmol/l, p=0.048) and 17-OH-progesterone (0.6 vs. 1.2 nmol/l, p=0.041) were noted in the pathological response group. After metyrapone administration, the pathological response group exhibited significantly lower 11-deoxycortisol (39.0 vs. 94.2 µg/l, p<0.001) and ACTH (49 vs. 113 pg/ml, p<0.001) concentrations as well as altered upstream metabolites. Untargeted metabolomics identified a total of 76 metabolites to be significantly up- or downregulated by metyrapone. A significant increase of the bile acid glycochenodeoxycholic acid (GCDC, p<0.01) was detected in both groups with an even stronger increase in the physiological response group. After a mean follow-up of 17.2 months, an 11-deoxycortisol cut-off of 70 µg/l showed a high diagnostic performance (sensitivity 100%, specificity 96%). Conclusion The metyrapone short test is safe and feasible in a day clinic setting. The alterations of the bile acid GCDC indicate that the liver might be involved in the acute stress response of the HPA axis.
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9
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Drandić D, Hartmann K, Barata C, Torguet R. Parent organizations' experiences of the pandemic response in maternity care in thirteen European countries. Eur J Midwifery 2022; 6:71. [PMID: 36591331 PMCID: PMC9773267 DOI: 10.18332/ejm/156902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/03/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
We surveyed changes to maternity care services in the first 17 months of the COVID-19 pandemic in 13 different European countries, from the perspective of national maternity service (parent) organizations advocating for a human rights approach to maternity services. A qualitative study was conducted in November 2020. An open-question survey was sent to national maternity service (parent) organizations and members of COST Action 18211 in Europe, asking about COVID-19 measures in maternity services (antenatally, intrapartum, postnatally, and overall satisfaction). From the open answers, 16 core issues were extracted. Between February and August 2021, semi-structured interviews with the national representatives of 14 parent member organizations in Europe were conducted, collecting details on overall national situations and changes due to COVID-19 measures. The reported experiences of parent organizations from 13 European countries show wide variations in epidemiological containment measures during the first 17 months of the COVID-19 pandemic. Practices differed between facilities, resulting in emotional disquiet and confusion for parent-patients. Most countries maintained antenatal and postnatal care but restricted psychosocial support (antenatal and birth companions, visitors). Organizations from nine countries reported that women had to wear masks during labor, and all but two countries saw separations of mothers and babies. Most parent organizations described a need for more reliable information for new parents. During the pandemic, non-evidence-based practices were (re-) established in many settings, depriving women and families of many factors which evidence has shown to be essential for a positive birthing experience. Based on the findings, we consider the challenges in maternity services and propose a strategy for future crises.
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Affiliation(s)
- Daniela Drandić
- Roda - Parents in Action, Zagreb, Croatia,Human Rights in Childbirth, United States
| | | | - Catarina Barata
- Institute of Social Sciences, University of Lisbon, Lisbon, Portugal,Portuguese Association for the Rights of Women in Pregnancy and Birth, Lisbon, Portugal
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10
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Abou-Dakn M, Schäfers R, Peterwerth N, Asmushen K, Bässler-Weber S, Boes U, Bosch A, Ehm D, Fischer T, Greening M, Hartmann K, Heller G, Kapp C, von Kaisenberg C, Kayer B, Kranke P, Lawrenz B, Louwen F, Loytved C, Lütje W, Mattern E, Nielsen R, Reister F, Schlösser R, Schwarz C, Stephan V, Kalberer BS, Valet A, Wenk M, Kehl S. Vaginal Birth at Term - Part 1. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020). Geburtshilfe Frauenheilkd 2022; 82:1143-1193. [PMID: 36339636 PMCID: PMC9633231 DOI: 10.1055/a-1904-6546] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. This first part presents recommendations and statements about patient information and counselling, general patient care, monitoring of patients, pain management and quality control measures for vaginal birth. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG 190 guideline "Intrapartum care for healthy women and babies". Other international guidelines were also consulted in specific cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions, if this was considered necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of the additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.
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Affiliation(s)
- Michael Abou-Dakn
- Klinik für Gynäkologie und Geburtshilfe, St. Joseph Krankenhaus, Berlin-Tempelhof, Berlin, Germany,Correspondence Prof. Dr. med. Michael Abou-Dakn Klinik für Gynäkologie und GeburtshilfeSt. Joseph Krankenhaus
Berlin-TempelhofWüsthoffstraße 1512101
BerlinGermany
| | - Rainhild Schäfers
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany,Prof. Dr. Rainhild Schäfers Hochschule für GesundheitDepartment für Angewandte
GesundheitswissenschaftenGesundheitscampus 6 – 844801
BochumGermany
| | - Nina Peterwerth
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany
| | - Kirsten Asmushen
- Gesellschaft für Qualität in der außerklinischen Geburtshilfe e. V., Storkow, Germany
| | | | | | - Andrea Bosch
- Duale Hochschule Baden-Württemberg Angewandte Hebammenwissenschaft, Stuttgart, Germany
| | - David Ehm
- Frauenarztpraxis Bern, Bern, Switzerland
| | - Thorsten Fischer
- Dept. of Gynecology and Obstetrics Paracelcus Medical University, Salzburg, Austria
| | - Monika Greening
- Hochschule für Wirtschaft und Gesellschaft, Hebammenwissenschaften – Ludwigshafen, Ludwigshafen, Germany
| | | | - Günther Heller
- Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Germany
| | - Claudia Kapp
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Constantin von Kaisenberg
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | - Beate Kayer
- Fachhochschule Burgenland, Studiengang Hebammen, Pinkafeld, Austria
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Frank Louwen
- Frauenklinik, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christine Loytved
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Wolf Lütje
- Institut für Hebammen, Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften ZHAW, Winterthur, Switzerland
| | - Elke Mattern
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Renate Nielsen
- Ev. Amalie Sieveking Krankenhaus – Immanuel Albertinen Diakonie Hamburg, Hamburg, Germany
| | - Frank Reister
- Frauenklinik, Universitätsklinikum Ulm, Ulm, Germany
| | - Rolf Schlösser
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christiane Schwarz
- Institut für Gesundheitswissenschaften FB Hebammenwissenschaft, Lübeck, Germany
| | - Volker Stephan
- Deutsche Gesellschaft für Kinder- und Jugendmedizin e. V., Köln, Germany
| | | | - Axel Valet
- Frauenklinik Dill Kliniken GmbH, Herborn, Germany
| | - Manuel Wenk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie Kaiserwerther Diakonie, Düsseldorf, Germany
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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11
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Abou-Dakn M, Schäfers R, Peterwerth N, Asmushen K, Bässler-Weber S, Boes U, Bosch A, Ehm D, Fischer T, Greening M, Hartmann K, Heller G, Kapp C, von Kaisenberg C, Kayer B, Kranke P, Lawrenz B, Louwen F, Loytved C, Lütje W, Mattern E, Nielsen R, Reister F, Schlösser R, Schwarz C, Stephan V, Kalberer BS, Valet A, Wenk M, Kehl S. Vaginal Birth at Term - Part 2. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020). Geburtshilfe Frauenheilkd 2022; 82:1194-1248. [PMID: 36339632 PMCID: PMC9633230 DOI: 10.1055/a-1904-6769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. The second part of this guideline presents recommendations and statements on care during the dilation and expulsion stages as well as during the placental/postnatal stage. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG190 guideline "Intrapartum care for healthy women and babies". Other international guidelines were also consulted in individual cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions where necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline, and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.
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Affiliation(s)
- Michael Abou-Dakn
- Klinik für Gynäkologie und Geburtshilfe, St. Joseph Krankenhaus, Berlin-Tempelhof, Berlin, Germany,Korrespondenzadresse Prof. Dr. med. Michael Abou-Dakn Klinik für Gynäkologie und GeburtshilfeSt. Joseph Krankenhaus
Berlin-TempelhofWüsthoffstraße 1512101
BerlinGermany
| | - Rainhild Schäfers
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany,Prof. Dr. Rainhild Schäfers Hochschule für GesundheitDepartment für Angewandte
GesundheitswissenschaftenGesundheitscampus 6 – 844801
BochumGermany
| | - Nina Peterwerth
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany
| | - Kirsten Asmushen
- Gesellschaft für Qualität in der außerklinischen Geburtshilfe e. V., Storkow, Germany
| | | | | | - Andrea Bosch
- Duale Hochschule Baden-Württemberg Angewandte Hebammenwissenschaft, Stuttgart, Germany
| | - David Ehm
- Frauenarztpraxis Bern, Bern, Switzerland
| | - Thorsten Fischer
- Dept. of Gynecology and Obstetrics Paracelcus Medical University, Salzburg, Austria
| | - Monika Greening
- Hochschule für Wirtschaft und Gesellschaft, Hebammenwissenschaften – Ludwigshafen, Ludwigshafen, Germany
| | | | - Günther Heller
- Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Germany
| | - Claudia Kapp
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Constantin von Kaisenberg
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | - Beate Kayer
- Fachhochschule Burgenland, Studiengang Hebammen, Pinkafeld, Austria
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Frank Louwen
- Frauenklinik, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christine Loytved
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Wolf Lütje
- Institut für Hebammen, Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften ZHAW, Winterthur, Switzerland
| | - Elke Mattern
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Renate Nielsen
- Ev. Amalie Sieveking Krankenhaus – Immanuel Albertinen Diakonie Hamburg, Hamburg, Germany
| | - Frank Reister
- Frauenklinik, Universitätsklinikum Ulm, Ulm, Germany
| | - Rolf Schlösser
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christiane Schwarz
- Institut für Gesundheitswissenschaften FB Hebammenwissenschaft, Lübeck, Germany
| | - Volker Stephan
- Deutsche Gesellschaft für Kinder- und Jugendmedizin e. V., Köln, Germany
| | | | - Axel Valet
- Frauenklinik Dill Kliniken GmbH, Herborn, Germany
| | - Manuel Wenk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie Kaiserwerther Diakonie, Düsseldorf, Germany
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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12
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Rohmann N, Stürmer P, Geisler C, Schlicht K, Hartmann K, Türk K, Hollstein T, Tran F, Rosenstiel P, Franke A, Heyckendorf J, Schreiber S, Schulte DM, Laudes M. Brief Research Report: Serum clara cell 16 kDa protein levels are increased in patients hospitalized for severe SARS-CoV-2 or sepsis infection. Front Immunol 2022; 13:1037115. [PMID: 36311771 PMCID: PMC9613110 DOI: 10.3389/fimmu.2022.1037115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Clara cell 16 kDa protein (CC16) is a secretory protein primarily expressed in epithelial cells in the lungs. Previous studies show that CC16 exerts anti-inflammatory and immune-modulatory properties in both acute and chronic pulmonary diseases. However, despite the evidence of CC16’s high biomarker potential, evaluation of its role in infectious diseases is yet very limited. Methods Serum CC16 concentrations were measured by ELISA and assessed in two different types of severe infections. Using a case-control study design, patients treated for either severe SARS-CoV-2 or severe non-pulmonary sepsis infection were compared to age- and sex-matched healthy human subjects. Results Serum CC16 was significantly increased in both types of infection (SARS-CoV-2: 96.22 ± 129.01 ng/ml vs. healthy controls: 14.05 ± 7.48 ng/ml, p = 0.022; sepsis: 35.37 ± 28.10 ng/ml vs. healthy controls: 15.25 ± 7.51 ng/ml, p = 0.032) but there were no distinct differences between infections with and without pulmonary focus (p = 0.089). Furthermore, CC16 serum levels were positively correlated to disease duration and inversely to the platelet count in severe SARS-CoV-2 infection. Conclusions Increased CC16 serum levels in both SARS-CoV-2 and sepsis reinforce the high potential as a biomarker for epithelial cell damage and bronchoalveolar−blood barrier leakage in pulmonary as well as non-pulmonary infectious diseases.
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Affiliation(s)
- Nathalie Rohmann
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Paula Stürmer
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Corinna Geisler
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Kristina Schlicht
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Katharina Hartmann
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Kathrin Türk
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Tim Hollstein
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Florian Tran
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Jan Heyckendorf
- Division of Pneumology, Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Dominik M. Schulte
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Matthias Laudes
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein, Kiel, Germany
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
- *Correspondence: Matthias Laudes,
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13
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Brandes J, Zobel I, Rohmann N, Schlicht K, Geisler C, Hartmann K, Türk K, von Schönfels W, Beckmann J, Tran F, Laudes M. Dipeptidylpeptidase (DPP)-4 inhibitor therapy increases circulating levels of anti-inflammatory soluble frizzle receptor protein (sFRP)-5 which is decreased in severe COVID-19 disease. Sci Rep 2022; 12:14935. [PMID: 36056109 PMCID: PMC9437412 DOI: 10.1038/s41598-022-18354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 08/10/2022] [Indexed: 11/09/2022] Open
Abstract
Obesity and type 2 diabetes (T2D) show an increased risk for a severe COVID-19 disease. Treatment with DPP4 inhibitor (DPP4i) results in reduced mortality and better clinical outcome. Here, we aimed to identify potential mechanisms for the observed DPP4i effect in COVID-19. Comparing T2D subjects with and without DPP4i treatment, we identified a significant increase of the anti-inflammatory adipokine sFRP5 in relation to DPP4 inhibition. sFRP5 is a specific antagonist to Wnt5a, a glycopeptide secreted by adipose tissue macrophages acting pro-inflammatory in various diseases. We therefore examined sFRP5 levels in patients hospitalised for severe COVID-19 and found significant lower levels compared to healthy controls. Since sFRP5 might consequently be a molecular link for the beneficial effects of DPP4i in COVID-19, we further aimed to identify the exact source of sFRP5 in adipose tissue on cellular level. We therefore isolated pre-adipocytes, mature adipocytes and macrophages from adipose tissue biopsies and performed western-blotting. Results showed a sFRP5 expression specifically in mature adipocytes of subcutaneous and omental adipose tissue. In summary, our data suggest that DPP4i increase serum levels of anti-inflammatory sFRP5 which might be beneficial in COVID-19, reflecting a state of sFRP5 deficiency.
