1
|
Lauffer-Vogt SU, Hediger H, Lauener SK, Schubert M. [The use of the DOS and Delirium Prevalence: a quantitative longitudinal study at a Swiss-German central hospital]. Pflege 2024; 37:89-97. [PMID: 37997948 DOI: 10.1024/1012-5302/a000965] [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] [Indexed: 11/25/2023]
Abstract
The use of the DOS and Delirium Prevalence: a quantitative longitudinal study at a Swiss-German central hospital Abstract: Background: With a prevalence of 12-64%, delirium is a common complication in acute care, associated with negative outcomes such as increased mortality and prolonged length of stay. Many hospitals have guidelines to improve the delirium management. The Delirium Observation Screening Scale (DOS) Score is collected in the study hospital from all patients ≥ 70 years at each shift for at least 3 days. Delirium is diagnosed by a physician and coded according to ICD-10. Purpose: Evaluation of the delirium screening with the DOS according to internal guideline in terms of number of DOS assessments performed, prevalence of delirium (DOS score ≥ 3 points, CD-10 code delirium). Method: This retrospective quantitative single-centre longitudinal study used 2017 and 2018 data of 10046 cases. Statistical analysis methods were used to analyse prevalence of delirium and subgroup comparisons. Results: At least one DOS score was documented in 92% of cases aged ≥ 70-years (n = 5038). DOS implementation varied between 60% in the early, 49% in the late and 38% in the night shift. The prevalence of delirium was 12% according to DOS score ≥ 3 and 4% according to physician diagnosis of a delirium. Cases with a DOS score ≥ 3 were significantly older, more often female, had more comorbidities and were depressed. Conclusions: DOS is performed in most patients when indicated. The DOS implementation frequency varied depending on the shift.
Collapse
Affiliation(s)
- Stefan Urs Lauffer-Vogt
- Klinik für Plastische Chirurgie und Handchirurgie, Klinik für Traumatologie, Universitätsspital Zürich, Schweiz
| | - Hannele Hediger
- Institut für Pflege, Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften, Winterthur, Schweiz
| | - Susanne Knüppel Lauener
- Abteilung für Praxisentwicklung und Forschung Pflege/MTT, Medizinische Direktion, Universitätsspital Basel, Schweiz
| | - Maria Schubert
- Institut für Pflege, Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften, Winterthur, Schweiz
| |
Collapse
|
2
|
Parigger T, Drothler S, Scherhäufl C, Gassner FJ, Schubert M, Steiner M, Höpner JP, Hödlmoser A, Schultheis L, Abu Bakar A, Neureiter D, Pleyer L, Egle A, Greil R, Geisberger R, Zaborsky N. Oncogenic MTOR signaling axis compensates BTK inhibition in a Chronic Lymphocytic Leukemia patient with Richter Transformation: A Case Report and Review of the Literature. Acta Haematol 2024:000537791. [PMID: 38402867 DOI: 10.1159/000537791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Targeting the B cell receptor (BCR) pathway via ibrutinib, a specific inhibitor of Bruton's tyrosine kinase, has shown marked clinical efficacy in treatment of patients with chronic lymphocytic leukemia (CLL), thus becoming a preferred first line option independent of risk factors. However, acquired resistance to ibrutinib poses a major clinical problem and requires the development of novel treatment combinations to increase efficacy and counteract resistance development and clinical relapse rates. CASE PRESENTATION In this study, we performed exome and transcriptome analyses of an ibrutinib resistant CLL patient in order to investigate genes and expression patterns associated with ibrutinib resistance. Here we provide evidence that ibrutinib resistance can be attributed to aberrant mammalian target of rapamycin (MTOR) signaling. CONCLUSION Thus, our study proposes that combined use of MTOR inhibitors with ibrutinib could be a possible option to overcome therapy resistance in ibrutinib treated patients.
Collapse
|
3
|
Aldecoa C, Bettelli G, Bilotta F, Sanders RD, Aceto P, Audisio R, Cherubini A, Cunningham C, Dabrowski W, Forookhi A, Gitti N, Immonen K, Kehlet H, Koch S, Kotfis K, Latronico N, MacLullich AMJ, Mevorach L, Mueller A, Neuner B, Piva S, Radtke F, Blaser AR, Renzi S, Romagnoli S, Schubert M, Slooter AJC, Tommasino C, Vasiljewa L, Weiss B, Yuerek F, Spies CD. Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients. Eur J Anaesthesiol 2024; 41:81-108. [PMID: 37599617 PMCID: PMC10763721 DOI: 10.1097/eja.0000000000001876] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Postoperative delirium (POD) remains a common, dangerous and resource-consuming adverse event but is often preventable. The whole peri-operative team can play a key role in its management. This update to the 2017 ESAIC Guideline on the prevention of POD is evidence-based and consensus-based and considers the literature between 01 April 2015, and 28 February 2022. The search terms of the broad literature search were identical to those used in the first version of the guideline published in 2017. POD was defined in accordance with the DSM-5 criteria. POD had to be measured with a validated POD screening tool, at least once per day for at least 3 days starting in the recovery room or postanaesthesia care unit on the day of surgery or, at latest, on postoperative day 1. Recent literature confirmed the pathogenic role of surgery-induced inflammation, and this concept reinforces the positive role of multicomponent strategies aimed to reduce the surgical stress response. Although some putative precipitating risk factors are not modifiable (length of surgery, surgical site), others (such as depth of anaesthesia, appropriate analgesia and haemodynamic stability) are under the control of the anaesthesiologists. Multicomponent preoperative, intra-operative and postoperative preventive measures showed potential to reduce the incidence and duration of POD, confirming the pivotal role of a comprehensive and team-based approach to improve patients' clinical and functional status.
Collapse
Affiliation(s)
- César Aldecoa
- From the Department of Anaesthesia and Postoperative Critical Care, Hospital Universitario Rio Hortega, Valladolid, Spain (CA), Department of Biomedical Studies, University of the Republic of San Marino, San Marino (GB), Department of Anesthesiology, Critical Care and Pain Medicine, 'Sapienza' University of Rome, Rome, Italy (FB, AF, LM), Specialty of Anaesthetics & NHMRC Clinical Trials Centre, University of Sydney & Department of Anaesthetics and Institute of Academic Surgery, Royal Prince Alfred Hospital (RDS), Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt Universität zu Berlin, Campus Charité Mitte, and Campus Virchow Klinikum (CDS, SK, AM, BN, LV, BW, FY), Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (PA), Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy (PA), Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden (RA), Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy (AC), School of Biochemistry and Immunology and Trinity College Institute of Neuroscience, Trinity College, Dublin, Ireland (CC), First Department of Anaesthesiology and Intensive Care Medical University of Lublin, Poland (WD), Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland (KI), Section of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (HK), Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland (KK), Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia (NG, NL, SP, SR), Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy (NL, SP), Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom (AMJM), Department of Anaesthesia and Intensive Care, Nykoebing Hospital; University of Southern Denmark, SDU (SK, FR), Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia (ARB), Center for Intensive Care Medicine, Luzerner Kantonsspital, Lucerne, Switzerland (ARB), Department of Health Science, Section of Anesthesiology, University of Florence (SR), Department of Anaesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy (SR), School of Health Sciences, Institute of Nursing, ZHAW Zurich University of Applied Science, Winterthur, Switzerland (MS), Departments of Psychiatry and Intensive Care Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (AJCS), Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium (AJCS) and Dental Anesthesia and Intensive Care Unit, Polo Universitario Ospedale San Paolo, Department of Biomedical, Surgical and Odontoiatric Sciences, University of Milano, Milan, Italy (CT)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Stadtmann MP, Bischofberger I, Balice-Bourgois C, Bianchi M, Burr C, Fierz K, de Goumoëns V, Kocher A, Kunz S, Naef R, Bachmann AO, Schubert M, Schwendimann R, Simon M, Waldboth V, Zanon-Di Nardo D, Nicca D, Zigan N. Setting new priorities for nursing research: The updated Swiss Nursing Research Agenda-a systematic, participative approach. Int Nurs Rev 2024. [PMID: 38197742 DOI: 10.1111/inr.12937] [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: 02/19/2023] [Accepted: 12/22/2023] [Indexed: 01/11/2024]
Abstract
AIM To identify current key areas for nursing research in Switzerland, we revised the Swiss Research Agenda for Nursing (SRAN) initially published in 2008. BACKGROUND By developing a research agenda, nursing researchers internationally prioritize and cluster relevant topics within the research community. The process should be collaborative and systematic to provide credible information for decisionmakers in health care research, policy, and practice. SOURCES OF EVIDENCE After a participative, systematic, and critical evaluation within and outside of the Swiss Association for Nursing Science, the updated SRAN 2019-2029 defines four research priorities (new models of care, nursing care interventions, work and care environment, and quality of care and patient safety) and four transversal themes (organization of research, research methodologies, research in health care policy and public health perspectives). CONCLUSION Adding to other national nursing research agendas, the categories are organized in a framework of key research priorities and transversal themes. They relate to the importance of global and local foci of research as well as challenges in health care services and policy systems. The agenda is an important prerequisite for enhancing the influence of nursing research in Switzerland and provides guidance for the next decade. IMPLICATIONS FOR NURSING PRACTICE The revised agenda ensures that research projects target key knowledge gaps and the discipline's core questions in respective countries. IMPLICATIONS FOR HEALTH POLICY Nursing research should inform and influence health policy on all institutional and political levels. Therefore, the integration of public health perspectives in research is one of the most important new aspects of SRAN 2019-2029.
