1
|
Bunting D, Adesuyi A, Findlay J, Pawlak M, Sanders D. Management of intraoperatively identified small bile duct stones in patients undergoing cholecystectomy. Langenbecks Arch Surg 2024; 409:70. [PMID: 38386114 PMCID: PMC10884054 DOI: 10.1007/s00423-024-03260-9] [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: 11/27/2023] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION The management of CBDS (common bile duct stones) in patients with co-existing gallbladder stones has been debated. Guidelines recommend patients with CBDS identified on imaging should be offered duct clearance; however, this is based on low-quality evidence. This study aimed to investigate the natural history of small CBDS identified using IOUS (intraoperative ultrasound) in patients undergoing cholecystectomy. This may provide evidence to support a short-term expectant management approach in such patients. METHODS Patients with CBDS diagnosed on IOUS during cholecystectomy were identified from a database of consecutive patients undergoing surgery. Patients with CBDS identified were divided into small stone (SS, ≤5 mm) and large stone (LS, >5 mm) groups. Intraoperative CBDS management, postoperative investigations, postoperative bile duct clearance, re-admissions, complications, length of stay (LOS) and follow-up are described. RESULTS Fifty-nine of 427 patients had CBDS identified on IOUS. In the SS group (n=51), 46 patients underwent short-term expectant management rather than immediate/planned bile duct clearance. Following short-term expectant management, 41/46 patients (89.1%) did not require postoperative endoscopic retrograde cholangiopancreatography and at >3 year follow-up, none has since presented with residual CBDS. Median LOS was 0 days in the short-term expectant management group and 2 days in the immediate/planned bile duct clearance group, P=0.039. CONCLUSIONS This study reports the natural history of small CBDS identified on IOUS in patients undergoing cholecystectomy. Such patients were safely treated with short-term expectant management associated with a reduced hospital LOS. This provides rationale for undertaking further research to establish this as a preferred management strategy.
Collapse
Affiliation(s)
- David Bunting
- Department of Upper GI and Abdominal Wall Surgery, North Devon District Hospital, Barnstaple, Devon, EX31 4JB, UK.
- University of Exeter Medical School, Exeter, EX1 2HZ, UK.
| | - Abidemi Adesuyi
- Department of Upper GI and Abdominal Wall Surgery, North Devon District Hospital, Barnstaple, Devon, EX31 4JB, UK
| | - John Findlay
- Department of Upper GI and Abdominal Wall Surgery, North Devon District Hospital, Barnstaple, Devon, EX31 4JB, UK
- University of Exeter Medical School, Exeter, EX1 2HZ, UK
| | - Maciej Pawlak
- Department of Upper GI and Abdominal Wall Surgery, North Devon District Hospital, Barnstaple, Devon, EX31 4JB, UK
- University of Exeter Medical School, Exeter, EX1 2HZ, UK
| | - David Sanders
- Department of Upper GI and Abdominal Wall Surgery, North Devon District Hospital, Barnstaple, Devon, EX31 4JB, UK
- University of Exeter Medical School, Exeter, EX1 2HZ, UK
| |
Collapse
|
2
|
Jurewicz A, Gasiorowska A, Leźnicka K, Pawlak M, Sochacka M, Machoy-Mokrzyńska A, Bohatyrewicz A, Maciejewska-Skrendo A, Pawlus G. Individual Factors Modifying Postoperative Pain Management in Elective Total Hip and Total Knee Replacement Surgery. Life (Basel) 2024; 14:211. [PMID: 38398720 PMCID: PMC10890574 DOI: 10.3390/life14020211] [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: 10/31/2023] [Revised: 12/20/2023] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
Total hip and knee replacements are the most common orthopedic procedures performed due to osteoarthritis. Pain is an intrinsic symptom accompanying osteoarthritis, persisting long before surgery, and continuing during the preoperative and postoperative periods. Appropriate pain management after surgery determines the comfort, duration, and cost of hospitalization, as well as the effectiveness of postoperative rehabilitation. Individual differences in pain perception and tolerance in orthopedic patients remain an important research topic. Therefore, the aim of this study was to investigate the predictors of analgesic requirements (morphine, acetaminophen, and ketoprofen), including individual pain threshold and tolerance, body mass index (BMI), diabetes, and beliefs about pain control in patients undergoing elective hip or knee arthroplasty using a multilevel regression model (N = 147, 85 women, 62 men, 107 after hip replacement, and 40 after knee replacement). Results: Higher pain tolerance was associated with a lower dose of morphine per kg after surgery. Patients undergoing hip surgery received a lower dose of ketoprofen than patients undergoing knee surgery. The more the patient believed in personal pain control, the stronger the negative relationship between pain tolerance and morphine requirement. The lowest doses were given to patients with the highest pain tolerance and the greatest belief in personal control. Factors such as belief in pain control and pain tolerance should be considered in comprehensive postoperative pain management in orthopedic patients to reduce opioid doses and, thus, side effects.
Collapse
Affiliation(s)
- Alina Jurewicz
- Department of Specialistic Nursing, Pomeranian Medical University, Żołnierska 48, 71-210 Szczecin, Poland;
| | - Agata Gasiorowska
- Faculty of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego 30b, 54-238 Wroclaw, Poland
| | - Katarzyna Leźnicka
- Department of Physical Education, Academy of Physical Education and Sport, 80-336 Gdansk, Poland; (K.L.); (A.M.-S.); (G.P.)
- Institute of Physical Culture Sciences, University of Szczecin, 70-453 Szczecin, Poland;
| | - Maciej Pawlak
- Department of Physiology and Biochemistry, Poznan University of Physical Education, 61-871 Poznan, Poland;
| | - Magdalena Sochacka
- Institute of Physical Culture Sciences, University of Szczecin, 70-453 Szczecin, Poland;
| | - Anna Machoy-Mokrzyńska
- Department of Experimental and Clinical Pharmacology, Pomeranian Medical University, 70-111 Szczecin, Poland;
| | - Andrzej Bohatyrewicz
- Department of Orthopaedics Traumatology and Musculoskeletal Oncology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland;
| | - Agnieszka Maciejewska-Skrendo
- Department of Physical Education, Academy of Physical Education and Sport, 80-336 Gdansk, Poland; (K.L.); (A.M.-S.); (G.P.)
- Institute of Physical Culture Sciences, University of Szczecin, 70-453 Szczecin, Poland;
| | - Grzegorz Pawlus
- Department of Physical Education, Academy of Physical Education and Sport, 80-336 Gdansk, Poland; (K.L.); (A.M.-S.); (G.P.)
| |
Collapse
|
3
|
Leźnicka K, Gasiorowska A, Pawlak M, Jażdżewska A, Maciejewska-Skrendo A, Chudecka M, Szumilewicz A. Changes in pain perception during pregnancy after one-time maximal physical exertion and an 8-week high-intensity interval training. Front Physiol 2023; 14:1304534. [PMID: 38148904 PMCID: PMC10750353 DOI: 10.3389/fphys.2023.1304534] [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: 10/10/2023] [Accepted: 11/27/2023] [Indexed: 12/28/2023] Open
Abstract
Background: Pain, a subjective sensation, poses a great challenge to the human body as a stressor. There is empirical evidence that moderate to intense physical activity increases pain tolerance and this may be critical during pregnancy for optimal pregnancy, fetal development, and delivery. To the best of our knowledge, it is the first study examining the changes in pain perception in pregnant women after a maximal progressive exercise test and after 8 weeks of high-intensity interval training (HIIT). Methods: Thirty-five women with uncomplicated singleton pregnancies between 13 and 28 weeks of gestation participated in the study. The HIIT intervention was developed in accordance with the recommendations and available data on HIIT during pregnancy. The maximal progressive cardiopulmonary exercise test was performed on a cycle ergometer with an electronically controlled load. Pressure pain threshold and pressure pain tolerance were measured with an algometer. Results: We found significant effects of the maximal exercise test and high-intensity interval training, such that the pregnant women had higher pain tolerance after the maximal exercise test than before and after the high-intensity interval training than the baseline. Conclusion: Our results suggest that post-exercise analgesia may be important in pregnant women and that high-intensity interval training appears to be beneficial for pregnant women to improve their pain tolerance while being obstetrically safe. Increased pain tolerance before labor could lead to better management of pain during labor and in the postpartum and lactation periods. Increasing pregnant women's awareness of this issue can improve their wellbeing and provide more comfort during labor.
Collapse
Affiliation(s)
- Katarzyna Leźnicka
- Faculty of Physical Culture, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Agata Gasiorowska
- Faculty of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Maciej Pawlak
- Department of Physiology and Biochemistry, Poznan University of Physical Education, Poznan, Poland
| | - Aleksandra Jażdżewska
- Faculty of Physical Culture, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Agnieszka Maciejewska-Skrendo
- Faculty of Physical Culture, Gdansk University of Physical Education and Sport, Gdansk, Poland
- Institute of Physical Culture Sciences University of Szczecin, Szczecin, Poland
| | - Monika Chudecka
- Institute of Physical Culture Sciences University of Szczecin, Szczecin, Poland
| | - Anna Szumilewicz
- Faculty of Physical Culture, Gdansk University of Physical Education and Sport, Gdansk, Poland
| |
Collapse
|
4
|
Stabilini C, van Veenendaal N, Aasvang E, Agresta F, Aufenacker T, Berrevoet F, Burgmans I, Chen D, de Beaux A, East B, Garcia-Alamino J, Henriksen N, Köckerling F, Kukleta J, Loos M, Lopez-Cano M, Lorenz R, Miserez M, Montgomery A, Morales-Conde S, Oppong C, Pawlak M, Podda M, Reinpold W, Sanders D, Sartori A, Tran HM, Verdaguer M, Wiessner R, Yeboah M, Zwaans W, Simons M. Update of the international HerniaSurge guidelines for groin hernia management. BJS Open 2023; 7:zrad080. [PMID: 37862616 PMCID: PMC10588975 DOI: 10.1093/bjsopen/zrad080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/05/2023] [Accepted: 07/16/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Groin hernia repair is one of the most common operations performed globally, with more than 20 million procedures per year. The last guidelines on groin hernia management were published in 2018 by the HerniaSurge Group. The aim of this project was to assess new evidence and update the guidelines. The guideline is intended for general and abdominal wall surgeons treating adult patients with groin hernias. METHOD A working group of 30 international groin hernia experts and all involved stakeholders was formed and examined all new literature on groin hernia management, available until April 2022. Articles were screened for eligibility and assessed according to GRADE methodologies. New evidence was included, and chapters were rewritten. Statements and recommendations were updated or newly formulated as necessary. RESULTS Ten chapters of the original HerniaSurge inguinal hernia guidelines were updated. In total, 39 new statements and 32 recommendations were formulated (16 strong recommendations). A modified Delphi method was used to reach consensus on all statements and recommendations among the groin hernia experts and at the European Hernia Society meeting in Manchester on October 21, 2022. CONCLUSION The HerniaSurge Collaboration has updated the international guidelines for groin hernia management. The updated guidelines provide an overview of the best available evidence on groin hernia management and include evidence-based statements and recommendations for daily practice. Future guideline development will change according to emerging guideline methodology.