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Affiliation(s)
- Juliane Brandes
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel; Düsternbrooker Weg, 17, 24105, Kiel, Germany
| | - Isabelle Zobel
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel; Düsternbrooker Weg, 17, 24105, Kiel, Germany
| | - Nathalie Rohmann
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel; Düsternbrooker Weg, 17, 24105, Kiel, Germany
| | - Kristina Schlicht
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel; Düsternbrooker Weg, 17, 24105, Kiel, Germany
| | - Corinna Geisler
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel; Düsternbrooker Weg, 17, 24105, Kiel, Germany
| | - Katharina Hartmann
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel; Düsternbrooker Weg, 17, 24105, Kiel, Germany
| | - Kathrin Türk
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel; Düsternbrooker Weg, 17, 24105, Kiel, Germany
| | - Witigo von Schönfels
- Department of General and Abdominal Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Jan Beckmann
- Department of General and Abdominal Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Florian Tran
- Institute of Clinical Molecular Biology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Matthias Laudes
- Institute of Diabetes and Clinical Metabolic Research, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel; Düsternbrooker Weg, 17, 24105, Kiel, Germany.
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany.
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14
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Henneke L, Schlicht K, Andreani NA, Hollstein T, Demetrowitsch T, Knappe C, Hartmann K, Jensen-Kroll J, Rohmann N, Pohlschneider D, Geisler C, Schulte DM, Settgast U, Türk K, Zimmermann J, Kaleta C, Baines JF, Shearer J, Shah S, Shen-Tu G, Schwarz K, Franke A, Schreiber S, Laudes M. A dietary carbohydrate - gut Parasutterella - human fatty acid biosynthesis metabolic axis in obesity and type 2 diabetes. Gut Microbes 2022; 14:2057778. [PMID: 35435797 PMCID: PMC9037427 DOI: 10.1080/19490976.2022.2057778] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [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] [Indexed: 02/04/2023] Open
Abstract
Recent rodent microbiome experiments suggest that besides Akkermansia, Parasutterella sp. are important in type 2 diabetes and obesity development. In the present translational human study, we aimed to characterize Parasutterella in our European cross-sectional FoCus cohort (n = 1,544) followed by validation of the major results in an independent Canadian cohort (n = 438). In addition, we examined Parasutterella abundance in response to a weight loss intervention (n = 55). Parasutterella was positively associated with BMI and type 2 diabetes independently of the reduced microbiome α/β diversity and low-grade inflammation commonly found in obesity. Nutritional analysis revealed a positive association with the dietary intake of carbohydrates but not with fat or protein consumption. Out of 126 serum metabolites differentially detectable by untargeted HPLC-based MS-metabolomics, L-cysteine showed the strongest reduction in subjects with high Parasutterella abundance. This is of interest, since Parasutterella is a known high L-cysteine consumer and L-cysteine is known to improve blood glucose levels in rodents. Furthermore, metabolic network enrichment analysis identified an association of high Parasutterella abundance with the activation of the human fatty acid biosynthesis pathway suggesting a mechanism for body weight gain. This is supported by a significant reduction of the Parasutterella abundance during our weight loss intervention. Together, these data indicate a role for Parasutterella in human type 2 diabetes and obesity, whereby the link to L-cysteine might be relevant in type 2 diabetes development and the link to the fatty acid biosynthesis pathway for body weight gain in response to a carbohydrate-rich diet in obesity development.
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Affiliation(s)
- Lea Henneke
- Institute of Diabetes and Clinical Metabolic Research, University of Kiel, Kiel, Germany
| | - Kristina Schlicht
- Institute of Diabetes and Clinical Metabolic Research, University of Kiel, Kiel, Germany
| | - Nadia A. Andreani
- Section of Evolutionary Medicine, Institute for Experimental Medicine University of Kiel, Kiel, Germany,Guest group for evolutionary medicine Max-Planck-Institute of Evolutionary Biology, Plön, Germany
| | - Tim Hollstein
- Institute of Diabetes and Clinical Metabolic Research, University of Kiel, Kiel, Germany
| | - Tobias Demetrowitsch
- Division of Food Technology, Department of Human Nutrition, University of Kiel, Kiel, Germany
| | - Carina Knappe
- Institute of Diabetes and Clinical Metabolic Research, University of Kiel, Kiel, Germany
| | - Katharina Hartmann
- Institute of Diabetes and Clinical Metabolic Research, University of Kiel, Kiel, Germany
| | - Julia Jensen-Kroll
- Division of Food Technology, Department of Human Nutrition, University of Kiel, Kiel, Germany
| | - Nathalie Rohmann
- Institute of Diabetes and Clinical Metabolic Research, University of Kiel, Kiel, Germany
| | - Daniela Pohlschneider
- Institute of Diabetes and Clinical Metabolic Research, University of Kiel, Kiel, Germany
| | - Corinna Geisler
- Institute of Diabetes and Clinical Metabolic Research, University of Kiel, Kiel, Germany
| | - Dominik M. Schulte
- Institute of Diabetes and Clinical Metabolic Research, University of Kiel, Kiel, Germany
| | - Ute Settgast
- Institute of Diabetes and Clinical Metabolic Research, University of Kiel, Kiel, Germany
| | - Kathrin Türk
- Institute of Diabetes and Clinical Metabolic Research, University of Kiel, Kiel, Germany
| | - Johannes Zimmermann
- Research Group Medical System Biology, Institute of Experimental Medicine, University of Kiel, Kiel, Germany
| | - Christoph Kaleta
- Research Group Medical System Biology, Institute of Experimental Medicine, University of Kiel, Kiel, Germany
| | - John F. Baines
- Section of Evolutionary Medicine, Institute for Experimental Medicine University of Kiel, Kiel, Germany,Guest group for evolutionary medicine Max-Planck-Institute of Evolutionary Biology, Plön, Germany
| | - Jane Shearer
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, Faculty Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Shrushti Shah
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, Faculty Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Grace Shen-Tu
- Alberta’s Tomorrow Project, Cancer Control Alberta, Alberta Health Services, Edmonton, AB, Canada
| | - Karin Schwarz
- Division of Food Technology, Department of Human Nutrition, University of Kiel, Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Matthias Laudes
- Institute of Diabetes and Clinical Metabolic Research, University of Kiel, Kiel, Germany,Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University Medical Centre Schleswig-Holstein, Kiel University, Kiel, Germany,CONTACT Matthias Laudes Institute of Diabetes and Clinical Metabolic Research, University of Kiel, Düsternbrooker Weg 17, 24105Kiel, Germany
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15
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Pannier F, Noppeney T, Alm J, Breu FX, Bruning G, Flessenkämper I, Gerlach H, Hartmann K, Kahle B, Kluess H, Mendoza E, Mühlberger D, Mumme A, Nüllen H, Rass K, Reich-Schupke S, Stenger D, Stücker M, Schmedt CG, Schwarz T, Tesmann J, Teßarek J, Werth S, Valesky E. S2k guidelines: diagnosis and treatment of varicose veins. Hautarzt 2022; 73:1-44. [PMID: 35438355 PMCID: PMC9358954 DOI: 10.1007/s00105-022-04977-8] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
Affiliation(s)
- F Pannier
- Praxis für Dermatologie und Phlebologie, Helmholtzstr. 4-6, 53123, Bonn, Germany.
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16
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Nsiah‐Dosu S, Scholz C, Orinska Z, Sadik CD, Ludwig RJ, Schmidt E, Zillikens D, Hartmann K. Mast cell‐deficient mice
Mcpt5Cre/Dicer
fl/fl
redefine the role of mast cells in experimental bullous pemphigoid. Skin Health and Disease 2022; 2:e70. [PMID: 35665207 PMCID: PMC9060025 DOI: 10.1002/ski2.70] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/02/2022]
Abstract
Background Bullous pemphigoid (BP) is the most frequent autoimmune blistering disease of the skin affecting the elderly. BP is immunopathologically characterized by autoantibodies against BP180 and BP230. With the growing evidence of cell‐mediated autoimmunity in the pathogenesis of BP, it still remains unclear whether mast cells (MCs) are involved, due to conflicting data obtained from Kit‐dependent MC‐deficient mouse models. Objectives To clarify the role of MCs in experimental BP; the dynamics in cutaneous MC numbers, associated immune cells and the development of disease in Kit‐independent MC‐deficient mouse model. Methods Employing a recently established murine adult passive transfer model of BP induced by the transfer of pathogenic immunoglobulin G (IgG), lesional skin biopsies were investigated histologically and immunohistochemically for the time‐dependent MC accumulation and dermal infiltration. Results The numbers of cutaneous MCs increased following the induction of BP, in part, maintained by MC proliferation. Numbers of T cells, neutrophils and eosinophils in the skin also increased after BP induction, with eosinophils showing a preferential co‐localization with MCs. Furthermore, clinical disease manifestation in MC‐deficient Mcpt5Cre/Dicerfl/fl mice remained unchanged compared to MC‐sufficient Dicerfl/fl mice. The composition of the immune cell infiltration including as T cells, neutrophils and eosinophils was largely unaffected by the absence of MCs. Conclusion MCs do not play a pivotal role in the pathogenesis of passive IgG‐transfer mediated BP model. Their increase in number may be a bystander effect following tissue injury. We therefore suggest caution regarding the selection of MCs as sole targets for the development of novel drugs for BP.
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Affiliation(s)
- S. Nsiah‐Dosu
- Department of Dermatology University of Luebeck Luebeck Germany
| | - C. Scholz
- Department of Dermatology University of Luebeck Luebeck Germany
- Department of Infectious Diseases and Microbiology University of Luebeck Luebeck Germany
| | - Z. Orinska
- Division of Experimental Pneumology Research Center Borstel Leibniz Lung Center Borstel Germany
- Division of Experimental Pneumology, Research Center Borstel, Leibniz Lungenzentrum Airway Research Center North (ARCN) German Center for Lung Research (DZL) Borstel Germany
| | - C. D. Sadik
- Department of Dermatology University of Luebeck Luebeck Germany
| | - R. J. Ludwig
- Luebeck Institute of Experimental Dermatology (LIED) University of Luebeck Luebeck Germany
| | - E. Schmidt
- Department of Dermatology University of Luebeck Luebeck Germany
- Luebeck Institute of Experimental Dermatology (LIED) University of Luebeck Luebeck Germany
| | - D. Zillikens
- Department of Dermatology University of Luebeck Luebeck Germany
| | - K. Hartmann
- Department of Dermatology University of Luebeck Luebeck Germany
- Division of Allergy Department of Dermatology University of Basel Basel Switzerland
- Department of Biomedicine University of Basel Basel Switzerland
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17
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Dittmar F, Heyer J, Figura M, Islam R, Hartmann K, Kliesch S, Wagenlehner F, Hedger M, Loveland B, Loveland K, Fietz D, Schuppe HC. Immune cell infiltration of testicular germ cell tumors – a clinical approach. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00637-6] [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: 11/04/2022]
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18
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Wozniak DM, Riesle-Sbarbaro SA, Kirchoff N, Hansen-Kant K, Wahlbrink A, Stern A, Lander A, Hartmann K, Krasemann S, Kurth A, Prescott J. Inoculation route-dependent Lassa virus dissemination and shedding dynamics in the natural reservoir - Mastomys natalensis. Emerg Microbes Infect 2021; 10:2313-2325. [PMID: 34792436 PMCID: PMC8654411 DOI: 10.1080/22221751.2021.2008773] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Lassa virus (LASV), a Risk Group-4 zoonotic haemorrhagic fever virus, affects sub-Saharan African countries. Lassa fever, caused by LASV, results in thousands of annual deaths. Although decades have elapsed since the identification of the Natal multimammate mouse (Mastomys natalensis) as a natural reservoir of LASV, little effort has been made to characterize LASV infection in its reservoir. The natural route of infection and transmission of LASV within M. natalensis remains unknown, and the clinical impact of LASV in M. natalensis is mostly undescribed. Herein, using an outbred colony of M. natalensis, we investigate the replication and dissemination dynamics of LASV in this reservoir following various inoculation routes. Inoculation with LASV, regardless of route, resulted in a systemic infection and accumulation of abundant LASV-RNA in many tissues. LASV infection in the Natal multimammate mice was subclinical, however, clinical chemistry values were transiently altered and immune infiltrates were observed histologically in lungs, spleens and livers, indicating a minor disease with coordinated immune responses are elicited, controlling infection. Intranasal infection resulted in unique virus tissue dissemination dynamics and heightened LASV shedding, compared to subcutaneous inoculation. Our study provides important insights into LASV infection in its natural reservoir using a contemporary infection system, demonstrating that specific inoculation routes result in disparate dissemination outcomes, suggesting intranasal inoculation is important in the maintenance of LASV in the natural reservoir, and emphasizes that selection of the appropriate inoculation route is necessary to examine aspects of viral replication, transmission and responses to zoonotic viruses in their natural reservoirs.