Collapse
Affiliation(s)
- Manuel P Stadtmann
- Department of Health, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | | | - Colette Balice-Bourgois
- Institute of Paediatrics of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Monica Bianchi
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Christian Burr
- Department of Health, Institut of Nursing, Bern University of Applied Sciences, Bern, Switzerland
| | - Katharina Fierz
- School of Health Sciences, Institute of Nursing, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | | | - Agnes Kocher
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Stefan Kunz
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zürich, Zürich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zürich, Switzerland
| | | | - Maria Schubert
- School of Health Sciences, Institute of Nursing, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - René Schwendimann
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Medizinische Direktion Pflege/MTT, Universitätsspital Basel, Markgräflerhof, Basel, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Veronika Waldboth
- School of Health Sciences, Institute of Nursing, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | | | - Dunja Nicca
- Institut of Epidemiology, Biostatistics and Prevention, University of Zürich, Zurich, Switzerland
| | - Nicole Zigan
- School of Health Sciences, Institute of Nursing, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| |
Collapse
|
5
|
Hildenbrand FF, Boettger S, Spiller T, Schubert M, Ernst J, von Känel R, Zipser CM. Sex-specific clinical characteristics and treatment responses in delirium management: findings from a prospective cohort study in elderly patients. Int Clin Psychopharmacol 2023; 38:384-393. [PMID: 37351574 DOI: 10.1097/yic.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Delirium incidence and phenotype differ between sexes. Sex differences in the selection of treatment strategies remain elusive. We evaluated sex-specific responses to non- and pharmacological management. In this observational prospective cohort study conducted at the University Hospital Zurich, Switzerland, 602 patients managed for delirium were analyzed. Remission and benefit ratios of treatments were calculated using Cox regression models. Baseline characteristics were similar in both sexes. Overall, 89% of all patients (540/602) received pharmacological management for delirium, most (77%) with one or two different medications. An equal number of male and female patients had either no medication ( P = 0.321) or three and more medications ( P = 0.797). Men had two different medications more often ( P = 0.009), while women more frequently received one medication ( P = 0.037). Remission rates within 20 days were higher in non-pharmacological treatment and similar between sexes, with odds of 1.36 in females, and 2.3 in males. Non-pharmacological treatment was equally efficacious in both sexes. Women who received supportive treatment and monotherapy had equal odds of remission. Men fared better with supportive care compared to pharmacologic therapies. Remission rates with different management strategies were similar between sexes. No sex differences were found regarding phenotypes, clinical course, and response to therapy.
Collapse
Affiliation(s)
- Florian F Hildenbrand
- Clinic for Internal Medicine, Department of Gastroenterology and Hepatology, Zurich City Hospital, University of Zurich
| | - Soenke Boettger
- Department for Consultation-Liaison Psychiatry, University Hospital Zurich, University of Zurich
| | - Tobias Spiller
- Department for Consultation-Liaison Psychiatry, University Hospital Zurich, University of Zurich
| | - Maria Schubert
- School of Health Professions, Institute of Applied Science, University of Zurich, Winterthur
| | - Jutta Ernst
- Institute of Nursing Science, University Hospital Zurich, University of Zurich
| | - Roland von Känel
- Department for Consultation-Liaison Psychiatry, University Hospital Zurich, University of Zurich
| | - Carl M Zipser
- Department for Consultation-Liaison Psychiatry, University Hospital Zurich, University of Zurich
- Department of Neurology and Neurophysiology, Balgrist University Hospital, University of Zurich, Switzerland
| |
Collapse
|
6
|
Zitzmann M, Schubert M, Sansone A, Kliesch S. Spontaneous alterations in semen parameters are associated with age, accessory gland function and the FSHB c.-211G>T variant. Andrology 2023; 11:1386-1397. [PMID: 36908159 DOI: 10.1111/andr.13426] [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: 12/14/2022] [Revised: 02/08/2023] [Accepted: 03/02/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND There is a strong within-subject alteration of semen parameters in men with infertility. However, it remains unknown in which subgroup variations are likely to occur and which semen parameters are affected. OBJECTIVE To evaluate parameters associated with spontaneous alterations in semen analysis. PATIENTS AND METHODS We retrospectively selected 3456 men with infertility without known causes affecting spermatogenesis or sperm output for analysis of repeated ejaculate samples. Exclusion criteria comprised sperm concentration <1 million/mL, abnormal follicle-stimulating hormone or low testosterone, and low bitesticular volume (<10 mL). Grouped linear two-level nested mixed-effect models were applied. The analyzed parameters included abstinence time, bitesticular volume, age, accessory gland markers, follicle-stimulating hormone, and FSHB c.-211 variants. RESULTS Groups include A (n = 397): ≥1.0 to <5.0 million/mL, B (n = 708): ≥5.0 to <15.0 million/mL, and C (n = 2351): ≥15.0 million/mL. Groups A, B, and C: changes in ejaculate volume were associated with alterations in total sperm count and motility (p < 0.003). Changes were, controlled for abstinence time (p < 0.001), related to α-glucosidase, fructose, or zinc (p = 0.005-0.02). Group A + B: fluctuations in follicle-stimulating hormone level influenced sperm concentration/count (p = 0.004-0.02), albeit only in men with FSHB c.-211 GG (p = 0.007-0.02). T-allele carriers did not show changes in follicle-stimulating hormone levels (p > 0.1). Group B: age <50 years (p = 0.007-0.01) and normal bitesticular volume (p = 0.008-0.02) were associated with spontaneous increases in sperm concentration, count, and motility. CONCLUSION Semen parameters exhibit intra-individual alterations associated with organic, hormonal, and genetic variables. Changes are pronounced in younger men with normal bitesticular volume and oligozoospermia to almost normozoospermia. The effect is modulated by abstinence time, accessory gland function, and fluctuations in follicle-stimulating hormone level, which is bound to FSHB c.-211G>T variant. Judgment of semen analysis should be based on two semen samples, with abstinence times between 4 and 5 days. As a future perspective, it might be investigated whether younger men with normal bitesticular volume who are unable to elicit increases in serum follicle-stimulating hormone (FSHB c.-211 genotype of GT/TT) benefit from improving accessory gland function and increasing follicle-stimulating hormone.
Collapse
Affiliation(s)
- Michael Zitzmann
- Department of Clinical and Surgical Andrology, Centre for Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - Maria Schubert
- Department of Clinical and Surgical Andrology, Centre for Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - Andrea Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Sabine Kliesch
- Department of Clinical and Surgical Andrology, Centre for Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| |
Collapse
|
7
|
Schubert M, Ausserhofer D, Schaffert-Witvliet B, Radtke FM, Neuner B. [Prevention of Post-operative Delirium]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:482-493. [PMID: 37725990 DOI: 10.1055/a-2065-3748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Postoperative delirium (POD) is an adverse but often preventable complication of surgery and surgery-related anaesthesia, and increasingly prevalent. This article provides an overview on non-pharmacological preventive measures, divided into individualized and non-individualized measures. Non-individualized measures, such as the most minimally invasive surgical procedure, avoidance of unnecessary fasting before surgery, and the most tolerable anaesthesia are used to minimize the risk of POD in all patients. Based on the results of preoperative screenings for risk factors such as frailty or cognitive impairment, individualized measures may encompass prehabilitation, treatment of specific risk factors, operation room companionship or cognitive, motor, and sensory stimulation as well as social support. This article additionally lists several examples of best practice approaches already implemented in German-speaking countries and websites for further readings.
Collapse
|
8
|
Yürümezoğlu HA, Schubert M, Sarıoğlu E, Kocaman G. Cultural adaptation of the revised Basel Instrument for Rationing of Care to the Turkish context: a study of validity and reliability. J Res Nurs 2023; 28:338-351. [PMID: 37885955 PMCID: PMC10599310 DOI: 10.1177/17449871231175788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Background Studies have shown that nurses do not complete one or more necessary nursing care elements in their last shift due to lack of time. The Basel Extent of Rationing Nursing Care (BERNCA) instrument is one of the most used scales to measure the rationing of nursing care. Aim This study is aimed to culturally adapt the revised BERNCA (BERNCA-R) instrument to the Turkish language and to test its validity and reliability. Methods A cross-sectional and methodological study was used. The instrument was adapted in three stages: translation and adaptation, content validity testing and validity and reliability. Data were obtained from 350 nurses working in two public acute care hospitals in Turkey, between September 2019 and January 2020. The descriptive statistics, content validity index, exploratory and confirmatory factor analyses, Cronbach's α, Guttman split-half and inter-item reliability analyses were performed for the analysis of the data. Results The Turkish version of the BERNCA-R instrument with a 27-item and three-subscales (monitoring, daily care and needs and psychosocial care) structure was found to have acceptable and good fit indices. Conclusion The Turkish version of the BERNCA-R instrument is valid and reliable tool to measure rationing of nursing care.