Collapse
Affiliation(s)
| | - Nadine van Veenendaal
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Eske Aasvang
- Department of Anaesthesiology, The Centre for Cancer and Organ Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ferdinando Agresta
- Department of Surgery, Vittorio Veneto General Hospital, Vittorio Veneto, Italy
| | - Theo Aufenacker
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Ine Burgmans
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - David Chen
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Andrew de Beaux
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Barbora East
- Department of Surgery, Fakultní Nemocnice v Motole, Prague, Czech Republic
| | | | - Nadia Henriksen
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital–Herlev and Gentofte, Herlev, Denmark
| | - Ferdinand Köckerling
- Vivantes Hospital Berlin, Academic Teaching Hospital of Charité University Medicine, Berlin, Germany
| | - Jan Kukleta
- Department of Surgery, Klinik Im Park, Zurich, Zurich, Switzerland
| | - Maarten Loos
- SolviMáx Centre of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands
- Department of General Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Manuel Lopez-Cano
- Department of Surgery, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Ralph Lorenz
- Department of Surgery, Hernia Center 3+CHIRURGEN, Berlin, Germany
| | - Marc Miserez
- Department of Surgery, KU Leuven–University Hospital Leuven, Leuven, Belgium
| | | | | | - Chris Oppong
- Department of Surgery, Derriford Hospital Plymouth, Plymouth, UK
| | - Maciej Pawlak
- North Devon Comprehensive Hernia Centre, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Mauro Podda
- Department of Surgery, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Wolfgang Reinpold
- Department of Surgery, Gross-Sand Hospital Hamburg, Hamburg, Germany
| | - David Sanders
- North Devon Comprehensive Hernia Centre, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Alberto Sartori
- Department of Surgery, Ospedale Civile di Montebelluna, Montebelluna, Italy
| | - Hanh Minh Tran
- Westmead Clinical School, Sydney Medical School, University of Sydney, New Galles, Australia
| | - Mireia Verdaguer
- Department of Surgery, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Reiko Wiessner
- Department of Surgery, Bodden-Kliniken Ribnitz-Damgarten GmbH, Ribnitz-Damgarten, Germany
| | - Michael Yeboah
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, P.M.B., Kumasi, West Africa
| | - Willem Zwaans
- SolviMáx Centre of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands
- Department of General Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Maarten Simons
- Department of Surgery, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, The Netherlands
| |
Collapse
|
5
|
van Veenendaal N, Foss NB, Miserez M, Pawlak M, Zwaans WAR, Aasvang EK. A narrative review on the non-surgical treatment of chronic postoperative inguinal pain: a challenge for both surgeon and anaesthesiologist. Hernia 2023; 27:5-14. [PMID: 36315351 PMCID: PMC9931782 DOI: 10.1007/s10029-022-02693-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic pain is one of the most frequent clinical problems after inguinal hernia surgery. Despite more than two decades of research and numerous publications, no evidence exists to allow for chronic postoperative inguinal pain (CPIP) specific treatment algorithms. METHODS This narrative review presents the current knowledge of the non-surgical management of CPIP and makes suggestions for daily practice. RESULTS There is a paucity for high-level evidence of non-surgical options for CPIP. Different treatment options and algorithms have been published for chronic pain patients in the last decades. DISCUSSION AND CONCLUSION It is suggested that non-surgical treatment is introduced in the management of all CPIP patients. The overall approach to interventions should be pragmatic, tiered and multi-interventional, starting with least invasive and only moving to more invasive procedures upon lack of effect. Evaluation should be multidisciplinary and should take place in specialized centres. We strongly suggest to follow general guidelines for treatment of persistent pain and to build a database allowing for establishing CPIP specific evidence for optimal analgesic treatments.
Collapse
Affiliation(s)
- N van Veenendaal
- Department of Anesthesiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - N B Foss
- Department of Anaesthesia and Intensive Care, Hvidovre University Hospital, Copenhagen, Denmark
| | - M Miserez
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - M Pawlak
- North Devon Comprehensive Hernia Centre, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - W A R Zwaans
- Department of General Surgery, Máxima Medical Center, Veldhoven, Eindhoven, The Netherlands.,SolviMáx Center of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E K Aasvang
- Department of Anesthesiology, Center for Cancer and Organ Diseases, Rigshopitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| |
Collapse
|
6
|
Leźnicka K, Pawlak M, Gasiorowska A, Jażdżewska A, Wilczyńska D, Godlewska P, Lubkowska A, Chudecka M, Maciejewska-Skrendo A, Santos-Rocha R, Szumilewicz A. Individual Characteristics and Pain Sensitivity during Pregnancy-A Cross-Sectional Study in Pregnant and Non-Pregnant Women. Int J Environ Res Public Health 2022; 19:14151. [PMID: 36361034 PMCID: PMC9657085 DOI: 10.3390/ijerph192114151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
The aim of the study was to describe the characteristics and factors related to pain perception in pregnant women, such as optimism, personality traits, and fear of developing COVID-19 consequences. Sixty-six pregnant women aged 23 to 42 years participated in the study, and the comparison group consisted of n = 59 non-pregnant female students aged 19 to 23 years. Pressure pain threshold and pain tolerance were measured with an algometer. To assess psychological characteristics, the Life-Orientation Test-Revised was used to assess optimism, the Fear of COVID-19 Scale was used to assess COVID-19 anxiety, and the Ten-Item Personality Inventory was applied to assess personality traits in a five-factor model. The main results of the study showed that pain tolerance was significantly lower in both dominant and non-dominant hand pregnant women than in the comparison group. The studied pregnant women had higher scores for conscientiousness, fear of COVID-19, and optimism compared with the non-pregnant women. Regression analysis showed that the variability in pain perception among pregnant women could not be explained by individual differences in personality traits, optimism, and fear of COVID-19.
Collapse
Affiliation(s)
- Katarzyna Leźnicka
- Faculty of Physical Education, Gdansk University of Physical Education and Sport, K. Górskiego St. 1, 80-336 Gdansk, Poland
| | - Maciej Pawlak
- Department of Physiology and Biochemistry, Poznan University of Physical Education, Królowej Jadwigi St. 27/39, 61-871 Poznań, Poland
| | - Agata Gasiorowska
- Faculty of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego 30b, 54-238 Wrocław, Poland
| | - Aleksandra Jażdżewska
- Faculty of Physical Education, Gdansk University of Physical Education and Sport, K. Górskiego St. 1, 80-336 Gdansk, Poland
| | - Dominika Wilczyńska
- Faculty of Physical Education, Gdansk University of Physical Education and Sport, K. Górskiego St. 1, 80-336 Gdansk, Poland
| | - Paulina Godlewska
- Faculty of Physical Education, Gdansk University of Physical Education and Sport, K. Górskiego St. 1, 80-336 Gdansk, Poland
| | - Anna Lubkowska
- Department of Functional Diagnostics and Physical Medicine, Faculty of Health Sciences, Pomeranian Medical University, 54 Żołnierska St., 71-210 Szczecin, Poland
| | - Monika Chudecka
- Institute of Physical Culture Sciences, University of Szczecin, 40B Piastów St., 71-065 Szczecin, Poland
| | - Agnieszka Maciejewska-Skrendo
- Faculty of Physical Education, Gdansk University of Physical Education and Sport, K. Górskiego St. 1, 80-336 Gdansk, Poland
- Institute of Physical Culture Sciences, University of Szczecin, 40B Piastów St., 71-065 Szczecin, Poland
| | - Rita Santos-Rocha
- ESDRM Sport Sciences School of Rio Maior, Polytechnic Institute of Santarém, 2040-413 Rio Maior, Portugal
- CIPER Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, 1649-004 Lisbona, Portugal
| | - Anna Szumilewicz
- Faculty of Physical Education, Gdansk University of Physical Education and Sport, K. Górskiego St. 1, 80-336 Gdansk, Poland
| |
Collapse
|
7
|
Wei R, Gilmore K, Findlay J, Sanders D, Pawlak M, Bunting D, Arain A. P-017 A FRAMEWORK FOR MULTIDISCIPLINARY TEAM MANAGEMENT OF ABDOMINAL WALL RECONSTRUCTION. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.117] [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: 11/14/2022]
Abstract
Abstract
Aim
Incisional hernias are common and can significantly impact a patient's quality of life. Traditionally, abdominal wall reconstruction (AWR) has been performed by general surgeons, or those with special interest, often working in isolation. However, there is increasing awareness of pre-optimisation, risk stratification, enhanced training, and personalising treatment using a wide range of techniques.
Methods & Results
For complex and higher-risk procedures, Multidisciplinary team (MDT) management is considered the standard of care for optimising outcomes. The lack of standardised protocols and clear evidence in AWR means that surgical management can vary greatly. This makes the MDT process even more important due to the complexity of the decision-making involved. We describe a successful MDT process for complex abdominal wall reconstruction at a tertiary referral centre. Patients are reviewed at weekly AWR meetings with a multidisciplinary team, which includes consultants, advanced clinical practitioners and trainees. This is an opportunity for objective risk stratification, radiological review and assessment of the patient's goals before preoptimization and operative planning. Prospective data is collected on all patients to allow for quality improvement and service development.
Conclusion
MDT management of abdominal wall hernia is gaining popularity but remains poorly established in most regions. The involvement of surgical colleagues and other specialists is crucial in developing this growing field of surgery. We hope to expand our team to include Radiologists and Nutritionists, with the possibility of extending to regional networks, as we continue to explore new techniques and methods in managing complex abdominal wall hernias.
Collapse
Affiliation(s)
- R Wei
- General Surgery, North Devon District Hospital. , Barnstaple , United Kingdom
| | - K Gilmore
- General Surgery, North Devon District Hospital. , Barnstaple , United Kingdom
| | - J Findlay
- General Surgery, North Devon District Hospital. , Barnstaple , United Kingdom
| | - D Sanders
- General Surgery, North Devon District Hospital. , Barnstaple , United Kingdom
| | - M Pawlak
- General Surgery, North Devon District Hospital. , Barnstaple , United Kingdom
| | - D Bunting
- General Surgery, North Devon District Hospital. , Barnstaple , United Kingdom
| | - A Arain
- General Surgery, North Devon District Hospital. , Barnstaple , United Kingdom
| |
Collapse
|
8
|
Pawlak M, Alabbasi I, Cocciolo F, Wei R. P-155 ROLE OF MDT IN CPIP MANAGEMENT: LITERATURE REVIEW. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.252] [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: 11/12/2022]
Abstract
Abstract
Abstract
Chronic Post-operative Inguinal Pain (CPIP), is recognised as a long term condition and has a significant effect on patients’ quality of life. CPIP affects 18–30% of patients after an open inguinal hernia repair and 6% of patients after a laparoscopic inguinal hernia repair. CPIP result from several causes such as a pre-operative nerve lesion in other area of the body, an intra-operative nerve injury, or due to the intensity of acute post-operative inflammation and healing. a multidisciplinary clinic would be considered the best approach in order to assess patients’ pain and identify an individual management plan. This review allowed the team to choose which literature could be used to support the implementation of the clinical practice change.
Method
Literature searches were performed using PubMed and Embase databases were searched using key terms to include all related articles in the last ten years. three independent reviewers to choose included and excluded articles with two steps.
Results
Out of 25 articles found by the research, 8 articles included in this review including MDT about CPIP, meeting including criteria after the full articles reviewed. it was important to understand the nature and mechanisms of Chronic Post-operative inguinal hernia. several risk factors have been identified, which may be causing CPIP such as young age, recurrent inguinal hernia repair procedure and presence of pain before the procedure. Because of the complexity of CPIP, many authors concluding that a multidisciplinary approach should be considered the more appropriate method to ensure an effective and safe treatment. This include the need of regular follow up after an inguinal hernia repair to identify the chronic pain and establish an appropriate management plan.
Conclusions
Although the literature review enabled the team to gather useful information about the topic of the clinical practice change; it was evident that more researches and studies need to be completed in order to identify the safest and effective treatment for patients presenting with CPIP.
Collapse
Affiliation(s)
- M Pawlak
- Upper GI Surgery, Northern Devon Healthcare NHS Trust , Barnstaple , United Kingdom
| | - I Alabbasi
- Upper GI Surgery, Northern Devon Healthcare NHS Trust , Barnstaple , United Kingdom
| | - F Cocciolo
- Upper GI Surgery, Northern Devon Healthcare NHS Trust , Barnstaple , United Kingdom
| | - R Wei
- Upper GI Surgery, Northern Devon Healthcare NHS Trust , Barnstaple , United Kingdom
| |
Collapse
|
9
|
Leźnicka K, Pawlak M, Maciejewska-Skrendo A, Buczny J, Wojtkowska A, Pawlus G, Machoy-Mokrzyńska A, Jażdżewska A. Is Physical Activity an Effective Factor for Modulating Pressure Pain Threshold and Pain Tolerance after Cardiovascular Incidents? Int J Environ Res Public Health 2022; 19:11276. [PMID: 36141549 PMCID: PMC9517088 DOI: 10.3390/ijerph191811276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/27/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this study was to investigate whether regular physical activity can alter the pressure pain threshold, pain tolerance, and subjective pain perception in individuals who have experienced a cardiovascular event. The study involved 85 individuals aged 37 to 84 years (M = 65.36) who qualified for outpatient cardiac rehabilitation, which consisted of 24 physical training sessions. The patients were all tested twice: on the first and last day of the outpatient cardiac rehabilitation program. Assessments of the pressure pain threshold and pain tolerance were performed with an algometer. To assess the pain coping strategies, the Pain Coping Strategies Questionnaire (CSQ) and parenting styles were measured retrospectively with subjective survey questions. The main results of the study showed that patients achieved significantly higher pressure pain thresholds after a physical training cycle (ps < 0.05, η2 = 0.05-0.14), but found no differences in the pain tolerance (ps > 0.05). A lower preference for the better pain coping strategy explanation (ß = -0.42, p = 0.013) and growing up in a family with a less neglectful atmosphere (ß = -0.35, p = 0.008) were associated with increased pressure pain threshold after physical training. The results suggest that physical activity is an important factor in modulating the pressure pain threshold.