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Affiliation(s)
- D M Wozniak
- ZBS5-Biosafety Level-4 Laboratory, Robert Koch-Institute, Berlin, Germany
| | | | - N Kirchoff
- ZBS5-Biosafety Level-4 Laboratory, Robert Koch-Institute, Berlin, Germany
| | - K Hansen-Kant
- ZBS5-Biosafety Level-4 Laboratory, Robert Koch-Institute, Berlin, Germany
| | - A Wahlbrink
- ZBS5-Biosafety Level-4 Laboratory, Robert Koch-Institute, Berlin, Germany
| | - A Stern
- ZBS5-Biosafety Level-4 Laboratory, Robert Koch-Institute, Berlin, Germany
| | - A Lander
- ZBS5-Biosafety Level-4 Laboratory, Robert Koch-Institute, Berlin, Germany
| | - K Hartmann
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Krasemann
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Kurth
- ZBS5-Biosafety Level-4 Laboratory, Robert Koch-Institute, Berlin, Germany
| | - J Prescott
- ZBS5-Biosafety Level-4 Laboratory, Robert Koch-Institute, Berlin, Germany
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19
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Schmid-Grendelmeier P, Gooderham M, Hartmann K, Konstantinou G, Fellmann M, Koulias C, Clibborn C, Biswas P, Brunner P. P153 EFFICACY AND SAFETY OUTCOMES FOR PATIENTS WITH ALLERGIC COMORBIDITIES IN THE JADE PROGRAM. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.141] [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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20
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Schlicht K, Rohmann N, Geisler C, Hollstein T, Knappe C, Hartmann K, Schwarz J, Tran F, Schunk D, Junker R, Bahmer T, Rosenstiel P, Schulte D, Türk K, Franke A, Schreiber S, Laudes M. Correction: Circulating levels of soluble Dipeptidylpeptidase-4 are reduced in human subjects hospitalized for severe COVID-19 infections. Int J Obes (Lond) 2021; 46:243. [PMID: 34671109 PMCID: PMC8526988 DOI: 10.1038/s41366-021-00988-y] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kristina Schlicht
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Nathalie Rohmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Corinna Geisler
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Tim Hollstein
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Carina Knappe
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Katharina Hartmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Jeanette Schwarz
- Institute of Clinical Chemistry, University of Kiel, Kiel, Germany.,Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Florian Tran
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany.,Division of Pneumology, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Domagoj Schunk
- Interdisciplinary Emergency Center, University of Kiel, Kiel, Germany
| | - Ralf Junker
- Institute of Clinical Chemistry, University of Kiel, Kiel, Germany
| | - Thomas Bahmer
- Division of Pneumology, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Dominik Schulte
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Kathrin Türk
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Stefan Schreiber
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany.,Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Matthias Laudes
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany.
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21
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Seoudy AK, Beckmann A, Wietzke-Braun P, Settgast U, Ziegenbruch U, Türk K, Hartmann K, Brandes J, Schulte DM, Wehkamp K, Trettow M, Schreiber S, Laudes M. Tagesklinische Versorgungsstruktur zur Komplextherapie der Adipositas III°. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1482-8115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Hintergrund Die konservativen Behandlungsmöglichkeiten der Adipositas III° (BMI ≥ 40 kg/m2) sind limitiert, da flächendeckend eine adäquate Versorgungsstruktur nicht vorgehalten wird. Am Universitätsklinikum Schleswig-Holstein, Campus Kiel, wurde 2018 eine Tagesklinik zur Komplextherapie der Adipositas III° eingerichtet mit Sicherung der Finanzierung durch die Kostenträger über Tagessätze gemäß Krankenhausentgeltgesetz.
Methode Von 201 Adipositaspatienten, die sich von Juni 2018 bis Mai 2020 vorstellten, wurde die Tagesklinikbehandlung analysiert und zusätzlich wurde das Körpergewicht ein Jahr später ausgewertet.
Ergebnisse Die Komplextherapie fand in wöchentlichen Behandlungseinheiten über 26 Wochen statt. 170 von 201 Patienten haben die Behandlung komplettiert, entsprechend einer Adhärenzquote von 84,6 %. Das mediane Alter betrug 46 Jahre. Die Mehrheit der Patienten war weiblichen Geschlechts (64,7 %). In der Gruppe der Responder (≥ 10 % Gewichtsreduktion) betrug die absolute Gewichtsabnahme 27,1 kg entsprechend etwa 20 %. Auch die Non-Responder (< 10 %) konnten ihr Körpergewicht um 8,8 kg reduzieren; in dieser Gruppe fand sich ein signifikant höherer Frauenanteil (81,3 % vs. 60,9 %, p = 0,039). Responder und Non-Responder unterschieden sich hinsichtlich des Bauch- und Hüftumfangs sowie der Fettmasse (p-Wert jeweils < 0,001). Am Therapieende wiesen die Responder niedrigere Triglyzerid- (p = 0,019) und HbA1c-Konzentrationen (p = 0,030) auf. Ein Jahr nach Beginn der Komplextherapie imponierte eine stabile Gewichtsreduktion in beiden Gruppen.
Schlussfolgerung Die teilstationäre Adipositas-Komplextherapie in einer internistischen Tagesklinik stellt eine effektive Methode zur anhaltenden Gewichtsreduktion von Patienten mit Adipositas III° dar.
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Affiliation(s)
| | - Alexia Beckmann
- Medizinische Klinik 1, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | - Ute Settgast
- Medizinische Klinik 1, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Ursula Ziegenbruch
- Medizinische Klinik 1, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Kathrin Türk
- Medizinische Klinik 1, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Katharina Hartmann
- Medizinische Klinik 1, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Juliane Brandes
- Medizinische Klinik 1, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | - Kai Wehkamp
- Medizinische Klinik 1, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Marc Trettow
- Medizinische Klinik 1, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Stefan Schreiber
- Medizinische Klinik 1, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Matthias Laudes
- Medizinische Klinik 1, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
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22
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Wehner A, Glöckner S, Weiss B, Ballhausen D, Stockhaus C, Zablotski Y, Hartmann K. Association between ACTH stimulation test results and clinical signs in dogs with hyperadrenocorticism treated with trilostane. Vet J 2021; 276:105740. [PMID: 34416401 DOI: 10.1016/j.tvjl.2021.105740] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022]
Abstract
Trilostane is the recommended medical treatment for dogs with hyperadrenocorticicm (HAC). The objective of this study was to investigate the association between ACTH stimulation test (ACTHST) results, and relevant clinical signs, in dogs treated with trilostane. A disease-specific questionnaire was developed, which included the owner's assessment of polydipsia, polyuria, polyphagia, panting, and satisfaction with the treatment, based on a 5-response category rating scale. Forty-nine dogs with HAC were prospectively enrolled. Dogs were grouped according to their recheck appointment (first recheck, 710 days after commencement of treatment or change of trilostane dose; second recheck, 4 weeks after the first recheck; third recheck, performed at 3-6 months intervals once the dog was well controlled). At the recheck appointment, the owner's questionnaire responses were recorded, and an ACTHST was performed, along with urine specific gravity measurement. Linear mixed effects models were used to assess differences among the three recheck time points and to test possible associations between ACTHST results and clinical signs. Significant differences between rechecks were present for stimulated cortisol (first to third recheck, P < 0.001; second to third recheck, P < 0.01), polydipsia (first to second recheck, P = 0.001), polyuria (first to second recheck, P < 0.001; first to third recheck, P = 0.001), and owner satisfaction (first to second recheck, P < 0.001; first to third recheck, P < 0.001). Backward stepwise variable elimination did not identify any significant associations between ACTHST results and clinical signs. Therefore, clinical signs of HAC were not predicted based on the ACTHST results.
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Affiliation(s)
- A Wehner
- Center of Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig Maximilian University, Munich, Germany.
| | - S Glöckner
- Center of Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig Maximilian University, Munich, Germany
| | - B Weiss
- Center of Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig Maximilian University, Munich, Germany
| | - D Ballhausen
- Veterinay Clinic for Small Animals, Haar, Germany
| | - C Stockhaus
- Veterinay Clinic for Small Animals, Haar, Germany
| | - Y Zablotski
- Center of Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig Maximilian University, Munich, Germany
| | - K Hartmann
- Center of Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig Maximilian University, Munich, Germany
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23
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Lalor J, Ayers S, Celleja Agius J, Downe S, Gouni O, Hartmann K, Nieuwenhuijze M, Oosterman M, Turner JD, Karlsdottir SI, Horsch A. Balancing restrictions and access to maternity care for women and birthing partners during the COVID-19 pandemic: the psychosocial impact of suboptimal care. BJOG 2021; 128:1720-1725. [PMID: 34268858 PMCID: PMC8441715 DOI: 10.1111/1471-0528.16844] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
- J Lalor
- School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland
| | - S Ayers
- Centre for Maternal and Child Health, City University of London, London, UK
| | - J Celleja Agius
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - S Downe
- University of Central Lancashire, Preston, UK
| | - O Gouni
- Cosmoanelixis Prenatal & Life sciences, Athens, Greece
| | - K Hartmann
- Mother Hood e.V., Bundeselterninitiative zum Schutz von Mutter und Kind während Schwangerschaft, Bonn, Germany
| | - M Nieuwenhuijze
- Research Centre for Midwifery Science Maastricht, Zuyd University, Maastricht, The Netherlands
| | - M Oosterman
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J D Turner
- Department of Infection and Immunity, Luxembourg Institute of Health, Strassen, Luxembourg
| | | | - A Horsch
- University of Lausanne, Lausanne, Switzerland
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24
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Hirsiger JR, Heijnen IA, Hartmann K, Berger CT. Anaphylaxis to goat's and sheep's milk in an adult tolerant to cow milk: A sensitization profile study. J Investig Allergol Clin Immunol 2021; 32:154-156. [PMID: 34160350 DOI: 10.18176/jiaci.0721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J R Hirsiger
- Translational Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - I Afm Heijnen
- Medical Immunology, Laboratory Medicine, University Hospital Basel, Switzerland
| | - K Hartmann
- Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland.,Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - C T Berger
- Translational Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland.,Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland
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25
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van Vugt FT, Hartmann K, Altenmüller E, Mohammadi B, Margulies DS. The impact of early musical training on striatal functional connectivity. Neuroimage 2021; 238:118251. [PMID: 34116147 DOI: 10.1016/j.neuroimage.2021.118251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/14/2020] [Revised: 05/05/2021] [Accepted: 06/07/2021] [Indexed: 12/26/2022] Open
Abstract
Evidence from language, visual and sensorimotor learning suggests that training early in life is more effective. The present work explores the hypothesis that learning during sensitive periods involves distinct brain networks in addition to those involved when learning later in life. Expert pianists were tested who started their musical training early (<7 years of age; n = 21) or late (n = 15), but were matched for total lifetime practice. Motor timing expertise was assessed using a musical scale playing task. Brain activity at rest was measured using fMRI and compared with a control group of nonmusicians (n = 17). Functional connectivity from seeds in the striatum revealed a striatal-cortical-sensorimotor network that was observed only in the early-onset group. In this network, higher connectivity correlated with greater motor timing expertise, which resulted from early/late group differences in motor timing expertise. By contrast, networks that differentiated musicians and nonmusicians, namely a striatal-occipital-frontal-cerebellar network in which connectivity was higher in musicians, tended to not show differences between early and late musicians and not be correlated with motor timing expertise. These results parcel musical sensorimotor neuroplasticity into a set of musicianship-related networks and a distinct set of predominantly early-onset networks. The findings lend support to the possibility that we can learn skills more easily early in development because during sensitive periods we recruit distinct brain networks that are no longer implicated in learning later in life.
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Affiliation(s)
- F T van Vugt
- Institute of Music Physiology and Musicians' Medicine, Emmichplatz 1, 30175 Hannover, Germany; Psychology Department, International Laboratory for Brain, Music, and Sound Research, University of Montreal, Canada; Psychology Department, McGill University, Montreal, Canada.
| | - K Hartmann
- Institute of Music Physiology and Musicians' Medicine, Emmichplatz 1, 30175 Hannover, Germany; Universitätsklinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - E Altenmüller
- Institute of Music Physiology and Musicians' Medicine, Emmichplatz 1, 30175 Hannover, Germany
| | - B Mohammadi
- CNS-LAB, International Neuroscience Institute (INI), Rudolf-Pichlmayr-Str., 4, 30625 Hannover, Germany
| | - D S Margulies
- CNRS UMR 8002, Integrative Neuroscience and Cognition Center, University of Paris, Paris, France
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Schuler L, Weingard I, Kiderlen M, Theodoridis A, Kriechenbauer N, Hartmann K. Rezidivraten und Form des Rezidivs nach endoluminaler Ablation der Vena saphena magna – Ein Vergleich von Laserablation (EVLA) 1470 nm, Radiofrequenz (RFITT und ClosureFast) sowie Heißdampf mit einer durchschnittlichen Nachbeobachtungszeit von 3,8 Jahren. Phlebologie 2021. [DOI: 10.1055/a-1033-2736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Zusammenfassung
Einleitung Erkrankungen des Venensystems, insbesondere auch die Insuffizienz der Vena saphena magna (VSM), gehören zu den häufigsten Krankheitsbildern in unserer Gesellschaft. Zur Behandlung stehen neben Krossektomie und Stripping sowie reiner Sklerosierungstherapie verschiedene endovenöse thermische Verfahren zur Verfügung, die in der vorliegenden Studie untereinander verglichen werden sollten.