Collapse
Affiliation(s)
- Havva Arslan Yürümezoğlu
- Associate Professor, Department of Nursing Management, Faculty of Nursing, Dokuz Eylul University, İzmir, Turkey
| | - Maria Schubert
- Professor, Institute of Nursing, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Emine Sarıoğlu
- Nurse, Department of Research and Education, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Gülseren Kocaman
- Emeritus Professor, Department of Nursing Management, Faculty of Nursing, Dokuz Eylul University, İzmir, Turkey
| |
Collapse
|
9
|
Kramer I, Schubert M. The use of patient sitters at a Swiss hospital: A retrospective observational study. PLoS One 2023; 18:e0287317. [PMID: 37315098 DOI: 10.1371/journal.pone.0287317] [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] [Received: 10/20/2022] [Accepted: 06/04/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE Patient sitters are frequently used in acute care hospitals to provide one-to-one care for agitated or disorientated patients to assure the safety and well-being of patients. However, there is still a lack of evidence on the use of patient sitters, especially in Switzerland. Therefore, the aim of this study was to describe and explore the use of patient sitters in a Swiss acute care hospital. METHODS In this retrospective, observational study we included all inpatients who were hospitalized between January and December 2018 in a Swiss acute care hospital and required a paid or volunteer patient sitter. Descriptive statistics were used to describe the extent of patient sitter use, patient characteristics, and organizational factors. For the subgroup analysis between internal medicine and surgical patients Mann-Whitney U tests and chi-square tests were used. RESULTS Of the total of 27'855 included inpatients, 631 (2.3%) needed a patient sitter. Of these, 37.5% had a volunteer patient sitter. The median patient sitter duration per patient per stay was 18.0 hours (IQR = 8.4-41.0h). The median age was 78 years (IQR = 65.0-86.0); 76.2% of patients were over the age of 64. Delirium was diagnosed in 41% of patients, and 15% had dementia. Most of the patients showed signs of disorientation (87.3%), inappropriate behavior (84.6%), and risk of falling (86.6%). Patient sitter uses varied during the year and between surgical and internal medicine units. CONCLUSIONS These results add to the limited body of evidence concerning patient sitter use in hospitals, supporting previous findings related to patient sitter use for delirious or geriatric patients. New findings include the subgroup analysis of internal medicine and surgical patients, as well as analysis of patient sitter use distribution throughout the year. These findings may contribute to the development of guidelines and policies regarding patient sitter use.
Collapse
Affiliation(s)
- Iris Kramer
- Institute of Nursing, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Maria Schubert
- Institute of Nursing, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| |
Collapse
|
10
|
Vaisband M, Schubert M, Gassner FJ, Geisberger R, Greil R, Zaborsky N, Hasenauer J. Validation of genetic variants from NGS data using deep convolutional neural networks. BMC Bioinformatics 2023; 24:158. [PMID: 37081386 PMCID: PMC10116675 DOI: 10.1186/s12859-023-05255-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 03/27/2023] [Indexed: 04/22/2023] Open
Abstract
Accurate somatic variant calling from next-generation sequencing data is one most important tasks in personalised cancer therapy. The sophistication of the available technologies is ever-increasing, yet, manual candidate refinement is still a necessary step in state-of-the-art processing pipelines. This limits reproducibility and introduces a bottleneck with respect to scalability. We demonstrate that the validation of genetic variants can be improved using a machine learning approach resting on a Convolutional Neural Network, trained using existing human annotation. In contrast to existing approaches, we introduce a way in which contextual data from sequencing tracks can be included into the automated assessment. A rigorous evaluation shows that the resulting model is robust and performs on par with trained researchers following published standard operating procedure.
Collapse
Affiliation(s)
- Marc Vaisband
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR); Cancer Cluster Salzburg, Paracelsus Medical University, Salzburg, Austria.
- Life and Medical Sciences Institute, University of Bonn, Bonn, Germany.
| | - Maria Schubert
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR); Cancer Cluster Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Franz Josef Gassner
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR); Cancer Cluster Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Roland Geisberger
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR); Cancer Cluster Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR); Cancer Cluster Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Nadja Zaborsky
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center; Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR); Cancer Cluster Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Jan Hasenauer
- Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| |
Collapse
|
11
|
Faessler L, Kofler S, Wenke-Zobler J, Brunner C, Schäfer-Keller P, De Geest S, Schubert M, Regez K, Schuetz P, Mueller B, Conca A. The use of nurse-led care intervention to improve self-care abilities subsequently decreasing readmission in multimorbid hospitalized patients: A quasi-experimental study in a real-world setting. Nurs Open 2023; 10:3787-3798. [PMID: 36852528 PMCID: PMC10170947 DOI: 10.1002/nop2.1637] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 08/25/2022] [Accepted: 01/13/2023] [Indexed: 03/01/2023] Open
Abstract
AIM Nurse-led care aims to optimize the discharge preparation with a focus on increasing patients' independency and self-care abilities. This study compared patients' improvements of self-care abilities and frequency of readmission rate between nurse-led care and regular nursing care within the acute hospital setting. DESIGN A quasi-experimental design within a real-world setting was used for this work. METHODS We included a pool of 2501 patients from a control group (medically stable in usual care) and 420 patients from an intervention group (nurse-led care). After propensity score matching, the study cohort consisted of 612 patients. RESULTS From admission to discharge, nurse-led care patients showed superior improvements of total self-care abilities compared to usual care patients. In particular, we found improvements in the following categories: mobility, grooming and excretion. Patients with nurse-led care were furthermore less frequently readmitted to hospital compared with the control group patients. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
Collapse
Affiliation(s)
- Lukas Faessler
- Department of Clinical Nursing Research and Development, Kantonsspital Aarau, Aarau, Switzerland
| | - Sabine Kofler
- Department of Clinical Nursing Research and Development, Kantonsspital Aarau, Aarau, Switzerland
| | - Juliane Wenke-Zobler
- Department of Clinical Nursing Research and Development, Kantonsspital Aarau, Aarau, Switzerland
| | - Corinne Brunner
- Pediatric Skin Center, Skin- and Wound Management, University Children's Hospital Zurich, Zurich, Switzerland
| | - Petra Schäfer-Keller
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland HES-SO, Fribourg, Switzerland
| | - Sabina De Geest
- Department Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Maria Schubert
- Department Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium.,School of Health Professions, Institute of Nursing, University of Applied Sciences (ZHAW), Winterthur, Switzerland
| | - Katharina Regez
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Antoinette Conca
- Department of Clinical Nursing Research and Development, Kantonsspital Aarau, Aarau, Switzerland
| |
Collapse
|
12
|
Blättler N, Schaffert B, Schubert M. [Evaluation of the implementation of non-pharmacological measures for the prevention and treatment of delirium: A retrospective cohort study]. Pflege 2023. [PMID: 36749189 DOI: 10.1024/1012-5302/a000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Evaluation of the implementation of non-pharmacological measures for the prevention and treatment of delirium: A retrospective cohort study Abstract. Background: Delirium is burdensome for the affected patients, their relatives, hospital staff and the health care system. Preventing delirium with targeted multicomponent interventions is therefore essential. Aim: To investigate the implementation of defined non-pharmacological, preventive, and supportive measures in patients with an increased risk of delirium and/or delirium by the hospital's directions. Methods: In this observational study, routine data from 175 hospitalized patients were included. Data on delirium prevention, treatment and presence of delirium were extracted from the patient records and analyzed using appropriate statistical methods. Group comparisons were made between the medical/surgical clinic and the delirium/no delirium group. Results: Of the 175 patients, 31 had delirium. For delirium prevention, measures to improve oxygen supply, excretion, pain and mobility were most frequently implemented and measures such as improving cognition and communication were least frequently implemented. In the case of delirium, measures to modify risk factors, ensure safety, as well as prophylaxis were applied most frequently. Between the two clinics and between the delirium/no delirium group significant differences in the frequency of these measures were shown. Conclusion: The differences in frequency of implementation provide preliminary evidence that clinic-specific delirium prevention, early detection, and treatment may be needed.
Collapse
Affiliation(s)
- Nadia Blättler
- Institut für Pflege, Departement Gesundheit, ZHAW Zürcher Hochschule für Angewandte Wissenschaften, Winterthur, Schweiz
| | - Bianca Schaffert
- Institut für Pflege, Departement Gesundheit, ZHAW Zürcher Hochschule für Angewandte Wissenschaften, Winterthur, Schweiz
| | - Maria Schubert
- Institut für Pflege, Departement Gesundheit, ZHAW Zürcher Hochschule für Angewandte Wissenschaften, Winterthur, Schweiz
| |
Collapse
|
13
|
Guekos A, Grata AC, Hubli M, Schubert M, Schweinhardt P. Are changes in nociceptive withdrawal reflex magnitude a viable central sensitization proxy? Implications of a replication attempt. Clin Neurophysiol 2023; 145:139-150. [PMID: 36272950 DOI: 10.1016/j.clinph.2022.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The nociceptive withdrawal reflex (NWR) has been proposed to read-out central sensitization (CS). Replicating a published study, it was assessed if the NWR magnitude reflects sensitization by painful heat. Additionally, NWR response rates were compared for two stimulation, the sural nerve at the lateral malleolus (SU) and the medial plantar nerve on the foot sole (MP), and three recording sites, biceps femoris (BF), rectus femoris (RF), and tibialis anterior (TA) muscles. METHODS 16 subjects underwent one experiment with six blocks of eight transcutaneous electrical stimulations to elicit the NWR while surface electromyography was collected. Tonic heat was concurrently applied in the same dermatome. Temperatures rose from 32 °C in the first to 46 °C in the last block following the previously published protocol. RESULTS Tonic heat did not influence NWR magnitude. The highest NWR response rate was obtained for MP-TA combination (79%). Regarding elicitation in all three muscles, SU stimulation outperformed MP (59% vs 57%). CONCLUSIONS The replication failed. NWR magnitude as a CS proxy in healthy subjects needs continued investigation. With respect to response rates, MP-TA proved efficient, whereas SU stimulation seemed preferable for multiple muscle recordings. SIGNIFICANCE Unclear methodological descriptions in the original study affected CS and NWR replication. The NWR magnitude changes induced by CS may closely depend on the different stimulation methods used.