Collapse
Affiliation(s)
- Katarzyna Leźnicka
- Department of Physical Education, Academy of Physical Education and Sport, ul. Kazimierza Górskiego 1, 80-336 Gdansk, Poland
| | - Maciej Pawlak
- Department of Physiology and Biochemistry, Poznan University of Physical Education, 61-871 Poznan, Poland
| | - Agnieszka Maciejewska-Skrendo
- Department of Physical Education, Academy of Physical Education and Sport, ul. Kazimierza Górskiego 1, 80-336 Gdansk, Poland
- Institute of Physical Culture and Health Promotion, University of Szczecin, 70-237 Szczecin, Poland
| | - Jacek Buczny
- Institute of Psychology, SWPS University of Social Sciences and Humanities, 81-745 Sopot, Poland
- Department of Experimental and Applied Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Anna Wojtkowska
- Institute of Psychology, SWPS University of Social Sciences and Humanities, 53-238 Wroclaw, Poland
| | - Grzegorz Pawlus
- Department of Physical Education, Academy of Physical Education and Sport, ul. Kazimierza Górskiego 1, 80-336 Gdansk, Poland
| | - Anna Machoy-Mokrzyńska
- Department of Experimental and Clinical Pharmacology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Aleksandra Jażdżewska
- Department of Physical Education, Academy of Physical Education and Sport, ul. Kazimierza Górskiego 1, 80-336 Gdansk, Poland
| |
Collapse
|
10
|
Jain A, Brown E, Htay H, Pawlak M, Chirumarry S, Gadi V, Singh S, Lim J, Gow S, Chen B, Jamaluddin S, Wang Y, Gori M, Venkataraya S, Foo M. POS-689 APPLICATION OF AN ADVANCED ULTRAFILTRATION MANAGEMENT SYSTEM USING AWAK SORBENT-BASED PERITIONEAL DIALYSIS IN A PORCINE MODEL. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
11
|
Łochyński D, Pawlak M, Everaert I, Podgórski T, Gartych M, Borucka AM, Celichowski J, Derave W, Kaczmarek D. Motor Unit Fatigability following Chronic Carnosine Supplementation in Aged Rats. Nutrients 2022; 14:nu14030514. [PMID: 35276873 PMCID: PMC8839880 DOI: 10.3390/nu14030514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/19/2022] [Accepted: 01/22/2022] [Indexed: 01/27/2023] Open
Abstract
Studies suggest that carnosine (beta-alanyl-L-histidine) is effective in treating neuromuscular diseases associated with aging, but there is still a need to clarify its role in motor units (MUs) function during aging. In this study, 40 male Wistar rats aged 15 months were randomly assigned to a control or to two experimental groups in which 0.1% carnosine supplementation was performed for 10 or 34 weeks. After 34 weeks, we examined fast fatigable (FF), fast fatigue-resistant (FR) and slow (S) MUs’ force properties and fatigability, as well as antioxidant potential, advanced glycation end products, activity of enzymes, and histidyl dipeptides content in the medial gastrocnemius muscle. Short- and long-term carnosine supplementation maintained the force of FF MUs at a higher level during its rapid decline seen from the initial 10 to 70 s of the fatigue test. In FF, especially long-term, and in FR MUs, especially short-term, carnosine supplementation resulted in less rapid force decline during the initial 70 s of the second fatigue protocol. Carnosine supplementation did not change muscle antioxidant potential and mortality rate (~35% in all groups), nor muscle mass with aging. Moreover, instead of the expected increase, a decrease in histidyl dipeptides by ~30% in the red portion of medial gastrocnemius muscle after long-term supplementation was found. After chronic carnosine supplementation, the specific changes in fatigue resistance were observed in FF and FR units, but not in S MU types that were not accompanied by an improvement of antioxidant potential and activity of glycolytic or oxidative enzymes in aged rats. These observations indicate that carnosine supplementation during aging may generate different physiological adaptations which should be considered as an important factor when planning treatment strategies.
Collapse
Affiliation(s)
- Dawid Łochyński
- Department of Neuromuscular Physiotherapy, Poznan University of Physical Education, 61-879 Poznan, Poland;
- Department of Neurobiology, Poznan University of Physical Education, 61-879 Poznan, Poland; (M.G.); (J.C.)
| | - Maciej Pawlak
- Department of Physiology and Biochemistry, Poznan University of Physical Education, 61-879 Poznan, Poland; (M.P.); (T.P.); (A.-M.B.)
| | - Inge Everaert
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium; (I.E.); (W.D.)
| | - Tomasz Podgórski
- Department of Physiology and Biochemistry, Poznan University of Physical Education, 61-879 Poznan, Poland; (M.P.); (T.P.); (A.-M.B.)
| | - Magdalena Gartych
- Department of Neurobiology, Poznan University of Physical Education, 61-879 Poznan, Poland; (M.G.); (J.C.)
| | - Anna-Maria Borucka
- Department of Physiology and Biochemistry, Poznan University of Physical Education, 61-879 Poznan, Poland; (M.P.); (T.P.); (A.-M.B.)
| | - Jan Celichowski
- Department of Neurobiology, Poznan University of Physical Education, 61-879 Poznan, Poland; (M.G.); (J.C.)
| | - Wim Derave
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium; (I.E.); (W.D.)
| | - Dominik Kaczmarek
- Department of Physiology and Biochemistry, Poznan University of Physical Education, 61-879 Poznan, Poland; (M.P.); (T.P.); (A.-M.B.)
- Correspondence: ; Tel.: +48-61-835-5182
| |
Collapse
|
12
|
Gök H, Jensen KK, Pawlak M, East B, Pendar E, Towfigh S, Brady R, de Beaux A. Leveraging Twitter and its Unique #HashTag Capability: A Novel Social Media Resource From the European Hernia Society. J Abdom Wall Surg 2022; 1:10018. [PMID: 38689799 PMCID: PMC11059142 DOI: 10.3389/jaws.2021.10018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/29/2021] [Indexed: 05/02/2024]
Abstract
Background: Digital and Social Media (#SoMe) platforms have revolutionized the way information is shared, classified and accessed among medical professionals worldwide. The aim of this study was to review the hashtags used on Twitter by @EuroHerniaS to provide a practical roadmap for easier social media utilization for hernia surgery stakeholders. Methods: The hashtags used in tweets and retweets of the @EuroHerniaS Twitter feed were collated since its foundation in November 2016. Results: The first hashtag used was #HerniaSurgery. Since foundation to July 2021, the @EuroHerniaS Twitter feed has used 90 separate hashtags. The number of new hashtags per year was increasing leading to the development of an online library. The increasing diversity of hernia related hashtags allows for the more detailed posting and searching of hernia related information on the #SoMe platform Twitter. Conclusion: The more detailed use of hashtags on Twitter is to be encouraged. Hernia surgeons can make use of them both when posting and reviewing posts to aid the categorization of posts.
Collapse
Affiliation(s)
- Hakan Gök
- European Hernia Society Social Media Advisory Board, Paris, France
- Hernia Istanbul, Hernia Surgery Center, Istanbul, Turkey
| | - Kristian K. Jensen
- European Hernia Society Social Media Advisory Board, Paris, France
- Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Maciej Pawlak
- European Hernia Society Website Advisory Board, Paris, France
- Northern Devon Healthcare NHS Trust, Barnstaple, UK
| | - Barbora East
- European Hernia Society Website Advisory Board, Paris, France
- 3rd Department of Surgery, 1st Medical Faculty, Charles University and Motol University Hospital, Prague, Czechia
| | - Enis Pendar
- Pendar Management Consulting and Business Development, Istanbul, Turkey
| | - Shirin Towfigh
- Beverly Hills Hernia Center, Beverly Hills, CA, United States
| | - Richard Brady
- Newcastle Centre for Bowel Disease Research Group, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Andrew de Beaux
- European Hernia Society Social Media Advisory Board, Paris, France
- Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
13
|
Helmert C, Haufe E, Heinrich L, Siegels D, Abraham S, Heratizadeh A, Harder I, Kleinheinz A, Wollenberg A, Wiemers F, Weisshaar E, Augustin M, von Kiedrowski R, Zink A, Pawlak M, Schäkel K, Wildberger J, Weidinger S, Werfel T, Schmitt J. Atopic dermatitis and depressive symptoms. Results of the German national AD Registry TREATgermany. J Eur Acad Dermatol Venereol 2021; 36:e279-e282. [PMID: 34779054 DOI: 10.1111/jdv.17812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C Helmert
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - E Haufe
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - L Heinrich
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - D Siegels
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - S Abraham
- Department of Dermatology, University Allergy Center, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - A Heratizadeh
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - I Harder
- Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Kleinheinz
- Clinics for Dermatology, Elbe Klinikum Buxtehude, Buxtehude, Germany
| | - A Wollenberg
- Clinics and Outpatient Clinics for Dermatology and Allergy, LMU Munich, Munich, Germany
| | - F Wiemers
- Practice Dr. med. Franca Wiemers, Leipzig, Germany
| | - E Weisshaar
- Occupational Dermatology, Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - M Augustin
- Institute for Health Services Research in Dermatology Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - R von Kiedrowski
- CMSS - Company for Medical Study and Service, Selters/Westerwald, Germany
| | - A Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - M Pawlak
- Practice Dr. med, Anika Hünermund and Mario Pawlak, Heilbad Heiligenstadt, Germany
| | - K Schäkel
- Department of Dermatology, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | | | - S Weidinger
- Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - T Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - J Schmitt
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | | |
Collapse
|
14
|
Pilz AC, Schielein MC, Schuster B, Heinrich L, Haufe E, Abraham S, Heratizadeh A, Harder I, Kleinheinz A, Wollenberg A, Wiemers F, Weisshaar E, Augustin M, von Kiedrowski R, Pawlak M, Schäkel K, Wildberger J, Hilgers M, Werfel T, Weidinger S, Schmitt J, Biedermann T, Zink A. Atopic Dermatitis: Disease Characteristics and Comorbidities in Smoking and Nonsmoking Patients from the TREATgermany Registry. J Eur Acad Dermatol Venereol 2021; 36:413-421. [PMID: 34743344 DOI: 10.1111/jdv.17789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/15/2021] [Accepted: 10/22/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease with a multifactorial genesis including genetic predispositions and environmental risk and trigger factors. One of the latter possibly is smoking, indicated by an increased prevalence of AD in adults and children that are actively or passively exposed to cigarette smoke. OBJECTIVES In this study AD characteristics and its atopic comorbidities are compared in smoking and nonsmoking AD patients. METHODS TREATgermany is a non-interventional clinical registry which includes patients with moderate to severe AD in Germany. Baseline data of patients included into TREATgermany from inception in June 2016 to April 2020 in 39 sites across Germany was analyzed comparing AD disease characteristics and comorbidities in smokers versus non-smokers. RESULTS Of 921 patients, 908 (male: 58.7%) with a mean age of 41.9 ± 14.4 reported their smoking status. The objective Scoring of Atopic Dermatitis (oSCORAD) did not differ between smokers (n=352; 38.8%) and nonsmokers, however lesions' intensity of oozing/crusts and excoriations as well as patient global assessment scores (PGA) of AD severity were higher in smoking as opposed to nonsmoking patients. Smokers reported a lower number of weeks with well-controlled AD and more severe pruritus than nonsmokers. Total IgE levels were more elevated in smokers and they displayed a younger age at initial diagnosis of bronchial asthma. After adjustment for potential confounders, the increased intensity of oozing/crusts, the reduced number of weeks with well-controlled AD and the greater pruritus remained different in smokers compared to nonsmokers. In addition, smoking patients with adult-onset AD showed a 2.5 times higher chance of involvement of the feet. CONCLUSIONS German registry data indicate that AD patients who smoke have a higher disease burden with a different distribution pattern of lesions in adult-onset AD.
Collapse
Affiliation(s)
- A C Pilz
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - M C Schielein
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - B Schuster
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - L Heinrich
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden
| | - E Haufe
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden
| | - S Abraham
- Department of Dermatology, University Allergy Center, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden
| | - A Heratizadeh
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover
| | - I Harder
- Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel
| | - A Kleinheinz
- Clinics for Dermatology, Elbe Klinikum Buxtehude
| | - A Wollenberg
- Clinics and Outpatient Clinics for Dermatology and Allergy, LMU Munich
| | - F Wiemers
- Practice Dr. med. Franca Wiemers, Leipzig
| | - E Weisshaar
- Occupational Dermatology, Department of Dermatology, University of Heidelberg
| | - M Augustin
- Institute for Health Services Research in Dermatology Hamburg, University Medical Center Hamburg Eppendorf
| | | | - M Pawlak
- Practice Dr. med, Anika Hünermund and Mario Pawlak, Heilbad Heiligenstadt
| | - K Schäkel
- Department of Dermatology, Ruprecht-Karls University Heidelberg
| | | | - M Hilgers
- Clinics for Dermatology and Allergy, University Hospital Aachen
| | - T Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover
| | - S Weidinger
- Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel
| | - J Schmitt
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden
| | - T Biedermann
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - A Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | | |
Collapse
|
15
|
Pawlak M, Trzos E, Kurpesa M. Microvolt t-wave alternans its clinical significance in the assessment of the risk of sudden cardiac death among patients with hypertrophic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Summary
Some patients with hypertrophic cardiomyopathy (HCM) are at significant risk of premature sudden death. Identification of the risk factors may enable effective prevention of adverse cardiac events in these patients. Assessment of the microvolt T-wave alternans (MTWA) is a recognized non-invasive diagnostic test used in risk stratification of sudden cardiac death (SCD). However, the number of reports on the frequency of occurrence of MTWA in HCM is small. Aim: Evaluation of the prognostic value of MTWA in predicting the risk of arrhythmic events (sudden cardiac death, documented VT/VF, appropriate ICD discharge) in patients with HCM.