Methoden Zwischen 2009 und 2013 wurde bei insgesamt 297 Patienten die insuffiziente VSM mit einer der 4 Methoden EVLA 1470 nm, ClosureFast, RFITT oder Heißdampf abladiert. Als primärer Endpunkt wurde die Rezidiv-Häufigkeit definiert. Die Nachkontrollen mit Duplexsonografie fanden 14 Tage postoperativ, 3 Monate postoperativ, nach 1 Jahr und schließlich jährlich mit einer durchschnittlichen Nachbeobachtungszeit von 3,8 Jahren und einer Follow-up-Rate von 81 % statt.
Ergebnisse Zum Zeitpunkt der letzten Nachkontrolle zeigten sich folgende anatomische Erfolgsraten der behandelten VSM: ClosureFast 95 %, EVLA 97 %, RFITT 79 % und Heißdampf 71 %. Schwerwiegende Komplikationen traten nur beim Heißdampf auf (Nekrosen an der Punktionsstelle), die Schmerzintensität lag bei allen Methoden 14 Tage postoperativ bei einem Median von 1–3 auf einer Skala von 1–10, bei den nachfolgenden Kontrollen lag der Median bei allen Methoden bei 1. Sowohl der Global Index Score (CIVIQ-Score) als auch der Venous Clinical Severity Score (VCSS) ließen sich durch alle endovenösen thermischen Methoden signifikant verbessern. In 5–12 % der Fälle trat ein Reflux der zuvor suffizienten Vena saphena magna accessoria (VSAA) auf.
Diskussion EVLA und ClosureFast sind zur Behandlung von Insuffizienzen der VSM mit hoher Erfolgsrate und vergleichbaren Ergebnissen zu Krossektomie und Stripping geeignet. Die Verfahren RFITT und Heißdampf zeigen im Vergleich signifikant niedrigere Verschlussraten und sind damit besonderen Situationen vorbehalten. Besonderes Augenmerk sollte auf das Vorhandensein einer zunächst nicht refluxiven VSAA gerichtet werden. Da sich hier eine erhöhte Rezidivrate bei dieser Vene zeigte, erscheint es sinnvoll, die VSAA primär mit zu abladieren.
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Bergmann M, Zablotski Y, Rieger A, Speck S, Truyen U, Hartmann K. Comparison of four commercially available point-of-care tests to detect antibodies against canine distemper virus in dogs. Vet J 2021; 273:105693. [PMID: 34148608 DOI: 10.1016/j.tvjl.2021.105693] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/06/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Abstract
Pre-vaccination antibody testing to determine dogs' immunity against canine distemper virus (CDV) is increasingly used. Four point-of-care tests (POC A-D) are available in Europe, but their diagnostic accuracy has not been compared. The study evaluated the diagnostic accuracy and usability of these tests. Sera of client-owned dogs (n = 198; healthy n = 22; unhealthy dogs n = 176) and specific pathogen-free (SPF) dogs (n = 40) were included. Virus neutralisation (VN) was performed as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy (OA) were determined. McNemar's test was used to determine significant differences between specificity and sensitivity of the tests and Cohen's kappa was used to assess agreement. The prevalence of anti-CDV antibodies by VN was 80% in client-owned dogs overall, with 100% prevalence in healthy dogs, and 0% in SPF dogs. POC-C and POC-D were considered easiest to perform. Specificity of all tests was high using sera from SPF dogs (88-100%). In healthy dogs, sensitivity was variable (45-98%). Specificity was low in all four POC tests when using sera from acutely ill dogs (6-53%) and clinically healthy dogs with chronic disease (5-77%). In client-owned dogs, including healthy and unhealthy dogs, agreement was poor between tests. All POC tests had a low specificity when investigating sera from ill client-owned dogs and usefullness of these tests especially in dogs that are acutely ill or have chronic disease is not supported by this study.
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Affiliation(s)
- M Bergmann
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany.
| | - Y Zablotski
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| | - A Rieger
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| | - S Speck
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, An den Tierkliniken 1, 04103 Leipzig, Germany
| | - U Truyen
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, An den Tierkliniken 1, 04103 Leipzig, Germany
| | - K Hartmann
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
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28
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Rohmann N, Schlicht K, Geisler C, Hollstein T, Knappe C, Krause L, Hagen S, Beckmann A, Seoudy AK, Wietzke-Braun P, Hartmann K, Schulte D, Türk K, Beckmann J, von Schönfels W, Hägele FA, Bosy-Westphal A, Franke A, Schreiber S, Laudes M. Circulating sDPP-4 is Increased in Obesity and Insulin Resistance but Is Not Related to Systemic Metabolic Inflammation. J Clin Endocrinol Metab 2021; 106:e592-e601. [PMID: 33084870 DOI: 10.1210/clinem/dgaa758] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Indexed: 12/18/2022]
Abstract
CONTEXT Dipeptidylpeptidase (DPP)-4 is a key regulator of the incretin system. It exists in a membrane-bound form and a soluble form (sDPP-4). Initial human studies suggested sDPP-4 to be an adipokine involved in metabolic inflammation. However, recent mechanistic data in genetically modified mice has questioned these findings. OBJECTIVES We examined circulating sDPP-4 in a cohort of n = 451 humans with different metabolic phenotypes and during 3 different weight loss interventions (n = 101) to further clarify its role in human physiology and metabolic diseases. DESIGN sDPP-4 serum concentrations were measured by enzyme-linked immunosorbent assay and related to several phenotyping data including gut microbiome analysis. RESULTS sDPP-4 increased with age and body weight and was positively associated with insulin resistance and hypertriglyceridemia but was reduced in manifest type 2 diabetes. In addition, we found reduced serum concentrations of sDPP-4 in subjects with arterial hypertension. In contrast to earlier reports, we did not identify an association with systemic markers of inflammation. Impaired kidney and liver functions significantly altered sDPP-4 concentrations while no relation to biomarkers for heart failure was observed. Having found increased levels of sDPP-4 in obesity, we studied surgical (gastric bypass and sleeve gastrectomy) and nonsurgical interventions, revealing a significant association of sDPP-4 with improvement of liver function tests but not with changes in body weight. CONCLUSIONS Our data suggest that sDPP-4 is related to hepatic abnormalities in obesity rather than primarily functioning as an adipokine and that sDPP-4 is implicated both in glucose and in lipid metabolism, but not fundamentally in systemic inflammation.
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Affiliation(s)
- Nathalie Rohmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Kristina Schlicht
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Corinna Geisler
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Tim Hollstein
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Carina Knappe
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Laura Krause
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Stefanie Hagen
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Alexia Beckmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Anna Katharina Seoudy
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Perdita Wietzke-Braun
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Katharina Hartmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Dominik Schulte
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Kathrin Türk
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Jan Beckmann
- Department of General, Visceral, Thoracic, Transplantation, and Pediatric Surgery, University of Kiel, Kiel, Germany
| | - Witigo von Schönfels
- Department of General, Visceral, Thoracic, Transplantation, and Pediatric Surgery, University of Kiel, Kiel, Germany
| | | | - Anja Bosy-Westphal
- Institut of Human Nutrition and Food Science, University of Kiel, Kiel, Germany
| | - Andre Franke
- Institut of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Stefan Schreiber
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
- Institut of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Matthias Laudes
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
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29
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Schlicht K, Rohmann N, Geisler C, Hollstein T, Knappe C, Hartmann K, Schwarz J, Tran F, Schunk D, Junker R, Bahmer T, Rosenstiel P, Schulte D, Türk K, Franke A, Schreiber S, Laudes M. Circulating levels of soluble Dipeptidylpeptidase-4 are reduced in human subjects hospitalized for severe COVID-19 infections. Int J Obes (Lond) 2020; 44:2335-2338. [PMID: 32958905 PMCID: PMC7503441 DOI: 10.1038/s41366-020-00689-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/20/2020] [Accepted: 09/09/2020] [Indexed: 12/17/2022]
Abstract
Dipeptidylpeptidase (DPP)-4 is a key regulator of the incretin system. For several years DPP-4 inhibitors in addition to GLP-1 analogues are of major importance in the clinical management of obesity and type 2 diabetes. DPP-4 is also known as CD26 and represents a membrane bound protease on the surface of several eukaryotic cell types. Of interest, DPP-4, like ACE2, has been shown to serve as a binding partner for corona-like viruses to enter host immune cells. Since metabolic diseases are major risk factors for the present COVID-19 pandemic, we examined circulating soluble DPP-4 serum concentrations in patients suffering from severe COVID-19 infection and in healthy human subjects in a case control design. In this analysis sDPP-4 levels were significantly lower in COVID-19 patients compared to controls (242.70 ± 202.12 ng/mL versus 497.70 ± 188.13 ng/mL, p = 0.02). We also examined sDPP-4 serum concentrations in patients suffering from sepsis not due to corona-like viruses. In these subjects, sDPP-4 levels were not different compared to healthy case controls (p = 0.14), which might suggest the decrease of sDPP-4 to be specific for corona-like virus infections. Currently, most data point towards membrane bound ACE2 in contrast to DPP-4 as the major binding partner for COVID-19 internalization into host immune cells. However, the finding that the circulating soluble form of DPP-4 is reduced in hospitalized patients might suggest a regulatory role for both, ACE and DPP-4, in COVID-19 infections, especially since obesity and type 2 diabetes are major risk factor for a severe course of the disease
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Affiliation(s)
- Kristina Schlicht
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Nathalie Rohmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Corinna Geisler
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Tim Hollstein
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Carina Knappe
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Katharina Hartmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Jeanette Schwarz
- Institute of Clinical Chemistry, University of Kiel, Kiel, Germany.,Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Florian Tran
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany.,Division of Pneumology, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Domagoj Schunk
- Interdisciplinary Emergency Center, University of Kiel, Kiel, Germany
| | - Ralf Junker
- Institute of Clinical Chemistry, University of Kiel, Kiel, Germany
| | - Thomas Bahmer
- Division of Pneumology, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Dominik Schulte
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Kathrin Türk
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Stefan Schreiber
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany.,Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Matthias Laudes
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany.
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30
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Preyß-Jägeler C, Hartmann K, Dorsch R. Changes in renal parameters and their association with subclinical vector-borne infections in Bernese Mountain dogs. BMC Vet Res 2020; 16:285. [PMID: 32787842 PMCID: PMC7425059 DOI: 10.1186/s12917-020-02506-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/30/2020] [Indexed: 11/25/2022] Open
Abstract
Background An increased risk for glomerulonephritis and a higher prevalence of antibodies to Borrelia (B.) burgdorferi sensu lato have been reported in Bernese mountain dogs (BMDs). The aim of the study was to determine the prevalence of laboratory abnormalities suggestive of kidney disease in clinically healthy BMDs compared to a control population and to investigate if there is a correlation with the occurrence of antibodies to B. burgdorferi sensu lato, Ehrlichia canis, and Anaplasma (A.) spp. and with the occurrence of Dirofilaria (D.) immitis antigen. A total of 197 BMDs and 57 control dogs were included in the study. Laboratory evidence of kidney disease was defined as renal azotemia and/or proteinuria with a urine protein creatinine ration of more than 0.5 in an inactive urine sediment. A SNAP®4Dx® ELISA (IDEXX, Laboratories, Inc., Westbrook, ME, USA) was used to detect antibodies to B. burgdorferi sensu lato, E. canis and Anaplasma spp. and antigen of D. immitis. Results Laboratory evidence of kidney disease was significantly more common in BMDs than in control dogs (17.8% versus 1.8%) (p = 0.005). The proportion of BMDs with anti-B. burgdorferi sensu latu antibodies and anti-A. phagocytophilum antibodies was significantly higher in BMDs (p < 0.001). However, an association between these findings could not be identified. Conclusion BMDs are more often affected by kidney disease and have a higher prevalence of antibodies to bacterial pathogens transmitted by Ixodes ticks than control dogs. However, a causal relationship between these two variables could not be established due to a lack of association between these two findings.