Collapse
Affiliation(s)
- A Guekos
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Decision Neuroscience Lab, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - A C Grata
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago IL, United States
| | - M Hubli
- Faculty of Medicine, University of Zurich, Zurich, Switzerland; Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - M Schubert
- Faculty of Medicine, University of Zurich, Zurich, Switzerland; Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - P Schweinhardt
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| |
Collapse
|
14
|
Seidler A, Freiberg A, Drössler S, Hussenoeder FS, Conrad I, Riedel-Heller S, Starke KR, Schubert M. Elevated risk of depression and anxiety disorder by „high strain“ occupations: a systematic review. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.091] [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] Open
Abstract
Abstract
Background
Poor working conditions might lead to mental illness.
Methods
We performed a systematic review with meta-analyses as an update of a review published in 2013. We registered the study protocol with PROSPERO (registration number: CRD42020170032) and searched for epidemiological studies in MEDLINE, PsycINFO, and Embase. Two reviewers carried out independently all review steps including title-abstract screening, full-text screening, risk-of-bias assessment and data extraction. Discordances were solved by consensus. We determined the certainty of evidence using the GRADE-approach.
Results
Ten cohort studies with acceptable study quality examined the relationship between high job strain and the incidence of depression. In the “classic” demand-control-model, ‘high strain’ (combination of high demands and low control) is compared with ‘low strain’ (combination of low demands and high job control). For high strain, the risk of depression was elevated by 73%, the pooled effect estimate for the risk of depression was 1.73 (95% CI 1.32-2.27. In a dichotomous analysis (without dividing job strain into the four dimensions mentioned above), there was a doubled risk of depression with high job strain (pooled effect estimate=1.99, 95% CI 1.68-2.35). We found comparable risk estimates for men and women. The GRADE assessment revealed a high certainty of evidence of the association between job strain and depression. We also found a considerably increased risk of anxiety disorder among individuals prone to high job strain.
Conclusions
This systematic review finds a clear association between high job strain (high demands in combination with low control) and depression as well as anxiety disorders.
Acknowledgment: This study was financially supported by SUVA (Schweizerische Unfallversicherungsanstalt).
Key messages
Collapse
Affiliation(s)
- A Seidler
- TU Dresden, Faculty of Medicine, Institute of Occupational and Social Medicine , Dresden, Germany
| | - A Freiberg
- TU Dresden, Faculty of Medicine, Institute of Occupational and Social Medicine , Dresden, Germany
| | - S Drössler
- TU Dresden, Faculty of Medicine, Institute of Occupational and Social Medicine , Dresden, Germany
| | - FS Hussenoeder
- University of Leipzig, Institute of Social Medicine, Occupational Occupational Medicine and Public Health , Leipzig, Germany
| | - I Conrad
- University of Leipzig, Institute of Social Medicine, Occupational Occupational Medicine and Public Health , Leipzig, Germany
| | - S Riedel-Heller
- University of Leipzig, Institute of Social Medicine, Occupational Occupational Medicine and Public Health , Leipzig, Germany
| | - K Romero Starke
- TU Dresden, Faculty of Medicine, Institute of Occupational and Social Medicine , Dresden, Germany
| | - M Schubert
- TU Dresden, Faculty of Medicine, Institute of Occupational and Social Medicine , Dresden, Germany
| |
Collapse
|
15
|
Kramer I, Zigan N, Tanner A, Schulze H, Schubert M. Soziale Roboter im Schweizer Gesundheitswesen – Einsatzmöglichkeiten, Chancen und Risiken aus der Sicht von potenziellen Anwendergruppen. Gr Interakt Org 2022. [PMCID: PMC9510382 DOI: 10.1007/s11612-022-00646-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Dieser Beitrag der Zeitschrift Gruppe. Interaktion. Organisation. (GIO) berichtet und vertieft die Ergebnisse eines interprofessionellen Projektes im Auftrag der TA-SWISS (Stiftung für Technologiefolgen-Abschätzung). In dem Projekt wurde u. a. untersucht, wie soziale Roboter aus der Sicht von Gesundheitsfachpersonen und von Bewohnerinnen und Bewohnern eines Alterszentrums zukünftig in der Schweiz eingesetzt werden können und welche Chancen und Risiken sie bei diesem Einsatz sehen. Hintergrund dieser Fragestellung war, dass soziale Roboter zunehmend im Gesundheitsbereich eingesetzt werden, die Perspektiven der potenziellen Anwenderinnen und Anwender jedoch nur wenig bekannt sind. Daher wurde mit einem explorativen Studiendesign im August 2020 ein Workshop („Round Table Gesundheit“) mit 26 Teilnehmenden durchgeführt, der Roboterszenarien, vier Fokusgruppeninterviews und eine Nachbefragung beinhaltete. Es zeigte sich in der vertieften Analyse, dass sich die von den Teilnehmenden genannten Einsatzmöglichkeiten von sozialen Robotern einerseits in zwei Anwendergruppen („Patientinnen/Patienten“ und „Gesundheitsfachpersonen“) und andererseits in zwei Rollen des sozialen Roboters (persönlich zugeordnet – „persönlicher Buddy/Assistent“ und nicht persönlich zugeordnet – „hilfreicher Kollege“) einteilen liessen. Die Chancen und Risiken sozialer Roboter liessen sich in die drei Spannungsfelder „Selbstbestimmung vs. soziale Isolation“, „Entlastung vs. Belastung & Abhängigkeit“ und „Sicherheit vs. Gefahren“ kategorisieren. Von potenziellen Anwenderinnen und Anwendern werden somit vielfältige Einsatzmöglichkeiten und Chancen für soziale Roboter im Gesundheitsbereich gesehen. Gleichzeitig gilt es auch die Risiken zu berücksichtigen und zu minimieren, damit soziale Roboter zukünftig erfolgreich in der Praxis eingesetzt werden können.
Collapse
|
16
|
Schubert M, Kilzer L, Dubielzig T, Schilling M, Ospelkaus C, Hampel B. Active impedance matching of a cryogenic radio frequency resonator for ion traps. Rev Sci Instrum 2022; 93:093201. [PMID: 36182479 DOI: 10.1063/5.0097583] [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] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/29/2022] [Indexed: 06/16/2023]
Abstract
A combination of direct current (DC) fields and high amplitude radio frequency (RF) fields is necessary to trap ions in a Paul trap. Such high electric RF fields are usually reached with the help of a resonator in close proximity to the ion trap. Ion trap based quantum computers profit from good vacuum conditions and low heating rates that cryogenic environments provide. However, an impedance matching network between the resonator and its RF source is necessary, as an unmatched resonator would require higher input power due to power reflection. The reflected power would not contribute to the RF trapping potential, and the losses in the cable induce additional heat into the system. The electrical properties of the matching network components change during cooling, and a cryogenic setup usually prohibits physical access to integrated components while the experiment is running. This circumstance leads to either several cooling cycles to improve the matching at cryogenic temperatures or the operation of poorly matched resonators. In this work, we demonstrate an RF resonator that is actively matched to the wave impedance of coaxial cables and the signal source. The active part of the matching circuit consists of a varactor diode array. Its capacitance depends on the DC voltage applied from outside the cryostat. We present measurements of the power reflection, the Q-factor, and higher harmonic signals resulting from the nonlinearity of the varactor diodes. The RF resonator is tested in a cryostat at room temperature and cryogenic temperatures, down to 4.3 K. A superior impedance matching for different ion traps can be achieved with this type of resonator.