Material and methods
122 patients with HCM underwent detailed clinical assessment and ECG- and echocardiographic examination. They underwent 24-hour ambulatory ECG monitoring, and the following elements were analysed: 1) arrhythmias, 2) heart rate variability (HRV) and the QT segment, 3) the presence of ventricular late potentials (LP), 4) heart rate turbulence (HRT). MTWA assessment was made during a test on a treadmill (Cambridge Heart). In accordance with the adopted criteria, the test was interpreted as negative, positive or indeterminate. Subsequently, positive and indeterminate results were described collectively as MTWA(+) and negative results as MTWA(−). Then the patients were divided into two groups: Group 1 – 57 patients (46,7%) with MTWA(−), and Group 2 – 65 patients (53,2%) with MTWA(+). In order to stratify the risk, the following were adopted as composite primary endpoints: sudden cardiac death or hospitalization for life-threatening arrhythmias (VT/VF), and appropriate ICD discharge.
Results
The mean follow-up period of the patients was 57±8 months; during that time, events that met the criteria for the endpoint occurred in 16 patients. On the basis of univariate analysis, 10 variables with a significant influence on the occurrence of an event were selected (unexplained syncope, NT-proBNP values elevated above 411 pg/ml, size of the left atrium over 44mm, diastolic thickness of the interventricular septum over 25 mm, the presence of MTWA(+), the QRS width >90 msec, QTc >467 msec, QTd >70 msec, SDNN <110 msec, and sinus rhythm turbulence parameters TS <2,9 ms/2RR). These variables were then included in a multivariate analysis. The model from a Cox regression analysis showed that the presence of unexplained syncope (HR=1,4), MTWA(+) (HR=1,5), size of the left atrium over 44mm (HR=5), and the thickness of the interventricular septum over 25 mm (HR=1,5) increased the risk of sudden events.
Conclusions
1) Patients with hypertrophic cardiomyopathy had a significant percentage of positive results of the microvolt T-wave alternans test (MTWA+), 2) Positive MTWA test result in patients with hypertrophic cardiomyopathy can help to identify patients at risk of sudden cardiac death.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- M Pawlak
- Bieganski Hospital, Cardiology, Lodz, Poland
| | - E Trzos
- Bieganski Hospital, Cardiology, Lodz, Poland
| | - M Kurpesa
- Bieganski Hospital, Cardiology, Lodz, Poland
| |
Collapse
|
16
|
Pawlak M, Newman M, Beaux AD, Tulloh B. 321 The Darn Technique for Small (< 2 Cm Diameter) Midline Hernias. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.586] [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: 11/12/2022]
Abstract
Abstract
Aim
Primary midline hernias arising in the linea alba are common. While mesh repair has been shown to reduce recurrence rates even in small hernias, many surgeons still use a suture repair for defects of less than 2 cm. The recent European and Americas Hernia Societies Guidelines recommended suture repair only for hernias <1 cm. A darn is a tension-free repair where, in effect, a “mesh” is hand-woven across the defect in situ.
Method
Eligible patients undergoing this repair between 1 January 2008 and 31 December 2017 were identified from a prospective computer-based medical record system and their case notes reviewed. Inclusion criteria were adult patients with a primary midline abdominal wall defect smaller than 2 cm at the widest point measured intra-operatively. Follow up was by telephone. Those who reported possible recurrence or other symptoms in the region of their repair were reviewed in person.
Results
47 suture-darn repairs were undertaken. Fifteen operations (32%) were performed under local anaesthesia. Forty-one patients were followed up with a mean of 80 ± 35 and median of 87 months after surgery. Six patients (13%) were lost to follow-up. Recurrence was found in two cases (5%) and one patient has since been diagnosed with a new epigastric hernia some 5 cm cranial to the previous repair.
Conclusions
The darn repair for small primary midline hernias is quick and inexpensive with promising long-term results. It can be performed under local anaesthesia. It can serve as an alternative to mesh repair for defects less than 2 cm in maximum dimension.
Collapse
Affiliation(s)
- M Pawlak
- North Devon Comperhensive Hernia Centre, Barnstaple, United Kingdom
| | - M Newman
- Upper GI Surgery Department, Edinburgh, United Kingdom
| | - A. De Beaux
- Upper GI Surgery Department, Edinburgh, United Kingdom
| | - B Tulloh
- Upper GI Surgery Department, Edinburgh, United Kingdom
| |
Collapse
|
17
|
Pawlak M, East B, de Beaux AC. Algorithm for management of an incarcerated inguinal hernia in the emergency settings with manual reduction. Taxis, the technique and its safety. Hernia 2021; 25:1253-1258. [PMID: 34036484 PMCID: PMC8147903 DOI: 10.1007/s10029-021-02429-1] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 05/11/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND An acute inguinal hernia remains a common emergency surgical condition worldwide. While emergency surgery has a major role to play in treatment of acute hernias, not all patients are fit for emergency surgery, nor are facilities for such surgery always available. Taxis is the manual reduction of incarcerated tissues from the hernia sack to its natural compartment, and can help delay the need for surgery from days to months. The aim of this study was to prepare a safe algorithm for performing manual reduction of incarcerated inguinal hernias in adults. METHODS Medline, Scopus, Ovid and Embase were searched for papers related to emergency inguinal hernias and manual reduction. In addition, the British National Formulary and Safe Sedation Practice for Healthcare Procedures: Standards and Guidance were reviewed. RESULTS A safe technique of manual reduction of an acute inguinal hernia, called GPS (Gentle, Prepared and Safe) Taxis, is described. It should be performed within 24 h from the onset of a painful irreducible lump in groin, and when concomitant symptoms and signs of bowel strangulation are absent. Conscious sedation guidelines should be followed. The most popular drug combination is of intravenous morphine and short-acting benzodiazepine, both titrated carefully for optimal and safe effect. The dose of drugs must be individualised, and the smallest effective dosage should be used to avoid oversedation. Following successful taxis, the patient should undergo a short period of observation. Urgent surgery can be undertaken during the same admission or up to several weeks later. CONCLUSIONS Taxis is a benign/non-invasive method for patients with an acute, non-strangulated inguinal hernias. It likely reduces the risk and complications of anaesthesia and surgery in the emergency settings. GPS Taxis should be considered as first line treatment in the majority of patients presenting with an acute inguinal hernia when existing bowel infarction is unlikely.
Collapse
Affiliation(s)
- M Pawlak
- Comprehensive Hernia Centre, North Devon District Hospital, Raleigh Heights, Barnstaple, EX31 4JB, UK.
| | - B East
- 3rd Department of Surgery at 1st Faculty of Medicine at Charles University, Motol University Hospital, Prague, Czech Republic
- 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | | |
Collapse
|
18
|
Heinrich L, Haufe E, Abraham S, Heratizadeh A, Harder I, Kleinheinz A, Wollenberg A, Weisshaar E, Wiemers F, Ertner K, Schäkel K, Augustin M, Wildberger J, von Kiedrowski R, Zink A, Pawlak M, Worm M, Sticherling M, Effendy I, Hilgers M, Quist S, Asmussen A, Handrick C, Bell M, Staubauch-Renz P, Schwarz B, Hong-Weldemann SH, Homey B, Werfel T, Weidinger S, Schmitt J. Einschätzung der Erkrankungsschwere der Neurodermitis durch Ärzte und Patienten in Abhängigkeit vom Geschlecht: Ergebnisse aus dem Deutschen Neurodermitisregister TREATgermany+. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- L Heinrich
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, TU Dresden
| | - E Haufe
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, TU Dresden
| | - S Abraham
- Universitäts AllergieCentrum Dresden, Klinik für Dermatologie, Universitätsklinikum Carl Gustav Carus
| | - A Heratizadeh
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover
| | - I Harder
- Zentrum für Entzündliche Hauterkrankungen, Klinik für Dermatologie und Allergologie, Universitäts-klinikum Schleswig-Holstein, Campus Kiel
| | | | - A Wollenberg
- Klinik und Poliklinik für Dermatologie und Allergologie, LMU München
| | - E Weisshaar
- Berufsdermatologie, Klinik für Dermatologie, Universität Heidelberg
| | - F Wiemers
- Praxis Dr. Ulrike Wiemers/Dr. Franca Wiemers
| | | | - K Schäkel
- Klinik für Dermatologie, Universität Heidelberg
| | - M Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf
| | | | | | - A Zink
- Klinik für Dermatologie und Allergologie, TU München & Zentrum für Umweltmedizin GmbH
| | - M Pawlak
- Praxis Dr. Anika Hünermund, Mario Pawlak
| | - M Worm
- Klinik für Dermatologie, Venerologie und Allergologie, Charité Berlin
| | - M Sticherling
- Klinik für Dermatologie, Universität Erlangen-Nürnberg
| | - I Effendy
- Klinik für Dermatologie, Klinikum Rosenhöhe
| | - M Hilgers
- Universitätsklinikum Aachen, Uniklinik RWTH Aachen
| | | | - A Asmussen
- Praxis Dr. Andrea Asmussen, Dermatologie an der Lesum
| | | | - M Bell
- Praxis Dr. Magnus Bell, Thomas Kaiser
| | - P Staubauch-Renz
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Mainz
| | | | | | - B Homey
- Klinik für Dermatologie, Universität Düsseldorf
| | - T Werfel
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover
| | - S Weidinger
- Zentrum für Entzündliche Hauterkrankungen, Klinik für Dermatologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - J Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, TU Dresden
| | | |
Collapse
|
19
|
Helmert C, Haufe E, Abraham S, Heratizadeh A, Harder I, Kleinheinz A, Wollenberg A, Wiemers F, Weisshaar E, Augustin M, von Kiedrowski R, Wildberg J, Pawlak M, Hilgers M, Worm M, Schäkel K, Sticherling M, Effendy I, Staubach-Renz P, Handrick C, Bell M, Asmussen A, Schwarz B, Werfel T, Weidinger S, Schmitt J. Fatigue und Neurodermitis: Ergebnisse aus dem deutschen Neurodermitisregister TREATgermany. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C Helmert
- Zentrum für evidenzbasierte Gesundheitsversorgung, Medizinische Fakultät Carl Gustav Carus, TU Dresden
| | - E Haufe
- Zentrum für evidenzbasierte Gesundheitsversorgung, Medizinische Fakultät Carl Gustav Carus, TU Dresden
| | - S Abraham
- UniversitätsAllergieZentrum, Klinik für Dermatologie, Universitätsklinikum Carl Gustav Carus
| | - A Heratizadeh
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover
| | - I Harder
- Zentrum für entzündliche Hauterkrankungen an der Klinik für Dermatologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | | | - A Wollenberg
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München
| | | | - E Weisshaar
- Berufsdermatologie, Universitätsklinikum Heidelberg
| | - M Augustin
- Institut für Versorgugnsforschung in der Dermatologie und Pflegeberufe, Universitätsklinikum Hamburg-Eppendorf
| | - R von Kiedrowski
- CMSS - Company for Medical Study and Service Selters, Dermatologische Spezialpraxis
| | | | | | - M Hilgers
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Aachen
| | - M Worm
- Klinik für Dermatologie, Venerologie und Allergologie, Charité Universitätsmedizin Berlin
| | | | | | - I Effendy
- Hautklinik, Klinikum Bielefeld Rosenhöhe
| | - P Staubach-Renz
- Universitätshautklinik und poliklinik, Universitätsmedizin Mainz
| | - C Handrick
- Praxis, für Haut- und Geschlechtskrankheiten
| | | | | | - B Schwarz
- Praxis, Dermatologie und Allergologie
| | - T Werfel
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover
| | - S Weidinger
- Zentrum für entzündliche Hauterkrankungen an der Klinik für Dermatologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - J Schmitt
- Zentrum für evidenzbasierte Gesundheitsversorgung, Medizinische Fakultät Carl Gustav Carus, TU Dresden
| |
Collapse
|
20
|
Maciejewska-Skrendo A, Pawlak M, Leońska-Duniec A, Jurewicz A, Kaczmarczyk M, Cięszczyk P, Leźnicka K. Can Injuries Have a Lasting Effect on the Perception of Pain in Young, Healthy Women and Men? Sports Health 2020; 13:278-284. [PMID: 33320785 DOI: 10.1177/1941738120953165] [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] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pain is a characteristic, unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is a subjective sensation, modulated by many factors such as age, sex, emotional state, national origin, or physical activity. Moreover, it is closely associated with intense physical activity, injuries, and traumas, which can significantly modulate pain tolerance. HYPOTHESIS We postulate that there are correlations between past injuries, physical activity, and intensity of pain perception (pain threshold and pain tolerance) in a population of healthy men and women. STUDY DESIGN Retrospective cohort study. LEVEL OF EVIDENCE Level 4. METHODS A total of 302 participants aged 18 to 32 years were included. The participants were divided into 2 groups (active and inactive individuals), in accordance with the scope of physical activity they had indicated. The test of pressure pain threshold and pressure pain tolerance was performed using an algometer. RESULTS Active women achieved significantly higher pain threshold and pain tolerance values in all measurements on the upper limb (except for the pain threshold on the left hand) compared with inactive women. In mediation analysis, the effect of injury remained significant only for the pressure pain tolerance in the dominant arm and the left hand in the female group. In the case of men, there were no significant differences in all measurements in view of the threshold and tolerance for pain between the groups of active and inactive and between men with injuries and without injuries. CONCLUSION Intense, regular physical activity is a factor modulating the perception of pain. This was demonstrated as lowered sensitivity to pain stimuli in a population of healthy women. CLINICAL RELEVANCE Injuries should be treated as an important factor modulating the perception of pain. We recommend detailed monitoring of injuries during treatment and control of pain sensation.