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Affiliation(s)
- C Preyß-Jägeler
- Clinic of Small Animal Medicine, LMU University of Munich, Veterinaerstrasse 13, 80539, Munich, Germany.
| | - K Hartmann
- Clinic of Small Animal Medicine, LMU University of Munich, Veterinaerstrasse 13, 80539, Munich, Germany
| | - R Dorsch
- Clinic of Small Animal Medicine, LMU University of Munich, Veterinaerstrasse 13, 80539, Munich, Germany
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31
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Ernst N, Friedrich M, Bieber K, Kasperkiewicz M, Gross N, Sadik C, Zillikens D, Schmidt E, Ludwig R, Hartmann K. Expression of PD‐1 and Tim‐3 is increased in skin of patients with bullous pemphigoid and pemphigus vulgaris. J Eur Acad Dermatol Venereol 2020; 35:486-492. [DOI: 10.1111/jdv.16780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022]
Affiliation(s)
- N. Ernst
- Luebeck Institute of Experimental Dermatology University of Luebeck Luebeck Germany
- Center for Research on Inflammation of the Skin University of Luebeck Luebeck Germany
- Department of Dermatology University of Luebeck Luebeck Germany
| | - M. Friedrich
- Department of Dermatology University of Luebeck Luebeck Germany
- Laboratory of Emerging Infections Bernhard Nocht Institute for Tropical Medicine Hamburg Germany
| | - K. Bieber
- Luebeck Institute of Experimental Dermatology University of Luebeck Luebeck Germany
- Center for Research on Inflammation of the Skin University of Luebeck Luebeck Germany
| | - M. Kasperkiewicz
- Department of Dermatology University of Luebeck Luebeck Germany
- Department of Dermatology Keck School of Medicine University of Southern California Los Angeles CA USA
| | - N. Gross
- Luebeck Institute of Experimental Dermatology University of Luebeck Luebeck Germany
- Center for Research on Inflammation of the Skin University of Luebeck Luebeck Germany
- Department of Dermatology University of Luebeck Luebeck Germany
| | - C.D. Sadik
- Center for Research on Inflammation of the Skin University of Luebeck Luebeck Germany
- Department of Dermatology University of Luebeck Luebeck Germany
| | - D. Zillikens
- Center for Research on Inflammation of the Skin University of Luebeck Luebeck Germany
- Department of Dermatology University of Luebeck Luebeck Germany
| | - E. Schmidt
- Luebeck Institute of Experimental Dermatology University of Luebeck Luebeck Germany
- Center for Research on Inflammation of the Skin University of Luebeck Luebeck Germany
- Department of Dermatology University of Luebeck Luebeck Germany
| | - R.J. Ludwig
- Luebeck Institute of Experimental Dermatology University of Luebeck Luebeck Germany
- Center for Research on Inflammation of the Skin University of Luebeck Luebeck Germany
| | - K. Hartmann
- Department of Dermatology University of Luebeck Luebeck Germany
- Division of Allergy Department of Dermatology University of Basel Basel Switzerland
- Department of Biomedicine University of Basel Basel Switzerland
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32
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Ferastraoaru D, Bax HJ, Bergmann C, Capron M, Castells M, Dombrowicz D, Fiebiger E, Gould HJ, Hartmann K, Jappe U, Jordakieva G, Josephs DH, Levi-Schaffer F, Mahler V, Poli A, Rosenstreich D, Roth-Walter F, Shamji M, Steveling-Klein EH, Turner MC, Untersmayr E, Karagiannis SN, Jensen-Jarolim E. AllergoOncology: ultra-low IgE, a potential novel biomarker in cancer-a Position Paper of the European Academy of Allergy and Clinical Immunology (EAACI). Clin Transl Allergy 2020; 10:32. [PMID: 32695309 PMCID: PMC7366896 DOI: 10.1186/s13601-020-00335-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022] Open
Abstract
Elevated serum IgE levels are associated with allergic disorders, parasitosis and specific immunologic abnormalities. In addition, epidemiological and mechanistic evidence indicates an association between IgE-mediated immune surveillance and protection from tumour growth. Intriguingly, recent studies reveal a correlation between IgE deficiency and increased malignancy risk. This is the first review discussing IgE levels and links to pathological conditions, with special focus on the potential clinical significance of ultra-low serum IgE levels and risk of malignancy. In this Position Paper we discuss: (a) the utility of measuring total IgE levels in the management of allergies, parasitosis, and immunodeficiencies, (b) factors that may influence serum IgE levels, (c) IgE as a marker of different disorders, and d) the relationship between ultra-low IgE levels and malignancy susceptibility. While elevated serum IgE is generally associated with allergic/atopic conditions, very low or absent IgE may hamper anti-tumour surveillance, indicating the importance of a balanced IgE-mediated immune function. Ultra-low IgE may prove to be an unexpected biomarker for cancer risk. Nevertheless, given the early stage of investigations conducted mostly in patients with diseases that influence IgE levels, in-depth mechanistic studies and stratification of malignancy risk based on associated demographic, immunological and clinical co-factors are warranted.
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Affiliation(s)
- D Ferastraoaru
- Department of Internal Medicine/Allergy and Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY USA
| | - H J Bax
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, 9th Floor, Guy's Tower, London, SE1 9RT UK.,School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - C Bergmann
- ENT Research Institute for Clinical Studies, Essen, Germany
| | - M Capron
- LIRIC-Unite Mixte de Recherche 995 INSERM, Universite de Lille 2, CHRU de Lille, Lille, France
| | - M Castells
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - D Dombrowicz
- Recepteurs Nucleaires, Maladies Cardiovasculaires et Diabete, Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, 59000 Lille, France
| | - E Fiebiger
- Division of Gastroenterology, Hepatology and Nutrition Research, Department of Medicine Research, Children's University Hospital Boston, Boston, MA USA
| | - H J Gould
- Randall Centre for Cell and Molecular Biophysics, School of Basic & Medical Biosciences, King's College London, New Hunt's House, London, SE1 1UL UK.,Medical Research Council & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - K Hartmann
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - U Jappe
- Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Luebeck, Luebeck, Germany.,Division of Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, Germany
| | - G Jordakieva
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - D H Josephs
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, 9th Floor, Guy's Tower, London, SE1 9RT UK.,School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - F Levi-Schaffer
- Pharmacology and Experimental Therapeutics Unit, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - V Mahler
- Division of Allergology, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - A Poli
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-Sur-Alzette, Luxembourg
| | - D Rosenstreich
- Department of Internal Medicine/Allergy and Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY USA
| | - F Roth-Walter
- The Interuniversity Messerli Research Inst, Univ. of Vet. Medicine Vienna, Med. Univ. Vienna, Univ. Vienna, Vienna, Austria
| | - M Shamji
- Immunomodulation and Tolerance Group, Imperial College London, and Allergy and Clinical Immunology, Imperial College London, London, UK
| | - E H Steveling-Klein
- Department of Dermatology, Allergy Division, University Hospital Basel, Basel, Switzerland
| | - M C Turner
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada
| | - E Untersmayr
- Institute of Pathophysiology and Allergy Research, Medical University Vienna, Vienna, Austria
| | - S N Karagiannis
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, 9th Floor, Guy's Tower, London, SE1 9RT UK.,NIHR Biomedical Research Centre at Guy's and St. Thomas' Hospitals and King's College London, Guy's Hospital, King's College London, London, UK
| | - E Jensen-Jarolim
- The Interuniversity Messerli Research Inst, Univ. of Vet. Medicine Vienna, Med. Univ. Vienna, Univ. Vienna, Vienna, Austria.,Institute of Pathophysiology and Allergy Research, Medical University Vienna, Vienna, Austria
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Cramer JP, Jimeno J, Han HH, Lin S, Hartmann K, Borkowski A, Sáez-Llorens X. Safety and immunogenicity of experimental stand-alone trivalent, inactivated Sabin-strain polio vaccine formulations in healthy infants: A randomized, observer-blind, controlled phase 1/2 trial. Vaccine 2020; 38:5313-5323. [PMID: 32563609 PMCID: PMC7347011 DOI: 10.1016/j.vaccine.2020.05.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/04/2020] [Accepted: 05/27/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND To increase the global supply of affordable IPV vaccine, preferably using Sabin viruses to comply with GAPIII requirements, Takeda has assessed three dosages of a stand-alone sIPV. METHODS In this phase I/II study two cohorts of 40 adults and 60 toddlers, respectively, were initially assessed for safety after receiving high-dosage sIPV compared with placebo (adults) or Salk IPV (toddlers). A cohort of 240 infants was then enrolled and randomized (1:1:1:1) to receive low-, medium- or high-dosage sIPV, or a reference Salk IPV in a three-dose primary schedule at 6, 10 and 14 weeks of age. Parents completed safety diaries for 4 weeks after each dose, and immunogenicity was measured as neutralization antibody titers at baseline and four weeks after vaccination. RESULTS All vaccinations were generally well-tolerated and sIPV had a comparable safety profile to the control arm in adults or the reference Salk IPV vaccine in toddlers and infants. Infants displayed dosage-dependent immune responses to sIPV when assayed using Sabin strains, which were equivalent to the reference IPV in the high-dosage sIPV group for serotypes 1 and 2, but not for Sabin and Salk serotype 3. Seroconversion rates (SCR) of the low- and medium-dosage groups were significantly lower than the Salk IPV group for both Sabin and Salk serotypes 1 and type 2 (p < 0.05), with no significant differences for Salk or Sabin serotypes 3. Responses to sIPV, particularly to Sabin types 1 and 2, were higher in initially seronegative infants, indicating possible interference by maternally-derived antibodies. CONCLUSIONS A novel stand-alone Sabin-based IPV vaccine was well tolerated with an acceptable safety profile, but less immunogenic than reference Salk IPV at 6, 10 and 14 weeks of age for Salk serotypes 1 and 2, with apparent interference by maternal antibodies. Additional preclinical assessments will be made before any further clinical development.
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Affiliation(s)
- Jakob P. Cramer
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - José Jimeno
- Department of Infectious Diseases at Hospital del Niño Dr. José Renán Esquivel, Sistema Nacional de Investigación at SENACYT, Centro de Vacunación Internacional (Cevaxin), Panama City, Panama, USA
| | | | | | | | | | - Xavier Sáez-Llorens
- Department of Infectious Diseases at Hospital del Niño Dr. José Renán Esquivel, Sistema Nacional de Investigación at SENACYT, Centro de Vacunación Internacional (Cevaxin), Panama City, Panama, USA
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Hartmann K, Pagliusi S, Precioso A. Landscape analysis of pharmacovigilance and related practices among 34 vaccine manufacturers' from emerging countries. Vaccine 2020; 38:5490-5497. [PMID: 32591289 PMCID: PMC7311355 DOI: 10.1016/j.vaccine.2020.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 05/29/2020] [Accepted: 06/05/2020] [Indexed: 11/18/2022]
Abstract
Developing Countries' Vaccine Manufacturers Network was tasked with the strategic goal of seeking solutions, jointly with manufacturers, for enabling the stable, sustainable supply of quality vaccines to developing countries to increase global immunization. As vaccines are given to millions of healthy people, including children, to prevent life-threatening diseases, vaccines must meet high safety standards. Vaccine safety monitoring is of paramount importance to maintain trust in vaccination programs globally. Once a vaccine is licensed and recommended for use, its safety and effectiveness must be monitored during its whole lifecycle, as the safety profile and protective effectiveness may change over time. A well-established safety governance model across the organization with underlying processes for data collection, signal and risk management and communication is essential. A "fit for purpose" pharmacovigilance system may vary as it depends on several factors. However, all vaccine manufacturers strive to achieve a pharmacovigilance system satisfying Good Pharmacovigilance Practices, in compliance with national, international and supranational requirements, as applicable. A landscape analysis, using a questionnaire covering nine pharmacovigilance key areas related to an effective system, was conducted to understand the existing pharmacovigilance structures, practices and expertise of vaccine manufacturers from emerging countries, on an institutional level. 34 of the 43 contacted manufacturers participated voluntarily. The survey results show that all respondents have established vaccine safety capacity, mainly in collecting and handling adverse events following immunization and implementing standardized processes; the survey also shows differences in the maturity of the manufacturers' pharmacovigilance system, Quality Management System, signal and risk management, and safety governance. The analysis provides a tool for manufacturers to gain a "bird's-eye" view of the structure of pharmacovigilance key areas and the operational dimensions covered by each area, to benchmarking against international expectations, serving as a basis to further strengthen pharmacovigilance systems, to support accelerated global vaccine supply.
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Affiliation(s)
| | - Sonia Pagliusi
- DCVMN International, Route de Crassier 7, 1262 Nyon, Switzerland.
| | - Alexander Precioso
- Butantan Institute, Av. Vital Brazil, 1500, 05503-900 Sao Paulo, Brazil.
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Fangmann D, Geisler C, Schlicht K, Hartmann K, Köpke J, Tiede A, Settgast U, Türk K, Schulte DM, Altmann K, Clawin-Rädecker I, Lorenzen PC, Schreiber S, Schwarz K, Laudes M. Differential effects of protein intake versus intake of a defined oligopeptide on FGF-21 in obese human subjects in vivo. Clin Nutr 2020; 40:600-607. [PMID: 32600859 DOI: 10.1016/j.clnu.2020.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/13/2020] [Accepted: 06/07/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND FGF-21 is described as a powerful metabolic regulator with beneficial effects including glucose-lowering and improvement of insulin sensitivity without hypoglycaemia. On the other hand, FGF-21 is activated when muscle and other tissues are stressed by external effects or internal cellular pathogens that lead to shortcomings in metabolic balance. Previous results suggested that FGF-21 could be a promising target to develop future metabolic therapeutics. PURPOSE The present study was performed to gain deeper insight into the regulation of FGF-21 by protein metabolism in obese human subjects. METHODS FGF-21 serum concentrations were measured in a cohort of n = 246 obese humans ± type 2 diabetes mellitus (T2DM) (median age 53.0 [46.0; 60.0] years and BMI 40.43 [35.11; 47.24] kg/m2) and related to the nutritional protein intake. In addition, the effect of a novel oligopeptide purified from a β-casein hydrolysate on FGF-21 was examined in vitro in liver cells and in vivo in a human intervention study with the main focus on metabolic inflammation including 40 mainly obese subjects (mean age 41.08 ± 9.76 years, mean BMI 38.29 ± 9.4 kg/m2) in a randomized 20 weeks double-blind cross-over design. MAIN FINDINGS In the cohort analysis, FGF-21 serum concentrations were significant lower with higher protein intake in obese subjects without T2DM but not in obese subjects with T2DM. Furthermore, relative methionine intake was inversely related to FGF-21. While global protein intake in obesity was inversely associated with FGF-21, incubation of HepG2 cells with a β-casein oligopeptide increased FGF-21 expression in vitro. This stimulatory effect was also present in vivo, since in the clinical intervention study treatment of obese subjects with the β-casein oligopeptide for 8 weeks significantly increased FGF-21 serum levels from W0 = 23.86 pg/mL to W8 = 30.54 pg/mL (p < 0.001), while no increase was found for placebo. CONCLUSION While the total nutritional protein intake is inversely associated with FGF-21 serum levels, a purified and well characterised oligopeptide is able to induce FGF-21 serum levels in humans. These findings suggest a differential role of various components of protein metabolism on FGF-21, rather than this factor being solely a sensor of total nutritional protein intake.