Collapse
Affiliation(s)
- M Schubert
- Institut für Elektrische Messtechnik und Grundlagen der Elektrotechnik, TU Braunschweig, Hans-Sommer Strasse 66, 38106 Braunschweig, Germany
| | - L Kilzer
- Institut für Quantenoptik, Leibniz Universität Hannover, Welfengarten 1, 30167 Hannover, Germany
| | - T Dubielzig
- Institut für Quantenoptik, Leibniz Universität Hannover, Welfengarten 1, 30167 Hannover, Germany
| | - M Schilling
- Institut für Elektrische Messtechnik und Grundlagen der Elektrotechnik, TU Braunschweig, Hans-Sommer Strasse 66, 38106 Braunschweig, Germany
| | - C Ospelkaus
- Institut für Quantenoptik, Leibniz Universität Hannover, Welfengarten 1, 30167 Hannover, Germany
| | - B Hampel
- Institut für Elektrische Messtechnik und Grundlagen der Elektrotechnik, TU Braunschweig, Hans-Sommer Strasse 66, 38106 Braunschweig, Germany
| |
Collapse
|
17
|
Schubert M, Romero Starke K, Kaboth P, Hegewald J, Reusche M, Gerlach J, Friedemann D, Zülke A, Riedel-Heller SG, Zeeb H, Seidler A. BELÄSTIGUNG UND SCHLAFGESTÖRTHEIT DURCH
VERKEHRSLÄRM: EIN VERGLEICH MIT DEN
WHO-EXPOSITIONS-WIRKUNGSFUNKTIONEN. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753826] [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: 12/12/2022]
Affiliation(s)
- M Schubert
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| | - K Romero Starke
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| | - P Kaboth
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| | - J Hegewald
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
- Bundesanstalt für Arbeitsschutz und Arbeitsmedizin,
Prävention arbeitsbedingter Erkrankungen, Berlin,
Deutschland
| | - M Reusche
- Universität Leipzig, Medizinische Fakultät, Institut
für Medizininformatik, Biometrie und Epidemiologie, Leipzig,
Deutschland
| | - J Gerlach
- Technische Universität Dresden, Institut für
Verkehrsplanung und Straßenverkehr, Professur für
Verkehrsökologie, Dresden, Deutschland
| | | | - A Zülke
- Universität Leipzig, Medizinische Fakultät, Institut
für Arbeits-, Sozial- und Umweltmedizin, Leipzig,
Deutschland
| | - SG Riedel-Heller
- Universität Leipzig, Medizinische Fakultät, Institut
für Arbeits-, Sozial- und Umweltmedizin, Leipzig,
Deutschland
| | - H Zeeb
- Leibniz-Institut für Präventionsforschung und
Epidemiologie – BIPS GmbH, Abteilung Prävention und Evaluation,
Bremen, Deutschland
| | - A Seidler
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| |
Collapse
|
18
|
Seidler A, Freiberg A, Drössler S, Hussenoeder FS, Conrad I, Riedel-Heller SG, Romero Starke K, Schubert M. Erhöhtes Risiko für Depressionen und
Angststörungen bei hohen psychosozialen beruflichen Belastungen
(„High Strain“): ein systematischer Review mit
Metaanalysen. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753709] [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: 12/12/2022]
Affiliation(s)
- A Seidler
- TU Dresden, Medizinische Fakultät Carl Gustav Carus, Institut
und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| | - A Freiberg
- TU Dresden, Medizinische Fakultät Carl Gustav Carus, Institut
und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| | - S Drössler
- TU Dresden, Medizinische Fakultät Carl Gustav Carus, Institut
und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| | - FS Hussenoeder
- Universität Leipzig, Medizinische Fakultät, Institut
für Sozialmedizin, Arbeitsmedizin und Public Health, Leipzig,
Deutschland
| | - I Conrad
- Universität Leipzig, Medizinische Fakultät, Institut
für Sozialmedizin, Arbeitsmedizin und Public Health, Leipzig,
Deutschland
| | - SG Riedel-Heller
- Universität Leipzig, Medizinische Fakultät, Institut
für Sozialmedizin, Arbeitsmedizin und Public Health, Leipzig,
Deutschland
| | - K Romero Starke
- TU Dresden, Medizinische Fakultät Carl Gustav Carus, Institut
und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| | - M Schubert
- TU Dresden, Medizinische Fakultät Carl Gustav Carus, Institut
und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| |
Collapse
|
19
|
Schubert M, Pérez Lanuza L, Wöste M, Dugas M, Carmona FD, Palomino-Morales RJ, Rassam Y, Heilmann-Heimbach S, Tüttelmann F, Kliesch S, Gromoll J. A GWAS in Idiopathic/Unexplained Infertile Men Detects a Genomic Region Determining Follicle-Stimulating Hormone Levels. J Clin Endocrinol Metab 2022; 107:2350-2361. [PMID: 35305013 PMCID: PMC9282256 DOI: 10.1210/clinem/dgac165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Approximately 70% of infertile men are diagnosed with idiopathic (abnormal semen parameters) or unexplained (normozoospermia) infertility, with the common feature of lacking etiologic factors. Follicle-stimulating hormone (FSH) is essential for initiation and maintenance of spermatogenesis. Certain single-nucleotide variations (SNVs; formerly single-nucleotide polymorphisms [SNPs]) (ie, FSHB c.-211G > T, FSHR c.2039A > G) are associated with FSH, testicular volume, and spermatogenesis. It is unknown to what extent other variants are associated with FSH levels and therewith resemble causative factors for infertility. OBJECTIVE We aimed to identify further genetic determinants modulating FSH levels in a cohort of men presenting with idiopathic or unexplained infertility. METHODS We retrospectively (2010-2018) selected 1900 men with idiopathic/unexplained infertility. In the discovery study (n = 760), a genome-wide association study (GWAS) was performed (Infinium PsychArrays) in association with FSH values (Illumina GenomeStudio, v2.0). Minor allele frequencies (MAFs) were analyzed for the discovery and an independent normozoospermic cohort. In the validation study (n = 1140), TaqMan SNV polymerase chain reaction was conducted for rs11031005 and rs10835638 in association with andrological parameters. RESULTS Imputation revealed 9 SNVs in high linkage disequilibrium, with genome-wide significance (P < 4.28e-07) at the FSHB locus 11p.14.1 being associated with FSH. The 9 SNVs accounted for up to a 4.65% variance in FSH level. In the oligozoospermic subgroup, this was increased up to 6.95% and the MAF was enhanced compared to an independent cohort of normozoospermic men. By validation, a significant association for rs11031005/rs10835638 with FSH (P = 4.71e-06/5.55e-07) and FSH/luteinizing hormone ratio (P = 2.08e-12/6.4e-12) was evident. CONCLUSIONS This GWAS delineates the polymorphic FSHB genomic region as the main determinant of FSH levels in men with unexplained or idiopathic infertility. Given the essential role of FSH, molecular detection of one of the identified SNVs that causes lowered FSH and therewith decreases spermatogenesis could resolve the idiopathic/unexplained origin by this etiologic factor.
Collapse
Affiliation(s)
| | | | - Marius Wöste
- Institute of Medical Informatics, University of Münster, Münster, North Rhine-Westphalia 48149, Germany
| | - Martin Dugas
- Institute of Medical Informatics, University of Münster, Münster, North Rhine-Westphalia 48149, Germany
- Institute of Medical Informatics, Heidelberg University Hospital, D-69120 Heidelberg, Germany
| | - F David Carmona
- Department of Genetics and Institute of Biotechnology, University of Granada, Granada, Andalusia 18016, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Andalusia 18012, Spain
| | - Rogelio J Palomino-Morales
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Andalusia 18012, Spain
- Department of Biochemistry and Molecular Biology I, Faculty of Sciences, University of Granada, Granada, Andalusia 18071, Spain
| | - Yousif Rassam
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, North Rhine-Westphalia 48149, Germany
| | - Stefanie Heilmann-Heimbach
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital, Bonn, North Rhine-Westphalia 53127, Germany
| | - Frank Tüttelmann
- Institute of Reproductive Genetics, University of Münster, Münster, North Rhine-Westphalia 48149, Germany
| | - Sabine Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, North Rhine-Westphalia 48149, Germany
| | - Jörg Gromoll
- Correspondence: Jörg Gromoll, Dr. rer. nat., Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology, University of Münster, Albert-Schweitzer-Campus 1, Geb. D11, 48149 Münster, Germany.
| |
Collapse
|
20
|
Schubert M, Krenz H, Sansone A, Kliesch S, Gromoll J. O-248 Cluster Analysis of men with idiopathic and unexplained male infertility identifies FSHB Genotype as relevant diagnostic parameter. Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.030] [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: 11/13/2022] Open
Abstract
Abstract
Study question
In a cohort of idiopathic and unexplained infertile men we aimed to identify subgroups with similar characteristics, and therewith underlying etiologic factors, by clustering approach.
Summary answer
We identified two distinct patient clusters. Across all diverse phenotypes of infertility, the strongest segregation markers were FSHB c.-211G>T, FSH, and bi-testicular volume.
What is known already
In about 30-75% of infertile men no major causative factors can be identified; leading to the diagnose of unexplained (normozoospermia) or idiopathic (abnormal semen parameters) male infertility. This cohort of men remains very heterogenous, albeit the detailed andrological characterization that is currently applied in infertility workup.
New analysis tools such as machine learning and cluster analysis can provide a more in-depth approach. Such explorative analyses have the potential to uncover hitherto hidden patterns in data that might be difficult to spot for andrologists but become visible by these tools.
Study design, size, duration
A Cluster analysis was retrospectively performed in a clinically well characterized cohort of 2742 men with unexplained or idiopathic male infertility. These men had visited our Centre within a 10-year period (2008-2018) for infertility workup. Due to the well curated database (Androbase®) we were able to include up to 37 andrologic parameters in the unbiased cluster analysis.