Collapse
Affiliation(s)
| | - Maciej Pawlak
- Department of Biochemistry, Poznań University of Physical Education, Poznań, Poland
| | - Agata Leońska-Duniec
- Department of Physical Education, Academy of Physical Education and Sport in Gdansk, Gdansk, Poland
| | - Alina Jurewicz
- Department of Orthopaedics, Traumatology and Orthopaedic Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Mariusz Kaczmarczyk
- Department of Physical Education, Academy of Physical Education and Sport in Gdansk, Gdansk, Poland
| | - Paweł Cięszczyk
- Department of Physical Education, Academy of Physical Education and Sport in Gdansk, Gdansk, Poland
| | - Katarzyna Leźnicka
- Department of Physical Education, Academy of Physical Education and Sport in Gdansk, Gdansk, Poland
| |
Collapse
|
21
|
Pawlak M, Newman M, de Beaux AC, Tulloh B. The darn technique for small (< 2 cm diameter) midline hernias. Hernia 2020; 25:625-630. [PMID: 32876796 DOI: 10.1007/s10029-020-02283-7] [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: 05/05/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Primary midline hernias arising in the linea alba are common. While mesh repair has been shown to reduce recurrence rates even in small hernias, many surgeons still use a suture repair for defects of less than 2 cm. The recent European and Americas Hernia Societies Guidelines recommended suture repair only for hernias smaller than 1 cm. A suture repair implies edge-to-edge or overlapping fascial margins, which necessarily involves tension on the repair. A darn is a tension-free repair where, in effect, a "mesh" is hand-woven across the defect in situ. METHODS The darn repair is a modification of the darn techniques for inguinal hernia repair. Eligible patients undergoing this repair at the Royal Infirmary of Edinburgh between 1 January 2008 and 31 December 2017 were identified from a prospective computer-based medical record system and their case notes reviewed. Inclusion criteria were adult patients with a primary midline abdominal wall defect smaller than 2 cm in the widest diameter of the hernia defect measured intra-operatively. Patients were followed up by telephone in 2019. Those who reported possible recurrence or other symptoms in the region of their hernia repair were reviewed in the outpatient clinic. RESULTS 47 suture-darn repairs were undertaken over the 10-year period. Fifteen of the darn repair operations (32%) were performed under local anaesthesia. Forty-one patients were followed up with a mean of 80 ± 35 and median of 87 months after surgery. Six patients (13%) were lost to follow-up. Recurrence was found in two cases (5%) and one patient has since been diagnosed with a new epigastric hernia some 5 cm cranial to the previous repair. CONCLUSIONS The darn repair for small primary midline hernias is quick and inexpensive with promising long-term results. It can be performed under local anaesthesia. It can serve as an alternative to mesh repair for defects less than 2 cm in maximum dimension.
Collapse
Affiliation(s)
- M Pawlak
- North Devon Comperhensive Hernia Centre, North Devon District Hospital, Barnstaple, UK.
| | - M Newman
- Upper GI Surgery Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A C de Beaux
- Upper GI Surgery Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - B Tulloh
- Upper GI Surgery Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
22
|
Jensen KK, Pawlak M, Gök H, East B, de Beaux AC. #herniasurgery on the #SoMe platform Twitter: the importance of communication in science. Hernia 2020; 26:373-374. [PMID: 32767181 DOI: 10.1007/s10029-020-02277-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/22/2020] [Indexed: 11/26/2022]
Affiliation(s)
- K K Jensen
- European Hernia Society Social Media Advisory Board, Madrid, Spain
- Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, Denmark
| | - M Pawlak
- European Hernia Society Website Advisory Board, Madrid, Spain
- Northern Devon Healthcare NHS Trust, Barnstaple, UK
| | - H Gök
- European Hernia Society Social Media Advisory Board, Madrid, Spain
- Hernia Istanbul®, Sisli, Istanbul, Turkey
| | - B East
- European Hernia Society Website Advisory Board, Madrid, Spain.
- 3rd Department of Surgery, Motol University Hospital, Prague, Czech Republic.
- 1st Faculty of Medicine, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - A C de Beaux
- European Hernia Society Social Media Advisory Board, Madrid, Spain
- Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
23
|
Kamińska J, Podgórski T, Kryściak J, Pawlak M. Effect of Simulated Matches on Post-Exercise Biochemical Parameters in Women's Indoor and Beach Handball. Int J Environ Res Public Health 2020; 17:ijerph17145046. [PMID: 32674282 PMCID: PMC7400244 DOI: 10.3390/ijerph17145046] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/03/2020] [Accepted: 07/10/2020] [Indexed: 11/16/2022]
Abstract
This study assesses the status of hydration and the acid-base balance in female handball players in the Polish Second League before and after simulated matches in both indoor (hall) and beach (outdoor) conditions. The values of biochemical indicators useful for describing water-electrolyte management, such as osmolality, hematocrit, aldosterone, sodium, potassium, calcium, chloride and magnesium, were determined in the players’ fingertip capillary blood. Furthermore, the blood parameters of the acid-base balance were analysed, including pH, standard base excess, lactate and bicarbonate ion concentration. Additionally, the pH and specific gravity of the players’ urine were determined. The level of significance was set at p < 0.05. It was found that both indoor and beach simulated matches caused post-exercise changes in the biochemical profiles of the players’ blood and urine in terms of water-electrolyte and acid-base balance. Interestingly, the location of a simulated match (indoors vs. beach) had a statistically significant effect on only two of the parameters measured post-exercise: concentration of calcium ions (lower indoors) and urine pH (lower on the beach). A single simulated game, regardless of its location, directly affected the acid-base balance and, to a smaller extent, the water-electrolyte balance, depending mostly on the time spent physically active during the match.
Collapse
|
24
|
Heratizadeh A, Haufe E, Stölzl D, Abraham S, Heinrich L, Kleinheinz A, Wollenberg A, Weisshaar E, Augustin M, Wiemers F, Zink A, von Kiedrowski R, Hilgers M, Worm M, Pawlak M, Sticherling M, Fell I, Handrick C, Schäkel K, Staubach-Renz P, Asmussen A, Schwarz B, Bell M, Effendy I, Bieber T, Homey B, Gerlach B, Tchitcherina E, Stahl M, Schwichtenberg U, Rossbacher J, Buck P, Mempel M, Beissert S, Biedermann T, Weidinger S, Schmitt J, Werfel T. Baseline characteristics, disease severity and treatment history of patients with atopic dermatitis included in the German AD Registry TREATgermany. J Eur Acad Dermatol Venereol 2020; 34:1263-1272. [PMID: 31721316 DOI: 10.1111/jdv.16078] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/17/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND The Atopic Dermatitis (AD) TREATgermany registry was initiated by the German Society for Dermatology (DDG) in 2011 to evaluate the 'real-life' situation of health care for patients with AD. OBJECTIVES Interim data analysis on baseline characteristics as well as current and prescribed systemic treatments of the TREATgermany registry patients. METHODS Patients (≥18 years) with moderate-to-severe AD [objective (o)SCORAD > 20], or with current or previous anti-inflammatory systemic treatment for AD within 24 months, were included and are followed up over at least 24 months. To assess clinical signs, the eczema area severity index (EASI, 0-72), the oSCORAD (0-83) and the Investigator Global Assessment (IGA; 6-point scale) were used. The disease severity was globally scored by the patients [Patient Global Assessment (PGA); six-step Likert scale]. Disease symptoms were assessed by the patient-oriented eczema measure (POEM, 0-28) and numeric rating scales (NRS, 0-10). Health-related quality of life was measured using the dermatological life quality index (DLQI, 0-30). RESULTS A total of 612 patients were recruited across 32 sites between 06/2016 and 01/2019 (mean age: 42.6 ± 14.2 years; mean oSCORAD: 40.8 ± 16.3). The mean POEM score was 16.3 ± 7.5. Pruritus was rated highest among subjective symptoms (NRS: 5.4 ± 2.7). The mean DLQI value was 11.3 ± 7.5. The frequency of arterial hypertension was lower (20.8%) compared with the general population, whilst this was higher for depression (10%). More than 60% of the patients had received systemic glucocorticosteroids, and 36.8% had received cyclosporine A prior to inclusion. Dupilumab was the leading substance documented as either 'current' (12.1%) or 'prescribed' (31.4%) at baseline. CONCLUSIONS These 'real-life' data clearly demonstrate the substantial disease burden. Most of TREATgermany patients were already treated with or prescribed dupilumab at baseline. Moreover, current findings indicate the urgent need for further alternative agents in order to achieve a perceptible improvement of quality of life of patients with moderate-to-severe AD.