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Affiliation(s)
- Daniela Fangmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Campus Kiel, University of Kiel, Kiel, 24105, Germany
| | - Corinna Geisler
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Campus Kiel, University of Kiel, Kiel, 24105, Germany
| | - Kristina Schlicht
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Campus Kiel, University of Kiel, Kiel, 24105, Germany
| | - Katharina Hartmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Campus Kiel, University of Kiel, Kiel, 24105, Germany
| | - Jana Köpke
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Campus Kiel, University of Kiel, Kiel, 24105, Germany
| | - Anika Tiede
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Campus Kiel, University of Kiel, Kiel, 24105, Germany
| | - Ute Settgast
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Campus Kiel, University of Kiel, Kiel, 24105, Germany
| | - Kathrin Türk
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Campus Kiel, University of Kiel, Kiel, 24105, Germany
| | - Dominik M Schulte
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Campus Kiel, University of Kiel, Kiel, 24105, Germany
| | - Karina Altmann
- Max Rubner-Institute, Federal Research Institute of Nutrition and Food, Department of Safety and Quality of Milk and Fish Products, Kiel, 24103, Germany
| | - Ingrid Clawin-Rädecker
- Max Rubner-Institute, Federal Research Institute of Nutrition and Food, Department of Safety and Quality of Milk and Fish Products, Kiel, 24103, Germany
| | - Peter Ch Lorenzen
- Max Rubner-Institute, Federal Research Institute of Nutrition and Food, Department of Safety and Quality of Milk and Fish Products, Kiel, 24103, Germany
| | - Stefan Schreiber
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Campus Kiel, University of Kiel, Kiel, 24105, Germany; Institute of Clinical Molecular Biology, University Hospital Schleswig-Holstein, Campus Kiel, University of Kiel, Kiel, 24118, Germany
| | - Karin Schwarz
- University of Kiel, Department of Food Technology, University of Kiel, Kiel, 24118, Germany
| | - Matthias Laudes
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Campus Kiel, University of Kiel, Kiel, 24105, Germany.
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Abstract
BACKGROUND The clinical knowledge about the course, complications and treatment of COVID-19 in children and adolescents is so far limited. AIM This systematic review summarizes the current scientific evidence regarding the clinical presentation of COVID-19 in hospitalized children based on available case series from China. In addition, first data from a nationwide pediatric hospital survey conducted by the German Society for Pediatric Infectious Diseases (DGPI) are presented. METHODS This study evaluated 12 case series from China with 6-2143 children infected with SARS-CoV‑2, which were identified by a literature search in PubMed up to 31 March 2020. The database of the German nationwide DGPI COVID-19 survey was accessed on 6 April 2020. RESULTS The median patient age in the case series was between 2 and 7 years and 18-45% were infants <1 year of age. The duration of hospital stay was 5-20 days. Most commonly reported symptoms were fever and cough; in 40-100% of cases involvement of the lower respiratory tract was reported, usually confirmed by computed tomography (CT). Severe and critical courses of disease were reported in up to 8% of the children including 2 fatalities. So far the German DGPI COVID-19 survey reported 33 hospitalized children up to 6 April 2020, mostly with upper airway infections. Of these children, 45% were infants and 32% had an underlying medical condition. So far 3 children (9%) needed admission to an intensive care unit. CONCLUSION COVID-19 in hospitalized children usually presented as an uncomplicated febrile upper airway infection or mild pneumonia. Severe cases or fatalities rarely occurred in children. Information on neonates and children with underlying chronic conditions as well as on therapeutic and preventive measures are urgently needed.
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Affiliation(s)
- A. Streng
- Kinderklinik und Poliklinik, Universitätsklinikum an der Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - K. Hartmann
- Kinderklinik und Poliklinik, Universitätsklinikum an der Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - J. Armann
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - R. Berner
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - J. G. Liese
- Kinderklinik und Poliklinik, Universitätsklinikum an der Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
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Koutny F, Weghuber D, Bollow E, Greber‐Platzer S, Hartmann K, Körner A, Reinehr T, Roebl M, Simic‐Schleicher G, Wabitsch M, Widhalm K, Wiegand S, Holl RW. Prevalence of prediabetes and type 2 diabetes in children with obesity and increased transaminases in European German-speaking countries. Analysis of the APV initiative. Pediatr Obes 2020; 15:e12601. [PMID: 31810110 PMCID: PMC7079233 DOI: 10.1111/ijpo.12601] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 05/11/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD), prediabetes and type 2 diabetes mellitus are known to be closely linked with obesity as early as during childhood. OBJECTIVES The study aimed to determine the prevalence of prediabetes and T2DM in children with obesity with or without increased transaminases. METHODS Data from the observational multicentre (n = 51), cross-sectional Adipositas Patienten Verlaufsbeobachtung registry were analyzed. Mild increase (mild group) was defined by alanine transaminase (ALT) >24 to ≤50 U/L and moderate to severe increase (advanced group) by ALT > 50 U/L. Prediabetes and T2DM were defined according to recent IDF/ISPAD guidelines. RESULTS The prevalence of prediabetes and T2DM was 11.9% (95% CI: 11.0-12.8) and 1.4% (95% CI: 1.1-1.7) among all participants (n = 4932; male = 2481; mean age 12.9 ± 2.7 years; BMI-SDS 2.1 ± 0.5; Tanner stage 3.2 ± 1.5). The prevalence of impaired glucose metabolism (prediabetes and T2DM) was 13.8% (95% CI: 12.1-15.4) in the mild, 21.9% (95% CI: 18.8-25.1) in the advanced group, 10.7% (95% CI: 9.4-11.9) in the control group. Mild and advanced groups had greater odds ratios for prediabetes [1.42; 95% CI: 1.17-1.72, 2.26-fold; (1.78-2.86), respectively], the advanced group also for T2DM [2.39 (1.36-4.21)] compared to controls. While an increase in transaminases predominantly affected boys, girls within the advanced group had a higher T2DM prevalence than males (5.4 vs. male 2.1%). CONCLUSIONS Children with obesity and increased liver transaminases as surrogates of NAFLD should be screened for T2DM.
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Affiliation(s)
- Florian Koutny
- Department of PediatricsParacelsus Private Medical SchoolSalzburgAustria,Obesity Research UnitParacelsus Private Medical SchoolSalzburgAustria
| | - Daniel Weghuber
- Department of PediatricsParacelsus Private Medical SchoolSalzburgAustria,Obesity Research UnitParacelsus Private Medical SchoolSalzburgAustria
| | - E. Bollow
- Institute of Epidemiology and Medical BiometryUniversity of Ulm, German Center for Diabetes ResearchUlmGermany
| | - S. Greber‐Platzer
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - K. Hartmann
- Medical Centre of Childhood and AdolescenceFrankfurtGermany
| | - A. Körner
- Center for Pediatric Research, Department of Women and Child HealthUniversity Hospital for Children & Adolescents, University of LeipzigLeipzigGermany
| | - T. Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents DattelnUniversity of Witten/HerdeckeDattelnGermany
| | - M. Roebl
- Department of Pediatrics and Pediatric NeurologyUniversity Medical Center GöttingenGöttingenGermany
| | | | - M. Wabitsch
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent MedicineUniversity Medical Center UlmUlmGermany
| | - K. Widhalm
- Division of Nutrition and Metabolism, Department of PediatricsMedical University of ViennaViennaAustria
| | - S. Wiegand
- Department of Pediatric Endocrinology and Diabetes, Center for social‐pediatric careCharité Universitätsmedizin BerlinBerlinGermany
| | - R. W. Holl
- Institute of Epidemiology and Medical BiometryUniversity of Ulm, German Center for Diabetes ResearchUlmGermany
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Mebs D, Yotsu-Yamashita M, Hartmann K, Elbert C, Zehner R, Toennes SW. Revisited - Failure of tetrodotoxin to protect red-spotted newts, Notophthalmus viridescens, from endoparasites. Toxicon 2020; 178:77-81. [PMID: 32250750 DOI: 10.1016/j.toxicon.2020.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/23/2020] [Accepted: 02/29/2020] [Indexed: 11/17/2022]
Abstract
Red-spotted newts, Notophthalmus viridescens, contain tetrodotoxin (TTX) and its analogue 6-epiTTX in variable concentrations. In a follow-up study, newts were sampled from a pond in Pennsylvania, USA, in 2010, 2014, and 2018. Their toxin levels were assayed by liquid-chromatography-fluorescence detection (LC-FLD), and assessment of their infection with endoparasites such as nematodes and helminths was performed by histological examination of internal organs. In the 2010 and 2014 samples, average prevalence of parasite infection was 53 and 60%, respectively, but reached 100% in the 2018 sample, where metacercaria stages of the digenean trematode genus Australapatemon/Apatemon (family: Strigeidae) were predominant causing severe tissue damage in liver and kidney. Mean values of TTX and 6-epiTTX were not significantly different in parasitized or parasite-free newts over the study period, confirming previous findings that host toxicity and parasite load are not negatively correlated. Whereas the role of TTX in defence against predators is undisputed, its efficacy to prevent parasitic infections is less obvious. Toxin-resistance of various metazoan parasites may promote their widespread occurrence in poisonous newts.
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Affiliation(s)
- Dietrich Mebs
- Institute of Legal Medicine, University of Frankfurt, Kennedyallee 104, D-60596, Frankfurt, Germany.
| | - Mari Yotsu-Yamashita
- Graduate School of Agricultural Science, Tohoku University, 468-1 Aramaki-Aza-Aoba, Aoba-ku, Sendai, 980-8572, Japan
| | - Katharina Hartmann
- Institute of Legal Medicine, University of Frankfurt, Kennedyallee 104, D-60596, Frankfurt, Germany
| | - Christine Elbert
- Institute of Legal Medicine, University of Frankfurt, Kennedyallee 104, D-60596, Frankfurt, Germany
| | - Richard Zehner
- Institute of Legal Medicine, University of Frankfurt, Kennedyallee 104, D-60596, Frankfurt, Germany
| | - Stefan W Toennes
- Institute of Legal Medicine, University of Frankfurt, Kennedyallee 104, D-60596, Frankfurt, Germany
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Knuever J, Persa O, Illerhaus A, Ralser D, Hartmann K, Betz R, Tantcheva‐poór I. Mast cell activation in Dowling–Degos disease. Br J Dermatol 2019; 181:1312-1314. [DOI: 10.1111/bjd.18221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- J. Knuever
- Department of Dermatology University of Cologne Cologne Germany
| | - O.D. Persa
- Department of Dermatology University of Cologne Cologne Germany
| | - A. Illerhaus
- Department of Dermatology University of Cologne Cologne Germany
| | - D.J. Ralser
- Institute of Human Genetics University of Bonn School of Medicine & University Hospital Bonn Bonn Germany
| | - K. Hartmann
- Department of Dermatology University of Cologne Cologne Germany
- Division of Allergy, Department of Dermatology University of Basel Basel Switzerland
| | - R.C. Betz
- Institute of Human Genetics University of Bonn School of Medicine & University Hospital Bonn Bonn Germany
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Hartmann K. Richtigstellung: Saphenofemorale Rezidive nach endovenöser thermischer Therapie und nach chirurgischer Therapie. Phlebologie 2019. [DOI: 10.1055/a-0890-8931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Thermische Ablation kostengünstiger als chirurgische Operation!Die Arbeitsgruppe Mumme, Mühlberger, Sidhwa und Hummel haben mit ihrer Arbeit „Alarmierend hohe Rate saphenofemoraler Rezidive nach endovenöser Lasertherapie“ (Phlebologie 2019;48:18–22) mehrere Behauptungen aufgestellt, die nochmals genauer beleuchtet werden müssen.
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Teng X, Li X, Xu S, Zhang J, Hartmann K, Laible M, Hipfel R, Bai Y, Ba X, Wu Z, Wirtz RM, Liu S, Ugur S. Abstract P4-02-12: Comparison of RT-qPCR with consensus immunohistochemistry by three pathologists for ER, PR, HER2 and Ki-67 in Chinese breast cancer patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-02-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
During the diagnostic work-up of breast carcinomas, immunohistochemistry (IHC) is the currently used method for assessing the expression of estrogen- (ER) and progesterone-receptors (PR), human epidermal growth factor receptor 2 (HER2) as well as of Ki-67 as a marker of tumor cell proliferation. In this study, we analyzed the concordance of these four breast cancer biomarkers between the RT-qPCR- and IHC-based (evaluated by three independent pathologists) determinations.
Methods
The expression of ER/ESR1, PR/PGR, HER2/ERBB2 and Ki-67/MKI67 was determined in 269 FFPE breast cancer samples with tumor content >20% from Chinese patients. For IHC, the samples were freshly cut, stained and assessed by three independent pathologists using the same scoring methods in a blinded fashion (positivity defined as: ER/PR ≥1%, HER2 >2+ and Ki-67 ≥20%). Measurement of the markers on the mRNA level was done on total RNA extracts prepared from whole tissue sections from the same FFPE blocks using the CE-marked RT-qPCR based IVD MammaTyper® on a Cobas® z480 qPCR cycler. IHC assessments of the three pathologists were compared to each other with regard to concordance of positive/negative results. Subsequently, agreement of RT-qPCR and IHC results for each marker and in samples in which the three pathologists had a consensus positive/negative IHC result was determined. Furthermore, we compared the MammaTyper® assessments from a subset of whole FFPE sections to data obtained from paired samples enriched for invasive carcinoma via macrodissection.