Participants/materials, setting, methods
After applying strict selection criteria 2742, of initially 7627, infertile men remained for cluster analysis (exclusion: obstructive -, genetic -, other causative factors, female factor; inclusion: azoo- to normozoospermia, FSH ≥ 1IU/l, Testosterone ≥ 8nmol/l). For subsequent analyses the following parameters were included: somatic/semen/hormone parameters, testicular sonography and testis volume, genotyping of the FSHB c.-211G>T (rs10835638) single nucleotide polymorphism. For cluster analysis, partitioning around medoids method was employed based on Gower distance between patients.
Main results and the role of chance
The applied cluster approach for the study population yielded two separate clusters (average silhouette width ∼0.12). These clusters showed significantly different distributions in bi-testicular volume, FSH and FSHB genotype. Cluster 1 contained all men homozygous for G (wildtype) in FSHB c.-211G>T (100%), while Cluster 2 contained most patients carrying a T allele (>96.6%). Even in subgroup analysis (Total sperm count (TSC) <1Mill and TSC 1³Mill) two clusters each were formed too. Again, the strongest segregation markers between the respective clusters were FSHB c.-211G>T, bitesticular volume, and FSH, supporting the notion of a contributing genetic factor.
Surprisingly, sperm parameters like TSC, motility and morphology played a minor role in cluster formation; as well as testicular maldescent, varicocele, smoking, and microlithiasis testes.
The genetic parameter of FSHB c.-211G>T in combination with the established parameters FSH and testicular volume should attract more attention in future clinical workups of infertile men with unknown etiologic factors.
Limitations, reasons for caution
Categorical and numeric features contribute diversely to the calculation of patient dissimilarity. Potentially, categorical features can have a higher impact because patients are rated as completely different if they fall in different categories; for numeric features, the dissimilarity depends on the range of values.
Wider implications of the findings
The FSHB SNP was identified as an informative segregation marker; we therefore suggest introducing diagnostic genotyping into clinical routine in men with so far idiopathic or unexplained male infertility. This may reduce the high number of infertile men with so far unknown origin by nearly one-third.
Trial registration number
DFG Clinical Research Unit 326 Male Germ Cells
Collapse
Affiliation(s)
- M Schubert
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology- University Münster , Münster, Germany
| | - H Krenz
- Institute of Medical Informatics, University of Münster , Münster, Germany
| | - A Sansone
- Department of Systems Medicine, Chair of Endocrinology and Medical Sexology- University of Rome Tor Vergata , Rome, Italy
| | - S Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology- University Münster , Münster, Germany
| | - J Gromoll
- Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology CeRA- University of Münster , Münster, Germany
| |
Collapse
|
21
|
Chiappinotto S, Papastavrou E, Efstathiou G, Andreou P, Stemmer R, Ströhm C, Schubert M, de Wolf-Linder S, Longhini J, Palese A. Antecedents of unfinished nursing care: a systematic review of the literature. BMC Nurs 2022; 21:137. [PMID: 35698217 PMCID: PMC9195215 DOI: 10.1186/s12912-022-00890-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 12/09/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unfinished Nursing Care (UNC) concept, that express the condition when nurses are forced to delay or omit required nursing care, has been largely investigated as tasks left undone, missed care, and implicit rationing of nursing care. However, no summary of the available evidence regarding UNC antecedents has been published. The aim of this study is to identify and summarise antecedents of UNC as documented in primary studies to date. METHODS A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. MEDLINE, CINAHL, SCOPUS, and PROSPERO databases were searched for quantitative studies reporting the relationships between antecedents and UNC published after 2004 up to 21 January 2020. The reference lists of secondary studies have been scrutinised to identify additional studies. Two reviewers independently identified studies and evaluated them for their eligibility and disagreements were resolved by the research team. The quality appraisal was based on the Joanna Briggs Institute Critical Appraisal tools, according to the study designs. A data extraction grid was piloted and then used to extract data. The antecedents that emerged were thematically categorised with an inductive approach. RESULTS Fifty-eight studies were included; among them, 54 were cross-sectional, three were cohort studies, and one was a quasi-experimental study. They were conducted mainly in the United States and in hospital settings. The UNC antecedents have been investigated to date at the (a) unit (e.g., workloads, non-nursing tasks), (b) nurse (e.g., age, gender), and (c) patient levels (clinical instability). CONCLUSIONS At the unit level, it is highly recommended to provide an adequate staff level, strategies to deal with unpredictable workloads, and to promote good practice environments to reduce or minimise UNC. By contrast, at the nurse and patient levels, there were no clear trends regarding modifiable factors that could decrease the occurrence of UNC. The map of antecedents that emerged can be used to design interventional studies aimed at changing research from merely descriptive to that which evaluates the effectiveness of interventions.
Collapse
Affiliation(s)
| | - Evridiki Papastavrou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Georgios Efstathiou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.,Nursing Services, Ministry of Health, Nicosia, Cyprus
| | | | | | | | - Maria Schubert
- School of Health Professions, Zurich University of Applied Science, Winterthur, Switzerland
| | - Susanne de Wolf-Linder
- School of Health Professions, Zurich University of Applied Science, Winterthur, Switzerland
| | - Jessica Longhini
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy.
| |
Collapse
|
22
|
Schmid M, Giger R, Nisa L, Mueller SA, Schubert M, Schubert AD. Association of Multiprofessional Preoperative Assessment and Information for Patients With Head and Neck Cancer With Postoperative Outcomes. JAMA Otolaryngol Head Neck Surg 2022; 148:259-267. [PMID: 35050322 PMCID: PMC8778600 DOI: 10.1001/jamaoto.2021.4048] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IMPORTANCE Multidisciplinary perioperative assessment for patients undergoing complex oncologic head and neck cancer (HNC) surgery is widely implemented. However, to our knowledge, the association of multiprofessional preoperative assessment, information, and briefing with postoperative outcomes has not been evaluated. OBJECTIVE To compare postoperative complications, length of hospital stay (LOS), readmissions, mortality, and costs per case among patients undergoing complex oncologic HNC surgery before and after the implementation of a comprehensive preoperative multiprofessional assessment and information day (MUPAID). DESIGN, SETTING, AND PARTICIPANTS This retrospective, single-center case-control study was conducted at a tertiary referral head and neck anticancer center/university cancer institute and compared patients with HNC who were undergoing complex oncological surgeries between January 2012 and July 2018 before (control group) and after (intervention group) implementation of the institutional MUPAID. Data analysis was conducted between 2019 and 2020. The intervention group comprised patients who participated in the MUPAID beginning in February 2015. These patients were assessed by a multiprofessional team and provided with structured and comprehensive information on the surgical procedure and its functional, social, financial, and psychological effects, as well as the postoperative care, rehabilitation, and follow-up period. Patients in the control group had also undergone complex oncologic HNC surgery and were selected through surgical procedure codes. MAIN OUTCOMES AND MEASURES The end points were postoperative rate and severity of complications, LOS, readmissions, mortality, and costs per case. RESULTS The study included 161 patients, 81 in the intervention (25 women [30.9%]) and 80 in the control group (18 women [22.5%]). The groups showed no relevant differences in sociodemographic, disease, and procedural characteristics. The intervention cohort presented with fewer major local and systemic complications (Clavien-Dindo score, III-V: 34.6% vs 52.5%; difference proportion, -0.179; 95% CI, -0.33 to -0.03), shorter median LOS (12 days [IQR, 10-16 days] vs 16 days [IQR, 11-20] days; effect size, 0.482; 95% CI Cohen d, 0.152-0.812) and decreased median charge per case ($50 848 [IQR, $42 510-$63 479] vs $69 602 [IQR, $45 631-$96 280]; effect size, 0.534; 95% CI Cohen d, 0.22-0.85). CONCLUSIONS AND RELEVANCE The results of this case-control study suggest that MUPAID for patients who are undergoing complex oncologic HNC surgery is associated with shortened LOS and costs per case as well as decreased complications severity. These results are promising on a patient level in the potential to minimize individual treatment burden, as well as on an institutional and health care system level in the potential significant optimization of surgical outcomes and financial aspects.