Collapse
Affiliation(s)
- A Heratizadeh
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - E Haufe
- Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - D Stölzl
- Department of Dermatology and Allergy, Center for Inflammatory Skin Diseases, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - S Abraham
- Department of Dermatology, University Allergy Center, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - L Heinrich
- Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - A Kleinheinz
- Clinics for Dermatology, Elbe Klinikum Buxtehude, Buxtehude, Germany
| | - A Wollenberg
- Clinics and Outpatient Clinics for Dermatology and Allergy, LMU Munich, Munich, Germany
| | - E Weisshaar
- Occupational Dermatology, Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - M Augustin
- Insitute for Health Services Research in Dermatology Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - F Wiemers
- Practice Dr. med. Franca Wiemers, Leipzig, Germany
| | - A Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Clinical Unit Allergology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Munich, Germany
| | - R von Kiedrowski
- CMSS - Company for Medical Study and Service, Selters/Westerwald, Germany
| | - M Hilgers
- Clinics for Dermatology and Allergy, University Hospital Aachen, Aachen, Germany
| | - M Worm
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - M Pawlak
- Practice Dr. med. Anika Hünermund and Mario Pawlak, Heilbad Heiligenstadt, Germany
| | - M Sticherling
- Department of Dermatology, University Hospital, Friedrich Alexander University Erlangen-Nurnberg, Erlangen, Germany
| | - I Fell
- Hautmedizin Bad Soden, Bad Soden, Germany
| | - C Handrick
- Practice Dr. med. Christiane Handrick, Berlin, Germany
| | - K Schäkel
- Department of Dermatology, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - P Staubach-Renz
- Department of Dermatology and Allergy, University Medical Center Mainz, Mainz, Germany
| | - A Asmussen
- Practice Dermatologie an der Lesum, Bremen, Germany
| | - B Schwarz
- Practice Dr. med. Beate Schwarz, Langenau, Germany
| | - M Bell
- Practice Dr. Magnus Bell, Thomas Kaiser, Andernach, Germany
| | - I Effendy
- Department of Dermatology, Hospital Rosenhoehe, Bielefeld, Germany
| | - T Bieber
- Department of Dermatology and Allergy, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - B Homey
- Department of Dermatology, Heinrich-Heine-University Duesseldorf, Düsseldorf, Germany
| | - B Gerlach
- Practice Dr. med. Beatrice Gerlach, Dresden, Germany
| | - E Tchitcherina
- Practice Dr. med. Ekaterina Tchitcherina, Friedberg/Hessen, Germany
| | - M Stahl
- Practice Dr. med. Maren Stahl, Osterode, Germany
| | | | | | - P Buck
- Goldbek Medical, Hamburg, Germany
| | - M Mempel
- Practice Prof. Dr. med. Martin Mempel, Elmshorn, Germany
| | - S Beissert
- Department of Dermatology, University Allergy Center, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - T Biedermann
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Clinical Unit Allergology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Munich, Germany
| | - S Weidinger
- Department of Dermatology and Allergy, Center for Inflammatory Skin Diseases, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J Schmitt
- Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - T Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | | |
Collapse
|
25
|
Abraham S, Haufe E, Harder I, Heratizadeh A, Kleinheinz A, Wollenberg A, Weisshaar E, Augustin M, Wiemers F, Zink A, Biedermann T, von Kiedrowski R, Hilgers M, Worm M, Pawlak M, Sticherling M, Fell I, Handrick C, Schäkel K, Staubach P, Asmussen A, Schwarz B, Bell M, Neubert K, Effendy I, Bieber T, Homey B, Gerlach B, Tchitcherina E, Stahl M, Schwichtenberg U, Rossbacher J, Buck P, Mempel M, Beissert S, Werfel T, Weidinger S, Schmitt J. Implementation of dupilumab in routine care of atopic eczema: results from the German national registry TREATgermany. Br J Dermatol 2020; 183:382-384. [PMID: 32068242 DOI: 10.1111/bjd.18958] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- S Abraham
- Department of Dermatology, University Allergy Center, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - E Haufe
- Center of Evidence-Based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - I Harder
- Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Heratizadeh
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - S Beissert
- Department of Dermatology, University Allergy Center, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - T Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - S Weidinger
- Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J Schmitt
- Center of Evidence-Based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | |
Collapse
|
26
|
Abstract
BACKGROUND Mesh is recommended for the repair of most hernias when prevention of recurrence is the primary endpoint. However, mesh may be associated with increased complications for the patient. The aim of this study was to quantify the use of mesh for abdominal wall hernia surgery in NHS England in recent years. MATERIALS AND METHODS The NHS Digital Secondary Uses Service database for 2016/17 and 2017/18 was interrogated for numbers of patient undergoing elective primary hernia surgery. Using the specific hernia code inguinal (T201-9), umbilical (T241-9), incisional (T251-9) and other abdominal wall hernia (T271-9), the use of mesh or suture repair was determined. Recurrent and emergency hernia surgery were excluded. All data were provided by NHS RightCare. RESULTS There are almost 100,000 hernia repairs performed annually in NHS England. For every four hernias, three are repaired with mesh. The percentage repaired by mesh varies by hernia type. Mesh repairs in inguinal, umbilical and incisional hernias accounted for 95%, 50% and 82%, respectively. CONCLUSIONS Mesh repair for all hernia types is more common than suture repair. However, for umbilical and other abdominal wall hernias, a significant proportion are repaired without the use of mesh.
Collapse
Affiliation(s)
- M Pawlak
- General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - B Tulloh
- General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A de Beaux
- General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
27
|
|
28
|
Brzeziński M, Sejda A, Pęksa R, Pawlak M, Bury K, Adamiak Z, Kowalik M, Jagielak D, Bartus K, Hołda MK, Litwinowicz R, Rogowski J. Evaluation of Local Tissue Reaction After the Application of a 3D Printed Novel Holdfast Device for Left Atrial Appendage Exclusion. Ann Biomed Eng 2019; 48:133-143. [PMID: 31309369 PMCID: PMC6928093 DOI: 10.1007/s10439-019-02320-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/04/2019] [Indexed: 12/16/2022]
Abstract
The left atrial appendage (LAA) is a small, finger-like extension of the left atrium and its exclusion is used as a treatment strategy to prevent ischemic stroke. Existing holdfast devices may damage the tissue, are unisized and not adjustable. A novel holdfast device for LAA exclusion devoid of these shortcomings was designed and 3D-printed using the Selective Laser Sintering (SLS) technology with polyamide powder and tested it on animal model. We selected the SLS 3D printing technology due to its wid14e availability and low production costs which could provide on-site 3D printing for specific patient. The purpose of this study was to evaluate the biocompatibility of the reported holdfast device and compare the histological results obtained for local tissue reactions to those obtained for an established grafting material. Thirty swine subdivided into two groups were examined. The LAA exclusion device was implanted and was either coated with a polyester vascular implant or not coated at all and the histological response to the device’s presence was evaluated which is a standard approach to test the device biocompatibility. In all cases, complete occlusion was seen without any pathological findings during the incubation time. In both groups, the surface of the atrium under a holdfast device was smooth and shiny and had no clots. The foreign body reaction of the LAA holdfast device made of polyamide powder was insignificantly lower compared to the polyester graft. Thus, it fulfils the parameters of biocompatibility at the highest degree, and makes it suitable material for the manufacturing of LAA holdfast devices.
Collapse
Affiliation(s)
- Maciej Brzeziński
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Aleksandra Sejda
- Department of Pathomorphology, Medical University of Gdansk, Gdańsk, Poland
| | - Rafał Pęksa
- Department of Pathomorphology, Medical University of Gdansk, Gdańsk, Poland
| | - Maciej Pawlak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Kamil Bury
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Zbigniew Adamiak
- Department of Surgery and Roentgenology, Faculty of Veterinary Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Maciej Kowalik
- Department of Anesthesiology and Intensive Care, Medical University of Gdansk, Gdańsk, Poland
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz K Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Kraków, Poland.
| | - Radoslaw Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Kraków, Poland
| | - Jan Rogowski
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| |
Collapse
|
29
|
Pawlak M, Ramza K, Streza M. Simultaneously Mapping of In-Depth Thermal Diffusivity and Effective Infrared Absorption Coefficient of Silicon-Doped Gallium Arsenide Wafer Using Lock-in Thermography. ANAL LETT 2019. [DOI: 10.1080/00032719.2017.1405966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M. Pawlak
- Institute of Physics, Nicolaus Copernicus University, Torun, Poland
| | - K. Ramza
- Institute of Physics, Nicolaus Copernicus University, Torun, Poland
| | - M. Streza
- Department of Molecular and Biomolecular Physics, National Institute for R&D of Isotopic and Molecular Technologies, Cluj Napoca, Romania
| |
Collapse
|
30
|
de Beaux AC, Pawlak M, East B, Gok H. Guidelines in hernia surgery – friend or foe. Int J Abdom Wall Hernia Surg 2019. [DOI: 10.4103/ijawhs.ijawhs_28_19] [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] Open
|
31
|
Willibald M, Stahlhut V, Kessler N, Stamm N, Gierke B, Pawlak M, Fehm T, Neubauer H. PGRMC1 promotes tumour progression of breast cancer by upregulating of ERα expression and EGFR signalling. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- M Willibald
- Universitätsklinikum Düsseldorf, Klinik für Frauenheilkunde und Geburtshilfe, Düsseldorf, Deutschland
| | - V Stahlhut
- Universitätsklinikum Düsseldorf, Klinik für Frauenheilkunde und Geburtshilfe, Düsseldorf, Deutschland
| | - N Kessler
- Universitätsklinikum Düsseldorf, Klinik für Frauenheilkunde und Geburtshilfe, Düsseldorf, Deutschland
| | - N Stamm
- Universitätsklinikum Düsseldorf, Klinik für Frauenheilkunde und Geburtshilfe, Düsseldorf, Deutschland
| | - B Gierke
- NMI Natural and Medical Science Institute, Universität Tübingen, Reutlingen, Deutschland
| | - M Pawlak
- NMI Natural and Medical Science Institute, Universität Tübingen, Reutlingen, Deutschland
| | - T Fehm
- Universitätsklinikum Düsseldorf, Klinik für Frauenheilkunde und Geburtshilfe, Düsseldorf, Deutschland
| | - H Neubauer
- Universitätsklinikum Düsseldorf, Klinik für Frauenheilkunde und Geburtshilfe, Düsseldorf, Deutschland
| |
Collapse
|
32
|
Strzemieczna M, Imiela J, Pawlak M. 3.10-P4How medical institutions in Masovia region in Poland are prepared for serving foreigners - systemic and non-systemic solutions. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Strzemieczna
- Institute of Social Nursing, Medical University of Warsaw, Poland
| | - J Imiela
- Institute of Social Nursing, Medical University of Warsaw, Poland
| | - M Pawlak
- Institute of Social Prevention and Resocialisation, University of Warsaw, Poland
| |
Collapse
|
33
|
Leźnicka K, Starkowska A, Tomczak M, Cięszczyk P, Białecka M, Ligocka M, Żmijewski P, Pawlak M. Temperament as a modulating factor of pain sensitivity in combat sport athletes. Physiol Behav 2017; 180:131-136. [DOI: 10.1016/j.physbeh.2017.08.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 08/08/2017] [Accepted: 08/23/2017] [Indexed: 11/24/2022]
|
34
|
Niebuhr H, König A, Pawlak M, Sailer M, Köckerling F, Reinpold W. Groin hernia diagnostics: dynamic inguinal ultrasound (DIUS). Langenbecks Arch Surg 2017; 402:1039-1045. [PMID: 28812139 DOI: 10.1007/s00423-017-1604-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 01/04/2017] [Accepted: 07/10/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Although clinical examination is the gold standard for the diagnosis of groin hernia, imaging procedures can improve the detection of femoral hernias, incipient hernias, and less-common types of hernias (e.g., an obturator hernia). The aim of this study is to evaluate the sensitivity and specificity of dynamic inguinal ultrasound (DIUS). MATERIALS AND METHODS Between July 2010 and June 2015, 4951 clinical and ultrasound examinations of the groin area were conducted at the Hanse-Hernienzentrum in Hamburg, Germany. The ultrasonographic findings were prospectively evaluated to determine the number of inguinal and femoral hernia diagnoses that were ultrasonically confirmed and also to consider cases in which clinical examination overlooked these diagnoses. The results were compared with the intraoperative findings. RESULTS The results show that standardized ultrasound examination of the groin area with high-frequency, small-part linear transducers also serves to accurately display femoral and small or occult groin hernias. The high-level specificity (0.9980) and sensitivity (0.9758) are proof of the procedure's quality. CONCLUSIONS To ensure high-quality hernia treatment, regular use of standardized ultrasound examinations is recommended.
Collapse
Affiliation(s)
- Henning Niebuhr
- Hanse-Hernienzentrum Hamburg, Alte Holstenstrasse 16, 21031, Hamburg, Germany.
| | - Anita König
- Abteilung für Anästhesiologie und Operative Intensivmedizin, Bethesda Krankenhaus Bergedorf, Glindersweg 80, 21029, Hamburg, Germany
| | - Maciej Pawlak
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Marco Sailer
- Klinik für Chirurgie, Bethesda Krankenhaus Bergedorf, Glindersweg 80, 21029, Hamburg, Germany
| | - Ferdinand Köckerling
- Vivantes Klinikum Spandau, Klinik für Chirurgie-Visceral- und Gefäßchirurgie, Neue Bergstraße 6, 13585, Berlin, Germany
| | - Wolfgang Reinpold
- Chirurgische Abteilung, Wilhelmsburger Krankenhaus Groß-Sand, Groß-Sand 3, 21107, Hamburg, Germany
| |
Collapse
|
35
|
Maurer M, Staubach P, Raap U, Richter-Huhn G, Bauer A, Ruëff F, Jakob T, Yazdi AS, Mahler V, Wagner N, Lippert U, Hillen U, Schwinn A, Pawlak M, Behnke N, Chaouche K, Chapman-Rothe N. H1-antihistamine-refractory chronic spontaneous urticaria: it's worse than we thought - first results of the multicenter real-life AWARE study. Clin Exp Allergy 2017; 47:684-692. [PMID: 28160338 DOI: 10.1111/cea.12900] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/05/2016] [Accepted: 01/12/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most data on chronic spontaneous urticaria (CSU) originate from highly selected patient populations treated at specialized centres. Little is known about CSU patient characteristics and the burden of CSU in routine clinical practice. AWARE (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) is an ongoing global study designed to assess chronic urticaria in the real-life setting. OBJECTIVE To describe the baseline characteristics of the first 1539 German AWARE patients with H1-antihistamine-refractory CSU. METHODS This prospective non-interventional study included patients (18-75 years) with a diagnosis of H1-antihistamine-refractory CSU for > 2 months. Baseline demographic and disease characteristics, comorbidities, and pharmacological treatments were recorded. Quality of life (QoL) was assessed using the dermatology life quality index (DLQI), chronic urticaria QoL questionnaire (CU-Q2 oL), and angioedema QoL questionnaire (AE-QoL, in cases of angioedema). Previous healthcare resource utilization and sick leave data were collected retrospectively. RESULTS Between March and December 2014, 1539 patients were assessed in 256 sites across Germany. The percentage of females, mean age, and mean body mass index were 70%, 46.3 years, and 27 kg/m2 , respectively. The mean urticaria control test score was 7.9, one in two patients had angioedema, and the most frequent comorbidities were chronic inducible urticaria (CIndU; 24%), allergic rhinitis (18.2%), hypertension (18.1%), asthma (12%), and depression (9.5%). Overall, 57.6% of patients were receiving at least one pharmacological treatment including second-generation H1-antihistamines (46.3%), first-generation H1-antihistamines (9.1%), and corticosteroids (15.8%). The mean DLQI, total CU-Q2 oL, and total AE-QoL scores were 8.3, 36.2, and 46.8, respectively. CSU patients reported frequent use of healthcare resources, including emergency services (29.7%), general practitioners (71.9%), and additional allergists or dermatologists (50.7%). CONCLUSIONS AND CLINICAL RELEVANCE This study reveals that German H1-antihistamine-refractory CSU patients have high rates of uncontrolled disease, angioedema, and comorbid CIndU, are undertreated, have impaired QoL, and rely heavily on healthcare resources.