Results
From the 269 samples, 256 were available for final analysis. When excluding cases with discordant IHC callings between the three pathologists (6.0% for ER; 7.4% PR; 4.1% Her2; 17.1% Ki-67)) the concordance to the RT-qPCR determination and consensus IHC-based analysis displayed an excellent agreement for ER (OPA: 95.4%, PPA: 97.5%, NPA: 91.5%, Kappa: 0.897), PR (OPA: 91.1%, PPA: 89.6%, NPA: 93.1%, Kappa: 0.820) and HER2 (OPA: 97.1%, PPA: 91.9%, NPA: 100.0%, Kappa: 0.936). For cancer MKI67 mRNA and Ki-67 protein expression, a lower but still good concordance was found (OPA: 90.1%, PPA: 91.8%, NPA: 83.3%, Kappa: 0.707). In addition, we could demonstrate an excellent agreement of quantitative RT-qPCR measurements between whole surface and paired tumor-enriched samples in 99 Chinese breast cancer patients with R2 of 0.927 for ER, 0.926 for PR, 0.923 for HER2 and 0.908 for KI67. Even under highly standardized IHC scoring conditions, the discordance rates in the RT-qPCR marker callings with 0.0% for ESR1, 5.0% for PGR, 3.0% for ERBB2, 13.1% for MKI67 were lower than disagreements by three pathologists on the identical slide.
Conclusion
Standardized determination of the breast cancer biomarkers ER, PR, HER2 and Ki-67 on the mRNA level shows high concordance to a consensus IHC determined by three experienced pathologists indicating that RT-qPCR may be a valid alternative for determining the four breast cancer biomarkers. In line with previous research we could show on a large set of samples that macrodissection is not required for reliable assessment of the four breast cancer markers in clinical FFPE samples.
Citation Format: Teng X, Li X, Xu S, Zhang J, Hartmann K, Laible M, Hipfel R, Bai Y, Ba X, Wu Z, Wirtz RM, Liu S, Ugur S. Comparison of RT-qPCR with consensus immunohistochemistry by three pathologists for ER, PR, HER2 and Ki-67 in Chinese breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-02-12.
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Affiliation(s)
- X Teng
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - X Li
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - S Xu
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - J Zhang
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - K Hartmann
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - M Laible
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - R Hipfel
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - Y Bai
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - X Ba
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - Z Wu
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - RM Wirtz
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - S Liu
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
| | - S Ugur
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Shuwen Biotech Co. Ltd., Zhejiang, China; The First Affiliated Hospital of Zhejiang University Medical College, Shengzhou Branch, Shaoxing, China; BioNTech Diagnostics GmbH, Mainz, Germany; STRATIFYER Molecular Pathology GmbH, Colgne, Germany; BioNTech AG, Mainz, Germany
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Lehr HA, Aulmann S, Etzrodt A, Laible M, Hartmann K, Gürtler C, Wirtz RM, Sahin U, Varga Z. Abstract P2-07-08: Standardized prediction of Oncotype DX® risk classes by local RT-qPCR. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-07-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Recent results from the prospective validation of the Oncotype DX® recurrence score (RS) have underlined the clinical validity of the assay for the prediction of chemotherapy benefit in ER+/HER2- early stage breast cancer patients. Due to health economic restrictions, some patients have no easy access to the test. A pre-selection of tumor samples may help identify patients with a high likelihood to be spared chemotherapy. Histology and semi-quantitative IHC are hence used to select samples for Oncotype testing, but these suffer from intra- and inter-observer variability, especially for Ki-67 which is a main factor in most RS prediction algorithms. We have established and validated a tool for the prediction of RS risk classes (TAILORx cutoff RS ≤25) based on highly standardized, reproducible and locally performed RT-qPCR measurements of ERBB2, ESR1, PGR and MKI67 mRNA using the CE-marked IVD MammaTyper®.
Methods: Total RNA was extracted from whole surface 10μm sections from FFPE breast cancer samples with a known RS result and a tumor cell content ≥20%. ERBB2, ESR1, PGR and MKI67 mRNA expression was measured by RT-qPCR on a CFX96 qPCR cycler using the MammaTyper® kit. A prediction model for an RS ≤25 result was established using multivariable logistic regression. Based on this model and the training data two cutoffs for confident prediction of low chemotherapy benefit patients in a clinical setting were established at 95% and 97.5% specificity. The model and the cutoffs were then fixed and validated in a second, separate set of breast cancer samples. ROC analysis was used to characterize predictive power of the continuous values resulting from the prediction model. Positive and negative predictive values for detection of an RS ≤25 result were also determined on the validation samples using the two pre-defined cutoffs.
Results: The sample set for training of the prediction model encompassed 202 samples including 29 samples (14.4%) with an RS >25. In an initial multivariable model with all four markers, PGR and MKI67 were the strongest predictors while the influence of ESR in the model was lower, but still significant. ERBB2 was no significant predictor in this set of ERBB2 negative samples and was therefore excluded from the final model which was based on three markers only. This three marker model achieved an AUC of 0.920 (95% CI: 0.871-0.968) in the training samples. When applying the fixed model from the training dataset to a second separately collected set of 104 samples containing 20 samples (19.2%) with an RS >25, an AUC of 0.883 (95% CI: 0.810-0.955) was documented. When further applying the two predefined cutoffs established in the training set, 45 and 36 of the 104 validation samples (43.3% and 34.6%) had a predicted low chemotherapy benefit result (RS ≤25). Even with the less stringent cutoff, not a single one of the RS >25 cases from the validation cohort was falsely predicted as RS ≤25 sample.
Conclusion: We have established a highly reliable method for prediction of Oncotype DX® low chemotherapy benefit results based on local and cost effective mRNA measurements. This method enables local pathologies to pre-assess routine samples using a highly precise molecular tool and thereby reserve the Oncotype DX® test for cases with ambiguous cancer biology.
Citation Format: Lehr H-A, Aulmann S, Etzrodt A, Laible M, Hartmann K, Gürtler C, Wirtz RM, Sahin U, Varga Z. Standardized prediction of Oncotype DX® risk classes by local RT-qPCR [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-07-08.
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Affiliation(s)
- H-A Lehr
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - S Aulmann
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - A Etzrodt
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - M Laible
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - K Hartmann
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - C Gürtler
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - RM Wirtz
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - U Sahin
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - Z Varga
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Stratifyer Molecular Pathology GmbH, Köln, Germany; Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
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Relling I, Akcay G, Fangmann D, Knappe C, Schulte DM, Hartmann K, Müller N, Türk K, Dempfle A, Franke A, Schreiber S, Laudes M. Role of wnt5a in Metabolic Inflammation in Humans. J Clin Endocrinol Metab 2018; 103:4253-4264. [PMID: 30137542 DOI: 10.1210/jc.2018-01007] [Citation(s) in RCA: 29] [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] [Received: 05/08/2018] [Accepted: 08/15/2018] [Indexed: 02/13/2023]
Abstract
CONTEXT Common nutrition-associated diseases like obesity and type 2 diabetes are linked to chronic low-grade inflammation. The secreted glycopeptide wingless-type mouse mammary tumor virus integration site family member 5a (wnt5a) has been implicated in metabolic inflammation in rodent models, suggesting a potential treatment target. Data on the role of wnt5a in human physiology have yielded conflicting results. OBJECTIVE Serum concentrations of wnt5a were measured in a cross-sectional cohort of 896 people to gain deeper insights into wnt5a physiology. DESIGN Serum concentrations of wnt5a were measured by ELISA and related to several phenotyping and genotyping data. In vitro experiments were performed in THP-1 macrophages to examine potential molecular mechanisms. RESULTS Wnt5a levels were significantly positively correlated to IL-6 and triglyceride levels. In subjects with diabetes, wnt5a levels were elevated and significantly correlated with fasting plasma glucose concentrations. Although wnt5a levels were not influenced by common single-nucleotide polymorphisms in the human wnt5a gene, environmental factors significantly altered wnt5a concentrations, as follows: (1) wnt5a levels were reduced in subjects with high nutritional load of the long-chain eicosatetraenoic acid independent of the total caloric intake and overall composition of the macronutrients, and (2) wnt5a levels were lower in humans with a high gut microbiome α diversity. In vitro experiments revealed that stimulation of the IL-6 receptor or the long-chain fatty acid receptor GPR40 directly affected wnt5a expression in human macrophages. CONCLUSION Our data suggest that wnt5a is important in linking inflammation to metabolism. The nutrition and the microbiome might be interesting targets to prevent and/or treat wnt5a-mediated metabolic inflammation.
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Affiliation(s)
- Isabelle Relling
- Department of Medicine 1, University of Kiel, 24105 Kiel, Germany
| | - Gül Akcay
- Department of Medicine 1, University of Kiel, 24105 Kiel, Germany
| | - Daniela Fangmann
- Department of Medicine 1, University of Kiel, 24105 Kiel, Germany
| | - Carina Knappe
- Department of Medicine 1, University of Kiel, 24105 Kiel, Germany
| | | | | | - Nike Müller
- Department of Medicine 1, University of Kiel, 24105 Kiel, Germany
| | - Kathrin Türk
- Department of Medicine 1, University of Kiel, 24105 Kiel, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, University of Kiel, 24105 Kiel, Germany
| | - Andre Franke
- Institute for Clinical Molecular Biology, University of Kiel, 24105 Kiel, Germany
| | - Stefan Schreiber
- Department of Medicine 1, University of Kiel, 24105 Kiel, Germany
- Institute for Clinical Molecular Biology, University of Kiel, 24105 Kiel, Germany
| | - Matthias Laudes
- Department of Medicine 1, University of Kiel, 24105 Kiel, Germany
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Fangmann D, Theismann EM, Türk K, Schulte DM, Relling I, Hartmann K, Keppler JK, Knipp JR, Rehman A, Heinsen FA, Franke A, Lenk L, Freitag-Wolf S, Appel E, Gorb S, Brenner C, Seegert D, Waetzig GH, Rosenstiel P, Schreiber S, Schwarz K, Laudes M. Targeted Microbiome Intervention by Microencapsulated Delayed-Release Niacin Beneficially Affects Insulin Sensitivity in Humans. Diabetes Care 2018; 41:398-405. [PMID: 29212824 DOI: 10.2337/dc17-1967] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [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] [Received: 09/20/2017] [Accepted: 11/08/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Gut microbiota represent a potential novel target for future prediabetes and type 2 diabetes therapies. In that respect, niacin has been shown to beneficially affect the host-microbiome interaction in rodent models. RESEARCH DESIGN AND METHODS We characterized more than 500 human subjects with different metabolic phenotypes regarding their niacin (nicotinic acid [NA] and nicotinamide [NAM]) status and their gut microbiome. In addition, NA and NAM delayed-release microcapsules were engineered and examined in vitro and in vivo in two human intervention studies (bioavailability study and proof-of-concept/safety study). RESULTS We found a reduced α-diversity and Bacteroidetes abundance in the microbiome of obese human subjects associated with a low dietary niacin intake. We therefore developed delayed-release microcapsules targeting the ileocolonic region to deliver increasing amounts of NA and NAM to the microbiome while preventing systemic resorption to avoid negative side effects (e.g., facial flushing). In vitro studies on these delayed-release microcapsules revealed stable conditions at pH 1.4, 4.5, and 6.8, followed by release of the compounds at pH 7.4, simulating the ileocolonic region. In humans in vivo, gut-targeted delayed-release NA but not NAM produced a significant increase in the abundance of Bacteroidetes. In the absence of systemic side effects, these favorable microbiome changes induced by microencapsulated delayed-release NA were associated with an improvement of biomarkers for systemic insulin sensitivity and metabolic inflammation. CONCLUSION Targeted microbiome intervention by delayed-release NA might represent a future therapeutic option for prediabetes and type 2 diabetes.
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Affiliation(s)
- Daniela Fangmann
- Department of Internal Medicine 1, University of Kiel, Kiel, Germany
| | | | - Kathrin Türk
- Department of Internal Medicine 1, University of Kiel, Kiel, Germany
| | - Dominik M Schulte
- Department of Internal Medicine 1, University of Kiel, Kiel, Germany
| | - Isabelle Relling
- Department of Internal Medicine 1, University of Kiel, Kiel, Germany
| | | | - Julia K Keppler
- Department of Food Technology, University of Kiel, Kiel, Germany
| | | | - Ateequr Rehman
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | | | - Andre Franke
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Lennart Lenk
- Institute for Experimental Cancer Research, University of Kiel, Kiel, Germany
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, University of Kiel, Kiel, Germany
| | - Esther Appel
- Zoological Institute, University of Kiel, Kiel, Germany
| | | | - Charles Brenner
- Department of Biochemistry, University of Iowa, Iowa City, IA
| | | | | | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Stefan Schreiber
- Department of Internal Medicine 1, University of Kiel, Kiel, Germany .,Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Karin Schwarz
- Department of Food Technology, University of Kiel, Kiel, Germany
| | - Matthias Laudes
- Department of Internal Medicine 1, University of Kiel, Kiel, Germany
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Eberhard K, Hartmann K. Eine jugendpsychiafrische Befundkarfe für erziehungsschwierige Minderjährige. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1636219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
Es wird über eine jugendpsychiatrische Befundkaxte für verwahrlosungsgefährdete bzw. verwahrloste Minderjährige berichtet. Die Befundkarte ist auf männliche Minderjährige spezifiziert, aber mit sinngemäßen Abänderungen und Ergänzungen auch für weibliche Minderjährige zu verwenden. Sie soll sowohl der gutachtlichen Beurteilung des einzelnen Verwahrlosten als auch der statistischen Analyse größerer Verwahrlostenkollektive dienen.Für die gutachterliche Beurteilung des einzelnen Verwahrlosten enthält die Befundkarte einen Katalog von Verwahrlosungsmerkmalen, auf welchem der Untersucher die jeweils erhobenen Befunde registrieren und ihre Anzahl und Valenz ablesen kann.Für die statistische Analyse größerer Verwahrlostenkollektive ist die Befundkarte mit einer Lochkarte kombiniert, auf welcher alle ermittelten Befunde abgelocht und für statistische Berechnungen ausgezählt werden können.Das methodische Prinzip der Befundkarte wird auch für die gutachtliche Beurteilung und statistische Analyse anderer psychopathologischer Syndrome empfohlen.