Collapse
Affiliation(s)
- Manuela Schmid
- Department of Nursing, Medical-Technical and Medical-Therapeutic Areas, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology–Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lluís Nisa
- Department of Otorhinolaryngology–Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Andreas Mueller
- Department of Otorhinolaryngology–Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria Schubert
- School of Health Professions, Zurich University of Applied Science, Winterthur, Switzerland,Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Adrian Daniel Schubert
- Department of Otorhinolaryngology–Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
23
|
Krenz H, Sansone A, Kliesch S, Gromoll J, Schubert M. FSHB Genotype Identified as a Relevant Diagnostic Parameter Revealed by Cluster Analysis of Men With Idiopathic Infertility. Front Endocrinol (Lausanne) 2021; 12:780403. [PMID: 34992580 PMCID: PMC8725293 DOI: 10.3389/fendo.2021.780403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/18/2021] [Indexed: 02/03/2023] Open
Abstract
Introduction and Objectives About 30-75% of infertile men are diagnosed with idiopathic infertility, thereby lacking major causative factors to explain their impaired fertility status. In this study, we used a large cohort of idiopathic infertile men to determine whether subgroups could be identified by an unbiased clustering approach and whether underlying etiologic factors could be delineated. Patients and Methods From our in-house database Androbase®, we retrospectively selected patients (from 2008 to 2018) with idiopathic male infertility (azoo- to normozoospermia) who fit the following selection criteria: FSH ≥ 1 IU/l, testosterone ≥ 8 nmol/l, ejaculate volume ≥ 1.5 ml. Patients with genetic abnormalities or partners with female factors were excluded.For the identified study population (n=2742), we used common andrologic features (somatic, semen and hormonal parameters, including the FSHB c.-211G>T (rs10835638) single nucleotide polymorphism) for subsequent analyses. Cluster analyses were performed for the entire study population and for two sub-cohorts, which were separated by total sperm count (TSC) thresholds: Cohort A (TSC ≥ 1 mill/ejac; n=2422) and Cohort B (TSC < 1 mill/ejac; n=320). For clustering, the partitioning around medoids method was employed, and the quality was evaluated by average silhouette width. Results The applied cluster approach for the whole study population yielded two separate clusters, which showed significantly different distributions in bi-testicular volume, FSH and FSHB genotype. Cluster 1 contained all men homozygous for G (wildtype) in FSHB c.-211G>T (100%), while Cluster 2 contained most patients carrying a T allele (>96.6%). In the analyses of sub-cohorts A/B, two clusters each were formed too. Again, the strongest segregation markers between the respective clusters were bi-testicular volume, FSH and FSHB c.-211G>T. Conclusion With this first unbiased approach for revealing putative subgroups within a heterogenous group of idiopathic infertile men, we did indeed identify distinct patient clusters. Surprisingly, across all diverse phenotypes of infertility, the strongest segregation markers were FSHB c.-211G>T, FSH, and bi-testicular volume. Further, Cohorts A and B were significantly separated by FSHB genotype (wildtype vs. T-allele carriers), which supports the notion of a contributing genetic factor. Consequently, FSHB genotyping should be implemented as diagnostic routine in patients with idiopathic infertility.
Collapse
Affiliation(s)
- Henrike Krenz
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Andrea Sansone
- Department of Systems Medicine, Chair of Endocrinology and Medical Sexology, University of Rome Tor Vergata, Rome, Italy
| | - Sabine Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology (CeRA), University of Münster, Münster, Germany
| | - Joerg Gromoll
- Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology (CeRA), University of Münster, Münster, Germany
| | - Maria Schubert
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology (CeRA), University of Münster, Münster, Germany
| |
Collapse
|
24
|
Zipser CM, Hildenbrand FF, Haubner B, Deuel J, Ernst J, Petry H, Schubert M, Jordan KD, von Känel R, Boettger S. Predisposing and Precipitating Risk Factors for Delirium in Elderly Patients Admitted to a Cardiology Ward: An Observational Cohort Study in 1,042 Patients. Front Cardiovasc Med 2021; 8:686665. [PMID: 34660708 PMCID: PMC8513394 DOI: 10.3389/fcvm.2021.686665] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/27/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: Although the risk factors for delirium in general medicine are well-established, their significance in cardiac diseases remains to be determined. Therefore, we evaluated the predisposing and precipitating risk factors in patients hospitalized with acute and chronic heart disease. Methods and Results: In this observational cohort study, 1,042 elderly patients (≥65 years) admitted to cardiology wards, 167 with and 875 without delirium, were included. The relevant sociodemographic and cardiac- and medical-related clusters were assessed by simple and multiple regression analyses and prediction models evaluating their association with delirium. The prevalence of delirium was 16.0%. The delirious patients were older (mean 80 vs. 76 years; p < 0.001) and more often institutionalized prior to admission (3.6 vs. 1.4%, p = 0.05), hospitalized twice as long (12 ± 10 days vs. 7 ± 7 days; p < 0.001), and discharged more often to nursing homes (4.8 vs. 0.6%, p < 0.001) or deceased (OR, 2.99; 95% CI, 1.53–5.85; p = 0.003). The most relevant risk factor was dementia (OR, 18.11; 95% CI, 5.77–56.83; p < 0.001), followed by history of stroke (OR, 6.61; 95% CI 1.35–32.44; p = 0.020), and pressure ulcers (OR, 3.62; 95% CI, 1.06–12.35; p = 0.040). The predicted probability for developing delirium was highest in patients with reduced mobility and institutionalization prior to admission (PP = 31.2%, p = 0.001). Of the cardiac diseases, only valvular heart disease (OR, 1.57; 95% CI, 1.01–2.44; p = 0.044) significantly predicted delirium. The patients undergoing cardiac interventions did not have higher rates of delirium (OR, 1.39; 95% CI 0.91–2.12; p = 0.124). Conclusion: In patients admitted to a cardiology ward, age-related functional and cognitive impairment, history of stroke, and pressure ulcers were the most relevant risk factors for delirium. With regards to specific cardiological factors, only valvular heart disease was associated with risk for delirium. Knowing these factors can help cardiologists to facilitate the early detection and management of delirium.
Collapse
Affiliation(s)
- Carl Moritz Zipser
- Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland.,Department of Neurology and Neurophysiology, University of Zurich, Balgrist University Hospital, Zurich, Switzerland
| | | | - Bernhard Haubner
- Department of Cardiology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Jeremy Deuel
- Stem Cell Institute, University of Cambridge, Cambridge, United Kingdom.,Department of Hematology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Jutta Ernst
- Center for Clinical Nursing Science, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Heidi Petry
- Center for Clinical Nursing Science, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Maria Schubert
- Zurich University of Applied Science, School of Health Professions, Winterthur, Switzerland
| | - Katja-Daniela Jordan
- Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Roland von Känel
- Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Soenke Boettger
- Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
25
|
Raguindin PF, Stoyanov J, Eriks I, Stucki G, Jordan X, Schubert M, Franco OH, Muka T, Glisic M. Changes in cardiometabolic risk factors during inpatient rehabilitation of traumatic spinal cord injury from a multicenter Swiss Spinal Cord Injury Cohort (SwiSCI). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2741] [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
Introduction
Cardiometabolic health has a growing relevance in spinal cord injury (SCI) considering the increasing survival and aging population. We explored longitudinal changes in cardiometabolic risk profile and examined whether injury characteristics could be a non-modifiable risk factor for individuals with SCI in subacute phase of the injury.
Methods
We used the data from a multicenter Swiss Spinal Cord Injury Cohort (SwiSCI) study and included adults with traumatic SCI (TSCI) without cardiometabolic diseases and diabetes at baseline. We included individuals with available data on admission and prior to discharge from first SCI rehabilitation. Blood pressure, lipid profile, fasting glucose, waist circumference (WC), weight, and body mass index (BMI) were compared according to the injury level (tetraplegia-TP vs paraplegia-PP) and completeness (motor complete-COM vs incomplete-INC). We used multivariable linear regression for cross-sectional analysis and linear mixed models for longitudinal analysis, adjusting for age, sex, lifestyle factors, medication-use, and injury characteristics. We performed age- (above and below median age) and sex-stratified analyses. Sensitivity analyses were also performed by removing systemic steroid-use (proxy for acute injury), adjusting for opioid-use (medication side-effect) and adjusting further for BMI and WC.
Results
We analyzed 258 individuals with TSCI (110 TP and 148 PP, 122 COM and 136 INC). Median age was 50 years (IQR 32–60), with 76.36% (n=197) of the population being male. The median rehabilitation duration was 5.5 months (IQR 3.2–7.1). On admission, the fully-adjusted models showed higher baseline weight, systolic BP, diastolic BP and triglycerides in PP than TP. Systolic BP, diastolic BP, HDL, HDL/LDL were higher in INC than COM. In the overall population, we observed increases in cholesterol, HDL, and HDL/LDL ratio over rehabilitation period. Individuals with PP had a higher increase in BMI as compared to TT, while no differences were detected when comparing INC and COM injury (Table 1–3). Results from sensitivity analyses were generally in line with the overall findings; however, at baseline, there was some indication that lipid profile may be different in COM and INC injury. In sex-stratified longitudinal analysis, triglycerides were higher in females PP than TP, and diastolic BP was higher in females with INC than COM. For age-stratified longitudinal analysis, elderly with PP have higher triglycerides than younger adults.
Conclusion
We reported changes in BMI and lipid profile during the inpatient rehabilitation of individuals with traumatic SCI and without history of cardiovascular diseases and diabetes. Injury characteristics may not be an independent risk factor for subacute phase, but maybe important in specific subgroups, like in women and in the elderly (>50 years old).