Collapse
Affiliation(s)
- M Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - P Staubach
- Department of Dermatology, University Hospital Mainz, Mainz, Germany
| | - U Raap
- Department of Dermatology and Allergy, Klinikum Oldenburg AöR, University of Oldenburg, Oldenburg, Germany
| | | | - A Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - F Ruëff
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - T Jakob
- Department of Dermatology and Allergology, Justus Liebig University, University Medical Center Gießen and Marburg, Gießen, Germany.,Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany
| | - A S Yazdi
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - V Mahler
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - N Wagner
- Department of Dermatology, Clinical Centre Darmstadt, Darmstadt, Germany
| | - U Lippert
- Department of Dermatology, Venereology and Allergology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - U Hillen
- Department of Dermatology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - A Schwinn
- Praxis für Dermatologie, Memmingen, Germany
| | - M Pawlak
- Hautarztpraxis, Heilbad Heiligenstadt, Germany
| | - N Behnke
- Hautarztpraxis, Panketal, Germany
| | | | | |
Collapse
|
36
|
Abstract
The new worldwide guidelines of all international hernia societies only recommend the mesh-based methods TEP, TAPP and Lichtenstein. The best mesh-free technique, the Shouldice operation, should only be used if the patient has declined the use of a mesh or no mesh is available. The systematic use of the Shouldice technique for smaller inguinal hernias and younger men should be confined to study settings. A tailored approach should be taken for mesh-based procedures to minimize the risk to patients. Due to lower pain rates the laparoendoscopic techniques TEP and TAPP are the methods of choice for primary male unilateral inguinal hernia. They are also preferred for female patients as they improve the diagnostics of femoral hernias as well as for bilateral inguinal hernias in female and male patients. The Lichtenstein operation tends to be recommended for scrotal hernia, following previous pelvic surgery, vascular surgery, liver cirrhosis, radiotherapy and intolerance of general anesthesia. This also applies for recurrent hernia following a previous laparoendoscopic primary operation. Similarly, recurrent hernia after a primary suture or mesh procedure should be repaired using the TEP or TAPP technique. In emergency procedures for incarceration the diagnostic superiority of laparoscopy and the ability to reposition the incarcerated organs should be utilized. The inguinal hernia can then be repaired at the same time or later depending on whether there is any local infection.
Collapse
Affiliation(s)
- H Niebuhr
- Hanse-Hernia Center, Alte Holstenstraße 16, 21031, Hamburg, Deutschland.
| | - M Pawlak
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, PL-210, Gdańsk, Polen
| | - F Köckerling
- Visceral- und Gefäßchirurgie, Zentrum für Minimal Invasive Chirurgie, Vivantes Klinikum Spandau, Berlin, Deutschland
| |
Collapse
|
37
|
Bader S, Zajac M, Friess T, Ruge E, Rieder N, Gierke B, Heubach Y, Thomas M, Pawlak M. Evaluation of multiple protein profiles from treated xenograft tumor models identifies a marker panel for FFPE tissue analysis with reverse phase protein arrays. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32933-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
38
|
Walkowska A, Pawlak M, Jane SM, Kompanowska-Jezierska E, Wilanowski T. Effects of high and low sodium diet on blood pressure and heart rate in mice lacking the functional grainyhead-like 1 gene. Physiol Res 2016; 66:163-165. [PMID: 27782736 DOI: 10.33549/physiolres.933298] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Hypertension is a major health problem throughout the world because of its high prevalence and its association with increased risk of cardiovascular disease. Two independent studies discovered a locus conferring susceptibility to essential hypertension on chromosome 2, in the 2p25 region, but the causative gene remains unknown. Grainyhead-like 1 (GRHL1) is one of the genes located in this region. Our experiments determined that the Grhl1 -null mice, when fed standard diet, have the same blood pressure as their wild type littermate controls. However, we discovered that blood pressure of these mice increases following high sodium diet and decreases when they are fed low sodium diet, and similar effects were not observed in the control wild type littermates. This suggests that the Grhl1 -null mice are sensitive to the development of salt-sensitive hypertension. Thus it is possible that the GRHL1 gene is involved in the regulation of blood pressure, and it may be the causative gene for the locus of susceptibility to essential hypertension in the 2p25 region.
Collapse
Affiliation(s)
- A Walkowska
- Department of Renal and Body Fluid Physiology, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland; Laboratory of Signal Transduction, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland.
| | | | | | | | | |
Collapse
|
39
|
Schneck H, Gierke B, Uppenkamp F, Behrens B, Niederacher D, Stoecklein NH, Templin MF, Pawlak M, Fehm T, Neubauer H. Anreicherung, Isolierung und molekulare Charakterisierung EpCAM-negativer zirkulierender Tumorzellen (CTCs) beim Mammakarzinom. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
40
|
Huntsman-Mapila P, Skeaff JM, Pawlak M, Beaudoin R. Addressing aquatic hazard classification for metals, metal compounds and alloys in marine systems. Mar Pollut Bull 2016; 109:550-557. [PMID: 27289283 DOI: 10.1016/j.marpolbul.2016.03.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 06/06/2023]
Abstract
New International Maritime Organization regulations require shippers to classify all solid bulk cargo to indicate whether they are Harmful to the Marine Environment (HME). The objective of this work was to adapt the freshwater Transformation/Dissolution Protocol (T/DP) to marine water to provide a method to determine, when compared with marine Ecotoxicity Reference Values (ERVs), whether a metal-bearing substance is HME. The substances examined were: Cu2O powder; Ni metal powder; Co3O4 powder; and a Ni-Co-Fe alloy, as wire cuttings, which were the same substances examined in the freshwater T/D validation study and afforded comparisons of the reactivity, or measure of the rate and extent of metal release from the metal-bearing substances in freshwater versus marine conditions. The marine T/D method is suitable for conducting examinations of metal-bearing substances with a wide range of reactivities, from the relatively reactive Cu2O powder and the alloy to the Co3O4 powder, which was the least reactive.
Collapse
Affiliation(s)
- P Huntsman-Mapila
- Mine Closure and Ecosystem Risk Management Program, CanmetMINING, Natural Resources Canada, 555 Booth St., Ottawa K1A 0G1, Canada.
| | - J M Skeaff
- Mine Closure and Ecosystem Risk Management Program, CanmetMINING, Natural Resources Canada, 555 Booth St., Ottawa K1A 0G1, Canada.
| | - M Pawlak
- Analytical Services Group, CanmetMINING, Natural Resources Canada, 555 Booth St., Ottawa K1A 0G1, Canada.
| | - R Beaudoin
- Mine Closure and Ecosystem Risk Management Program, CanmetMINING, Natural Resources Canada, 555 Booth St., Ottawa K1A 0G1, Canada.
| |
Collapse
|
41
|
Słopień RS, Różycka AR, Słopień AS, Pawlak M, Warenik-Szymankiewicz A, Sajdak S, Jagodziński PJ. The genetic background of climacteric symptoms in women during menopause. CLIN EXP OBSTET GYN 2016. [DOI: 10.12891/ceog2076.2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
42
|
Słopień RS, Słopień AS, Pawlak M, Warenik-Szymankiewicz A, Sajdak S. Depressive symptoms’ pattern in postmenopausal women. CLIN EXP OBSTET GYN 2016. [DOI: 10.12891/ceog2087.2016] [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: 11/01/2022]
|
43
|
Kaczmarek D, Łochyński D, Everaert I, Pawlak M, Derave W, Celichowski J. Role of histidyl dipeptides in contractile function of fast and slow motor units in rat skeletal muscle. J Appl Physiol (1985) 2016; 121:164-72. [PMID: 27197862 DOI: 10.1152/japplphysiol.00848.2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 10/02/2015] [Accepted: 05/18/2016] [Indexed: 11/22/2022] Open
Abstract
The physiological role of the muscle histidyl dipeptides carnosine and anserine in contractile function of various types of muscle fibers in vivo is poorly understood. Ten adult male Wistar rats were randomly assigned to two groups: control and supplemented for 10 wk with beta-alanine, the precursor of carnosine (∼640 mg·kg body wt(-1)·day(-1)). Thereafter, contractile properties and fatigability of isolated fast fatigable (FF), fast resistant to fatigue (FR), and slow motor units (MUs) from the medial gastrocnemius were determined in deeply anaesthetized animals. The fatigue resistance was tested with a 40-Hz fatigue protocol followed by a second protocol at 40 Hz in fast and 20 Hz in slow units. In the supplemented rats, histidyl dipeptide concentrations significantly increased (P < 0.05) by 25% in the red portion of the gastrocnemius, and carnosine increased by 94% in the white portion. The twitch force of FF units and maximum tetanic force of FR units were significantly increased (P < 0.05), and the half-relaxation time was prolonged in slow units (P < 0.05). FF units showed less fatigue during the first 10 s, and FR units showed higher forces between 10 and 60 s during the 40-Hz fatigue test. In slow units, forces declined less during the first 60 s of the 20-Hz test. In conclusion, this in vivo experiment demonstrates that an elevation in muscle histidyl dipeptide content elicits beneficial changes in MU contractile characteristics and fatigue resistance. Carnosine and anserine seem to play an important yet divergent role in various MUs.
Collapse
Affiliation(s)
- Dominik Kaczmarek
- Department of Neurobiology, Poznan University of Physical Education, Poznań, Poland; Department of Physiology, Biochemistry and Hygiene, Poznan University of Physical Education, Poznań, Poland;
| | - Dawid Łochyński
- Department of Neurobiology, Poznan University of Physical Education, Poznań, Poland; Department of Motor Rehabilitation, Poznan University of Physical Education, Poznań, Poland; and
| | - Inge Everaert
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Maciej Pawlak
- Department of Physiology, Biochemistry and Hygiene, Poznan University of Physical Education, Poznań, Poland
| | - Wim Derave
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Jan Celichowski
- Department of Neurobiology, Poznan University of Physical Education, Poznań, Poland
| |
Collapse
|
44
|
Słopień RS, Pawlak M, Warenik-Szymankiewicz A, Sajdak S. The improvement of hirsutism and the decrease of testosterone concentration in the peripheral blood serum after removing an endometrioid ovarian cyst. CLIN EXP OBSTET GYN 2016. [DOI: 10.12891/ceog3025.2016] [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: 11/01/2022]
|
45
|
Brzeziński M, Bury K, Dąbrowski L, Holak P, Sejda A, Pawlak M, Jagielak D, Adamiak Z, Rogowski J. The New 3D Printed Left Atrial Appendage Closure with a Novel Holdfast Device: A Pre-Clinical Feasibility Animal Study. PLoS One 2016; 11:e0154559. [PMID: 27219618 PMCID: PMC4878741 DOI: 10.1371/journal.pone.0154559] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 04/15/2016] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Many patients undergoing cardiac surgery have risk factors for both atrial fibrillation (AF) and stroke. The left atrial appendage (LAA) is the primary site for thrombi formation. The most severe complication of emboli derived from LAA is stroke, which is associated with a 12-month mortality rate of 38% and a 12-month recurrence rate of 17%. The most common form of treatment for atrial fibrillation and stroke prevention is the pharmacological therapy with anticoagulants. Nonetheless this form of therapy is associated with high risk of major bleeding. Therefore LAA occlusion devices should be tested for their ability to reduce future cerebral ischemic events in patients with high-risk of haemorrhage. AIM The aim of this study was to evaluate the safety and feasibility of a novel left atrial appendage exclusion device with a minimally invasive introducer in a swine model. MATERIALS AND METHODS A completely novel LAA device, which is composed of two tubes connected together using a specially created bail, was designed using finite element modelling (FEM) to obtain an optimal support force of 36 N at the closure line. The monolithic form of the occluder was obtained by using additive manufacturing of granular PA2200 powder with the technology of selective laser sintering (SLS). Fifteen swine were included in the feasibility tests, with 10 animals undergoing fourteen days of follow-up and 5 animals undergoing long-term observation of 3 months. For one animal, the follow-up was further prolonged to 6 months. The device was placed via minithoracotomy. After the observation period, all of the animals were euthanized, and their hearts were tested for LAA closure and local inflammatory and tissue response. RESULTS After the defined observation period, all fifteen hearts were explanted. In all cases the full closure of the LAA was achieved. The macroscopic and microscopic evaluation of the explanted hearts showed that all devices were securely integrated in the surrounding tissues. No pericarditis or macroscopic signs of inflammation at the site of the device were found. All pigs were in good condition with normal weight gain and no other clinical symptoms. CONCLUSION This novel 3D printed left atrial appendage closure technique with a novel holdfast device was proven to be safe and feasible in all pigs. A benign healing process without inflammation and damage to the surrounding structures or evidence of new thrombi formation was observed. Moreover, the uncomplicated survival and full LAA exclusion in all animals demonstrate the efficacy of this novel and relatively cheap device. Further clinical evaluation and implementation studies should be performed to introduce this new technology into clinical practice.