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Lehr HA, Aulmann S, Laible M, Etzrodt A, Hartmann K, Gürtler C, Sahin U, Varga Z. Abstract P1-06-11: Prediction of oncotype DX® results based on local gene expression measurements by MammaTyper®. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-06-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Oncotype DX® recurrence score (RS) has emerged as a recommended risk classifier for patients with ER+/HER2- early-stage breast cancer. While RS is one of the most rigorously studied risk scores, it is also one of the most expensive tests, thus remaining beyond reach for a many patients.
The necessity for an affordable method for estimating risk of recurrence has motivated investigations on the correlation between RS and traditional parameters such as IHC for ER, PR and Ki67. However, semi-quantitative IHC lacks standardization across different laboratories especially for Ki67.
In this study we therefore investigated whether the standardized assessment of HER2, ER, PR, and Ki67 on mRNA level could better serve for prediction of low risk RS cases.
Methods: ERBB2, ESR1, PGR and MKI67 mRNA expression was measured by RT-qPCR in extracts from FFPE breast cancer samples using the MammaTyper® test. Complete data for RS, IHC, grading and mRNA measurement was available for 198 samples. Tumor subtypes according to St Gallen surrogate definition from 2013 were assigned based on binary mRNA marker classification (pos/neg) according to pre-defined cut-offs. Subtype results were compared to RS risk classes based on commercial and TAILORx-trial cut-offs. RS low risk classification (RS ≤25) based on four IHC markers and grading was estimated using the online tool breastrecurrenceestimator.onc.jhmi.edu and compared to observed RS classes.
Finally, the prediction of continuous RS values by mRNA or semi-quantitative IHC measurement was compared by linear regression and subsequent ROC analysis of prediction models.
Results: The distribution of RS risk classes in the set of samples with full data was 21% RS 0-10, 39% RS 11-17, 27% RS 18-25, 7% RS 26-30 and 7% RS >30. MammaTyper® called 38% (76) of the samples as Luminal A-like. From these samples 70% and 99% had RS values below 18 and 25 respectively. Only 1 MammaTyper® Luminal A-like sample had an RS >30.
Estimation of RS according to the online tool resulted in classification of 61% (121) of the samples as low risk (RS ≤25). Of these 74% and 98% of samples had observed RS values below 18 and between 18 and 25 respectively. 2 and 1 samples called as low risk by the online tool had an RS of 26-30 and >30 and, respectively.
In linear regression analysis of IHC against RS only PR and Ki67 were significant predictors (p-values <0.0001 and 0.0128) while when using mRNA values ESR1, PGR and MKI67 were found as predictors of RS in the multivariate model (all p-values <0.0001). On a training set (67% of samples) the IHC based prediction model was correlated to the observed RS with an R2 of 0.305 whereas the mRNA based model achieved an R2 of 0.489. When the models were applied to training and validation dataset (33% of samples) for prediction of an RS >25 result, the IHC based model had AUCs of 0.887 and 0.836, respectively, while the mRNA based model achieved AUCs of 0.909 and 0.899, respectively.
Conclusion: mRNA based prediction of RS was considerably better than prediction based on IHC. As Ki67 IHC standardization is reaching its limits, local gene expression measurements with their high degree of standardization could serve as a safer way for prediction of Oncotype low risk results.
Citation Format: Lehr H-A, Aulmann S, Laible M, Etzrodt A, Hartmann K, Gürtler C, Sahin U, Varga Z. Prediction of oncotype DX® results based on local gene expression measurements by MammaTyper® [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-06-11.
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Affiliation(s)
- H-A Lehr
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - S Aulmann
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - M Laible
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - A Etzrodt
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - K Hartmann
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - C Gürtler
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - U Sahin
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Z Varga
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany; OptiPath - MVZ für Pathologie, Frankfurt a.M., Germany; BioNTech Diagnostics GmbH, Mainz, Germany; Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
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Laible M, Hartmann K, Gürtler C, Anzeneder T, Weber S, Keller T, Sahin U. Abstract P3-08-14: Prediction of distant recurrence in low risk early breast cancer by RT-qPCR based subtyping using MammaTyper®. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-08-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Estrogen receptor (ER/ESR1), progesterone receptor (PR/PGR) and epidermal growth factor receptor 2 (HER2/ERBB2) are routinely assessed by immunohistochemistry (IHC) during workup of breast cancer samples. The routine use of Ki67 (MKI67) IHC assessment in the context of breast cancer subtyping, however, remains controversial, due to poor reproducibility and lack of standardization.
The MammaTyper® test is an in-vitro diagnostic (IVD) test which measures the expression status of the four breast cancer biomarkers ERBB2, ESR1, PGR and MKI67 on the mRNA level via reverse transcription-quantitative PCR (RT-qPCR) and has demonstrated a high degree of reproducibility in the assessment of the four markers.
In this retrospective analysis we assessed the prognostic power of molecular subtyping by MammaTyper® in archived samples from low risk early breast cancers treated with adjuvant endocrine therapy only.
Methods:
ER+/HER2- (according to initial diagnosis) FFPE breast cancer samples from patients treated with adjuvant endocrine therapy only were obtained from 6 different centers. Tumor cellularity was assessed by H&E staining and RNA was extracted from samples with a tumor cell content of ≥20% using a bead-based RNA purification kit (RNXtract®). Total RNA was then used as input for MammaTyper® RT-qPCR. Expression values were classified as positive or negative for each marker based on predefined cutoff values. Tumor subtypes were assigned to each sample based on the combination of binary (pos/neg) single marker expression status according the St Gallen surrogate subtype definition. Distant disease free survival of Luminal A-like samples vs. samples with other subtypes was assessed by Kaplan Meier analysis and Cox regression using SAS version 9.4.
Results:
The final analysis included 319 samples with sufficient tumor cellularity and RNA content for reliable analysis. The rate of distant recurrence in the analyzed set was 8.5%. Median follow up was 7.8 years. The MammaTyper® test called 60% (192) of samples as Luminal-A-like (4.7% (9) distant events), 37% (119) as Luminal B-like (HER2 negative) (13.4% (16) distant events), 1.3% (4) as Triple negative (ductal) (25% (1) distant events), 0.6% (2) as “not defined according to St Gallen” (ESR1-/PGR+) (50% (1) distant events) and 0.6% (2) as Luminal B-like (HER2 positive) (no distant events).
When comparing Luminal A-like samples with the samples of the other subtypes in survival analysis, Luminal A-like samples had a significantly better distant disease free survival when assessing samples from patients with pN0 status (278) (p=0.0177, HR=0.344 (95% CI 0.137-0.866), pN1 status (0-3 affected nodes) (314) (p=0.0153, HR=0.374 (95% CI 0.163-0.855) as well as for all samples (p=0.0032, HR=0.319 (95% CI 0.143-0.711).
Conclusion:
Determination of HER2, ER, PR and Ki67 mRNA levels allows molecular subtyping according to the St Gallen surrogate subtype definition. Low risk of distant recurrence could be confirmed for the MammaTyper® Luminal A-like samples suggesting that for this patient group endocrine treatment alone may be sufficient. The high degree of standardization of mRNA measurement may drive the use of the Ki67/MKI67 biomarker in routine breast cancer pathology.
Citation Format: Laible M, Hartmann K, Gürtler C, Anzeneder T, Weber S, Keller T, Sahin U. Prediction of distant recurrence in low risk early breast cancer by RT-qPCR based subtyping using MammaTyper® [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-08-14.
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Affiliation(s)
- M Laible
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - K Hartmann
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - C Gürtler
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - T Anzeneder
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - S Weber
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - T Keller
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
| | - U Sahin
- BioNTech Diagnostics GmbH, Mainz, Germany; PATH Biobank, München, Germany; ACOMED Statistik, Leipzig, Germany
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Busch K, Wehner A, Dorsch R, Hartmann K, Unterer S. Akuter blutiger Durchfall als Vorstellungsgrund bei einem Hund mit primärem Hypoadrenokortizismus. Tierarztl Prax Ausg K 2018. [DOI: 10.1055/s-0038-1623781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ZusammenfassungEin 7 Jahre alter, männlich-kastrierter Schäferhundmischling wurde wegen akuten blutigen Erbrechens und wässrig-blutigen Durchfalls vorgestellt. Aufgrund klinischer Präsentation, unspezifischer Laborwertveränderungen, unauffälliger Elektrolytwerte und schneller klinischer Besserung auf Infusionstherapie wurde die Diagnose “hämorrhagische Gastroenteritis” (HGE) gestellt. Bei erneuter Vorstellung des Hundes wegen Leistungsschwäche einen Monat später bestanden Elektrolytverschiebungen (Hyperkaliämie und Hyponatriämie), die charakteristisch für einen typischen Hypoadrenokortizismus sind. Mittels ACTH-Stimulationstest wurde eine Unterfunktion der Nebennierenrinde bestätigt. Dieser Fallbericht zeigt, dass sich Patienten in einer Addison-Krise mit akutem hämorrhagischem Durchfall präsentieren können. Durch Erbrechen und Durchfall kann es zu einem Kaliumverlust über den Gastrointestinaltrakt kommen, wodurch typische Elektrolytverschiebungen für einen Morbus Addison verschleiert werden. Im Zweifelsfall sollte bei jedem Patienten mit blutigem Durchfall zum Ausschluss eines Hypoadrenokortizismus eine Bestimmung der basalen Kortisolkonzentration erfolgen.
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Remer C, Sauter-Louis C, Hartmann K, Dorsch R. Feline lower urinary tract disease in a German cat population. Tierarztl Prax Ausg K 2018. [DOI: 10.1055/s-0038-1623769] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Summary
Objective: To investigate epidemiologic data, clinical signs, results of urinalysis and causes of lower urinary tract disease in a German veterinary hospital population of cats and to determine if the demographic data, history, clinical signs and urinalysis results correlate with a particular etiology. Materials and methods: Cats presented with signs of feline lower urinary tract disease (FLUTD) with a documented history and physical examination, a complete urinalysis (urine specific gravity, urine dipstick and sediment, urine culture) of urine obtained by cystocentesis or catheterization, and diagnostic imaging of the urinary tract were included into the study. Cats that had received a previous treatment during the same episode of FLUTD were excluded. Results: A total of 302 cats were included into the study. Cats with FLUTD presented throughout the seasons with similar frequency. The most common diagnosis was feline idiopathic cystitis (FIC) (55.0%), followed by bacterial urinary tract infection (UTI) (18.9%), urethral plug (10.3%) and urolithiasis (7.0%). Urethral obstruction was significantly more frequent in cats with FIC than in cats with UTI. Cats with FIC and urethral plugs were significantly younger and had significantly higher body weights than cats with UTI and neoplasia. FIC and urethral plugs were significantly more common causes of FLUTD in cats younger than 10 years compared to cats that were 10 years or older (65.2% versus [vs.] 35.8% and 13.3% vs. 3.0%), while the incidences of UTI and neoplasia increased with age (12.9% vs. 41.8% and 1.0% vs. 13.4%). Conclusion and clinical relevance: FIC and UTI are the most common diagnoses in cats with FLUTD, with a significant age-related difference in incidence.
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Fischer Y, Weber K, Sauter-Louis C, Hartmann K. The Rivalta’s test as a diagnostic variable in feline effusions – evaluation of optimum reaction and storage conditions. Tierarztl Prax Ausg K 2018. [DOI: 10.1055/s-0038-1623722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Summary
Objective: The Rivalta’s test is used to diagnose feline infectious peritonitis (FIP) in cats with effusion. Only little information on the influence of sample storage and reaction conditions on test results is available, and diagnostic sensitivity and specificity to diagnose FIP vary considerably between few available studies. This study determined the influence of storage of effusion, modifications on reaction conditions, and inter-observer variation. Material and methods: The Rivalta’s test was repeated up to 21 days after storage at room temperature, in the refrigerator, or freezer. The test was performed by two independent, blinded investigators. It was also performed using different volumes of acetic acid, different acids, and different kinds of water. Results: Even after storage for 21 days, test results were comparable. While inter-observer variation revealed substantial disagreement, different modifications in performance showed no major influence on test outcome. Conclusion: The Rivalta’s test seems to be a very robust test concerning storage conditions. Modifications in reaction condition also do not substantially influence outcome. However, the test is subjective and depends on the evaluating person.
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