Collapse
Affiliation(s)
- M. Brzeziński
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - K. Bury
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
- * E-mail:
| | - L. Dąbrowski
- Faculty of Mechanical Engineering, Gdansk University of Technology, Gdansk, Poland
| | - P. Holak
- Department of Surgery and Roentgenology, Faculty of Veterinary Medicine, University of Warmia and Mazury Olsztyn, Olsztyn, Poland
| | - A. Sejda
- Department of Pathomorphology, Medical University of Gdansk, Gdansk, Poland
| | - M. Pawlak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - D. Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Z. Adamiak
- Department of Surgery and Roentgenology, Faculty of Veterinary Medicine, University of Warmia and Mazury Olsztyn, Olsztyn, Poland
| | - J. Rogowski
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
46
|
Fehm T, Schneck H, Gierke B, Pawlak M, Templin M, Niederacher D, Neubauer H. Abstract P2-02-13: EpCAM-independent enrichment approach for isolation of circulating tumor cells (CTCs) in breast cancer - What can be found in the EpCAM-depleted fraction? Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-02-13] [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
Circulating tumor cells (CTCs) are the potential precursors of metastatic disease. Many assays have been established for the enumeration of CTCs. However, major limitations include the reliance on the expression of the cell surface marker epithelial cell adhesion molecule (EpCAM). These approaches may not detect CTCs that either express no/low levels of EpCAM or undergo epithelial-to-mesenchymal transition (EMT). We present an enrichment strategy combining different antibodies specific for surface proteins and extracellular matrix (ECM) components to capture EpCAMneg cell lines and EpCAMneg CTCs from EpCAM-depleted breast cancer blood samples. Expression of proteins (Trop2, CD49f, cMet, CK8, CD44, ADAM8, CD146, TEM8, CD47) was verified by immunofluorescence on EpCAM-positive (e.g. MCF7, SKBR3) and -negative (MDA-MB-231) breast cancer cell lines; antibodies and ECM proteins (e.g. hyaluronic acid (HA), collagen I, laminin) were further spotted in a single- and multi-arrayed format onto glass slides (Schott, NEXTERION® AL) and coupled to immunomagnetic beads (Dynabeads/Adembeads). Tumor cell adhesion of EpCAMpos/neg cell lines was visualized by Coomassie/MitoTracker; EpCAMneg CTCs enriched via functionalized Adem-/Dynabeads were identified by immunofluorescence staining for anti-pan-Cytokeratin(CK)-FITC/anti-CD45 AF647/DAPI and quantified manually by microscopy. Regarding cell lines, marginal binding of EpCAMneg MDA-MB-231 cells to EpCAM-antibodies could be observed. Efficient adhesion/capturing of EpCAMneg cells could be achieved via HA and immobilized antibodies against CD49f and Trop2. By analyzing 29 EpCAM-depleted fractions from 25 metastatic breast cancer patients, we were able to identify EpCAMneg CTCs in 69% of the samples [range 1-24] applying Trop2, CD49f, cMet, CK8 and/or HA magnetic enrichment. Accessorily, EpCAMneg dual-positive (CKpos/CD45pos) cells could be traced in 28 out of 29 samples [range 1-480]. Herein, we demonstrate an enhanced enrichment strategy to optimize capturing of EpCAMneg CTCs by targeting various cell surface antigens with antibody mixtures and ECM components. Thereby, potential relevant CTCs can be gathered and subjected to subsequent molecular analysis.
Citation Format: Fehm T, Schneck H, Gierke B, Pawlak M, Templin M, Niederacher D, Neubauer H. EpCAM-independent enrichment approach for isolation of circulating tumor cells (CTCs) in breast cancer - What can be found in the EpCAM-depleted fraction?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-02-13.
Collapse
Affiliation(s)
- T Fehm
- Heinrich-Heine-University of Duesseldorf, Duesseldorf, Germany; NMI Natural and Medical Sciences Institute at the University of Tuebingen, Reutlingen, Germany
| | - H Schneck
- Heinrich-Heine-University of Duesseldorf, Duesseldorf, Germany; NMI Natural and Medical Sciences Institute at the University of Tuebingen, Reutlingen, Germany
| | - B Gierke
- Heinrich-Heine-University of Duesseldorf, Duesseldorf, Germany; NMI Natural and Medical Sciences Institute at the University of Tuebingen, Reutlingen, Germany
| | - M Pawlak
- Heinrich-Heine-University of Duesseldorf, Duesseldorf, Germany; NMI Natural and Medical Sciences Institute at the University of Tuebingen, Reutlingen, Germany
| | - M Templin
- Heinrich-Heine-University of Duesseldorf, Duesseldorf, Germany; NMI Natural and Medical Sciences Institute at the University of Tuebingen, Reutlingen, Germany
| | - D Niederacher
- Heinrich-Heine-University of Duesseldorf, Duesseldorf, Germany; NMI Natural and Medical Sciences Institute at the University of Tuebingen, Reutlingen, Germany
| | - H Neubauer
- Heinrich-Heine-University of Duesseldorf, Duesseldorf, Germany; NMI Natural and Medical Sciences Institute at the University of Tuebingen, Reutlingen, Germany
| |
Collapse
|
47
|
Slopień R, Rózycka A, Slopień A, Pawlak M, Warenik-Szymankiewicz A, Sajdak S, Jagodziński P. The genetic background of climacteric symptoms in women during menopause. CLIN EXP OBSTET GYN 2016; 43:495-499. [PMID: 29734534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The subject of the study is the evaluation of the correlation between the polymorphism of candidate genes in the etiology of depression and the occurrence of the symptoms of the climacteric syndrome in women during menopause. The group subjected to the study comprised of 203 women aged between 42-65 years: 71 of them still menstruated (premenopausal group) and 132 at least one year after the last period (postmenopausal group), admitted to the Department of Gynecological Endocrinology at the University of Medical Sciences in Poznan with symptoms of the climacteric syndrome All the examined women were evaluated according to the degree of severity of the climacteric syndrome symptoms using the Kupperman index and the concentration of FSH, LH hormones, 17β-estradiol, PRL, total testosterone, and DHEAS in peripheral blood serum. Among the candidate genes in the aetiology of depression the following were selected for the research: the serotonergic system receptor genes: 5HTR2A, 5HTR1B, 5HTR2C, TPH 1, TPH2, and MAO-A; the genes of noradrenergic and dopaminergic systems (COMT, NET), the genes of the GABAergic (GABRBl) system, a gene of the estrogen receptor (ESR1), and the genes of the enzymes crucial in the methyl cycle (MTHRF, MTR, and MTHFD1). With regards to the correlation between the examined polymorphisms and the occurrence of the symptoms of the climacteric syndrome, the associations analysis indicated a connection between GABRBl.TaqI polymorphism and the occurrence of vertigo in premenopausal women (0.0198; after correction: 0.0497 CC to CA). The correlation was also found regarding the examined polymorphisms and the concentration of the examined hormones in blood serum: TPH1.MaeI polymorphism and the LH concentration in the postmenopausal group (0.004; after correction: 0.014 CC to CA), NET.Eco1471 polymorphism, and the 17β-estradiol concentration in the postmenopausal group (0.0208; after correction: 0.048 GG to GA) and HTR2AMspI polymorphism and PRL concentration in all examined women (0.03; after correction: 0.038 TT to CT).
Collapse
|
48
|
Słopień R, Pawlak M, Warenik-Szymankiewicz A, Sajdak S. The improvement of hirsutism and the decrease of testosterone concentration in the peripheral blood serum after removing an endometrioid ovarian cyst. CLIN EXP OBSTET GYN 2016; 43:455-456. [PMID: 27328515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The study describes the case of a patient, in which as a result of removing an endometrioid ovarian cyst, there was an improvement as regards hirsutism and the decrease of testosterone concentration in the serum of peripheral blood.
Collapse
|
49
|
Slopień R, Slopień A, Pawlak M, Warenik-Szymankiewicz A, Sajdak S. Depressive symptoms' pattern in postmenopausal women. CLIN EXP OBSTET GYN 2016; 43:544-545. [PMID: 29734545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The study was conducted to elucidate the problem of depressive symptoms' pattern in climacteric women. The study included 128 postmenopausal women aged 47-65 years admitted to the Department of Gynecological Endocrinology, Poznan University of Medical Science because of climacteric symptoms. The authors assessed the intensity of climacteric symptoms with the Kupperman index and the severit of depressive symptoms with the Hamilton depression scale. They measured BMI of all studied women. The average score of the Hami ton scale in the studied group was 11 points (SD ± 7 points). No depressive symptoms were found in 40 (31.2%) of the study participants. A slight increase in the severity of the depression symptoms was found in 64 (50%) and 23 (29.9%) displayed depressive symptoms at moderate severity, while one (1.3%) study participant was diagnosed with very severe depressive symptoms. Depressive symptoms observe most often were: somatic symptoms of anxiety and fear experienced in 90 (70.2%), light and interrupted sleep reported in 88 (68.6%), an general symptoms in 88 (68.6%) of the study participants.
Collapse
|
50
|
Sygitowicz G, Maciejak A, Piniewska-Juraszek J, Pawlak M, Góra M, Burzyńska B, Dłużniewski M, Opolski G, Sitkiewicz D. Interindividual variability of atorvastatin treatment influence on the MPO gene expression in patients after acute myocardial infarction. Acta Biochim Pol 2015; 63:89-95. [PMID: 26697531 DOI: 10.18388/abp.2015_1014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 10/30/2015] [Accepted: 11/22/2015] [Indexed: 11/10/2022]
Abstract
Myeloperoxidase (MPO) and C-reactive protein (CRP) may play critical roles in generation of oxidative stress and the development of the systemic inflammatory response. The aim of the study was to determine the effect of atorvastatin therapy on the MPO gene expression and its plasma level in relation to lipids level lowering and an anti-inflammatory response in patients after acute myocardial infarction. The research material was represented by 112 samples. Thirty-eight patients with first AMI receiving atorvastatin therapy (40 mg/day) and followed up for one month were involved in the study. The relative MPO gene expression in peripheral blood mononuclear cells (PBMCs) was examined using RT-qPCR in 38 patients before-, 38 patients after-therapy and in 36 patients as the control group. The plasma concentrations of MPO and serum concentrations of biochemical parameters were determined using commercially available diagnostic tests. After one month of atorvastatin therapy, in 60.5% patients a decrease of MPO gene expression, whereas in 39.5% patients an increase, was observed. The plasma MPO levels behaved in the same way as the MPO gene expression. However, the serum lipids and CRP concentrations were significantly lower after one month of atorvastatin therapy in both groups of patients - with decreased and increased MPO gene expression. Atorvastatin exhibited a different effect on MPO gene expression and its plasma level. Short-term atorvastatin therapy resulted in lipid lowering and anti-inflammatory activity in patients after AMI, independently of its effect on MPO gene expression. The molecular mechanisms of this phenomenon are not yet defined and require further research.
Collapse
Affiliation(s)
- Grażyna Sygitowicz
- Department of Medical Laboratory Diagnostics, Medical University of Warsaw, Warsaw, Poland
| | - Agata Maciejak
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Joanna Piniewska-Juraszek
- Department of Cardiology, Hypertension & Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Pawlak
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Góra
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Beata Burzyńska
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Mirosław Dłużniewski
- Department of Cardiology, Hypertension & Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Sitkiewicz
- Department of Medical Laboratory Diagnostics, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|