Funding Acknowledgement
Type of funding sources: None. MethodsResults
Collapse
Affiliation(s)
- P F Raguindin
- Institute of Social and Preventive Medicine. University of Bern, Bern, Switzerland
| | - J Stoyanov
- Swiss Paraplegic Research, Notwill, Switzerland
| | - I Eriks
- Swiss Paraplegic Center, Nottwil, Switzerland
| | - G Stucki
- Swiss Paraplegic Research, Notwill, Switzerland
| | - X Jordan
- Clinique Romande de Réadaptation, Sion, Switzerland
| | - M Schubert
- University Hospital Balgrist, Zurich, Switzerland
| | - O H Franco
- Institute of Social and Preventive Medicine. University of Bern, Bern, Switzerland
| | - T Muka
- Institute of Social and Preventive Medicine. University of Bern, Bern, Switzerland
| | - M Glisic
- Swiss Paraplegic Research, Notwill, Switzerland
| | | |
Collapse
|
26
|
Schubert M, Weise SM, Knöller K. Atmospheric washout of 35S during single rain events - Implications for 35S sampling schemes. J Environ Radioact 2021; 237:106669. [PMID: 34118616 DOI: 10.1016/j.jenvrad.2021.106669] [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: 03/12/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 06/12/2023]
Abstract
Cosmogenic radiosulfur (35S; half-life: 87.4 days) is transferred with the rain to the groundwater (as 35SO42-) and can be used as residence time tracer for the detection of sub-yearly groundwater residence times. Due to the distinct but non-regular annual 35S pattern in precipitation, related data evaluation requires consideration of a35S input function that is based on representative rain samples. While minor rain events can easily be sampled quantitatively and hence representatively, a long-lasting rain event may get documented by a sample that represents only a certain sequence of the event, thus potentially resulting in a35S activity concentration that might not be representative. With the aim to examine the magnitude of temporal variations of the 35S activity concentration in rain during long-lasting rain events, we present and discuss two related exemplary 35S time series. Furthermore, we evaluate the applicability of the parameters total sulfate and electrical conductivity (EC), both detected in rainwater as easily attainable 35S proxies. The results of the study show (i) that the 35S activity concentration may vary substantially during long-lasting rain events due to atmospheric migration processes and aerosol washout and (ii) that neither sulfate nor EC are suitable as 35S proxies due to the different origin of 35S on the one hand and sulfate/EC on the other. Hence, for the determination of a35S activity concentration that is representative for a long-lasting rain event 35S analyses of an adequate number of sub-samples cannot be avoided.
Collapse
Affiliation(s)
- M Schubert
- UFZ Helmholtz Centre for Environmental Research, Permoserstr. 15, 04318, Leipzig, Germany.
| | - S M Weise
- UFZ Helmholtz Centre for Environmental Research, Theodor-Lieser-Str. 4, 06120, Halle, Germany
| | - K Knöller
- UFZ Helmholtz Centre for Environmental Research, Theodor-Lieser-Str. 4, 06120, Halle, Germany
| |
Collapse
|
27
|
Sieber M, Rudiger A, Schüpbach R, Krüger B, Schubert M, Bettex D. Outcome, demography and resource utilization in ICU Patients with delirium and malignancy. Sci Rep 2021; 11:18756. [PMID: 34548568 PMCID: PMC8455636 DOI: 10.1038/s41598-021-98200-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/31/2021] [Indexed: 01/09/2023] Open
Abstract
Delirium in the general intensive care unit (ICU) population is common, associated with adverse outcomes and well studied. However, knowledge on delirium in the increasing number of ICU patients with malignancy is scarce. The aim was to assess the frequency of delirium and its impact on resource utilizations and outcomes in ICU patients with malignancy. This retrospective, single-center longitudinal cohort study included all patients with malignancy admitted to ICUs of a University Hospital during one year. Delirium was diagnosed by an Intensive Care Delirium Screening Checklist (ICDSC) score ≥ 4. Of 488 ICU patients with malignancy, 176/488 (36%) developed delirium. Delirious patients were older (66 [55-72] vs. 61 [51-69] years, p = 0.001), had higher SAPS II (41 [27-68] vs. 24 [17-32], p < 0.001) and more frequently sepsis (26/176 [15%] vs. 6/312 [1.9%], p < 0.001) and/or shock (30/176 [6.1%] vs. 6/312 [1.9%], p < 0.001). In multivariate analysis, delirium was independently associated with lower discharge home (OR [95% CI] 0.37 [0.24-0.57], p < 0.001), longer ICU (HR [95% CI] 0.30 [0.23-0.37], p < 0.001) and hospital length of stay (HR [95% CI] 0.62 [0.50-0.77], p < 0.001), longer mechanical ventilation (HR [95% CI] 0.40 [0.28-0.57], p < 0.001), higher ICU nursing workload (B [95% CI] 1.92 [1.67-2.21], p < 0.001) and ICU (B [95% CI] 2.08 [1.81-2.38], p < 0.001) and total costs (B [95% CI] 1.44 [1.30-1.60], p < 0.001). However, delirium was not independently associated with in-hospital mortality (OR [95% CI] 2.26 [0.93-5.54], p = 0.074). In conclusion, delirium was a frequent complication in ICU patients with malignancy independently associated with high resource utilizations, however, it was not independently associated with in-hospital mortality.
Collapse
Affiliation(s)
- Mattia Sieber
- grid.508842.30000 0004 0520 0183Department of Internal Medicine, Zuger Kantonsspital, Landhausstrasse 11, 6340 Baar, Switzerland
| | - Alain Rudiger
- grid.459754.e0000 0004 0516 4346Department of Medicine, Spital Limmattal, Urdorferstrasse 100, 8952 Schlieren, Switzerland
| | - Reto Schüpbach
- grid.412004.30000 0004 0478 9977Institute of Intensive Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Bernard Krüger
- grid.412004.30000 0004 0478 9977Cardio-Surgical Intensive Care Unit, Institute of Anesthesiology, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Maria Schubert
- grid.19739.350000000122291644School of Health Professions, Institute of Nursing, Zurich University of Applied Science, Technikumstr. 81, P.O. Box, 8401 Winterthur, Switzerland
| | - Dominique Bettex
- grid.412004.30000 0004 0478 9977Cardio-Surgical Intensive Care Unit, Institute of Anesthesiology, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| |
Collapse
|
28
|
Yang Y, Venkataramani V, Schubert M, Beretta C, Botz M, Fankhauser L, Wick W, Kuner T, Winkler F. P13.01 Neuronal activity drives distinct invasion modes of glioma cells. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.112] [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] Open
Abstract
Abstract
BACKGROUND
Gliomas are incurable brain tumors characterized by their infiltrative growth which makes them a whole-brain disease. Previously we described membrane protrusions called tumor microtubes (TMs), and glutamatergic synapses between neurons and glioma cells, as mechanisms contributing to glioma cell invasion and tumor progression. However, the interrelation of the two, and the exact mechanisms of glioma cell dynamics over time was unknown. Therefore, we investigate neuronal synaptic input on TM-associated glioma cell motility.
MATERIAL AND METHODS
Here we established a novel workflow for analyzing single glioma cell dynamics over several hours with in-vivo two-photon microscopy. First, a membranous fluorescent marking of patient-derived glioma cells was established to reliably track membrane changes. Secondly, augmented microscopy based on deep- and machine-learning algorithms was used to track glioma cells. Neuronal activity was manipulated with different doses of isoflurane anesthesia, and used to study its effects on glioma cell dynamics.
RESULTS
This novel method revealed that motility of glioma cells can be described by the displacement of whole glioma cell somata (somatokinesis) and TM dynamics. TM motility in turn could be sub-categorized into protrusion, retraction and branching. Next, we describe three different invasion modes, all with similarities to different cell types involved in CNS development. Lastly, the effects of neuronal activity on glioma cell invasion were investigated. With the application of high anesthesia and subsequently reduced neuronal activity, TM turnover, branching events and as a result glioma cell invasion were inhibited, but in a heterogeneous manner.
CONCLUSION
The novel workflow allowed to comprehensively characterize glioma cell invasion over several hours. Its application demonstrates novel, hitherto unknown cellular mechanisms of glioma cell invasion, and provides a link between TM biology and neuron-glioma communication. Finally, neuronal input drives distinct subtypes of glioma cell motility patterns.All in all, this work presents an important first step in understanding mechanisms that lead to the whole- brain colonization of glioma cells making these brain tumors incurable. A further characterization of the exact molecular mechanisms that drive neuronal activity-dependent glioma cell motility is warranted.
Collapse
Affiliation(s)
- Y Yang
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - V Venkataramani
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - M Schubert
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - C Beretta
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
- CellNetworks Math-Clinic, Heidelberg University, Heidelberg, Germany
| | - M Botz
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - L Fankhauser
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - W Wick
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - T Kuner
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - F Winkler
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
29
|
Schubert M, Pérez Lanuza L, Wöste M, Dugas M, Rassam Y, Heilmann-Heimbach S, Tüttelmann F, Kliesch S, Gromoll J. O-089 A Genome Wide Association Study in men with unexplained infertility identifies nine SNPs at the FSHB locus to be associated with Follicle Stimulating Hormone level. Hum Reprod 2021. [DOI: 10.1093/humrep/deab125.019] [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] Open
Abstract
Abstract
Study question
Which single nucleotide polymorphisms (SNPs) are associated with Follicle stimulating hormone (FSH) levels in men with unexplained infertility and can affect FSH action and spermatogenesis?
Summary answer
We identified a genomic region at chromosome 11p.14.1, including nine SNPs, that are significantly associated with FSH levels in men with unexplained infertility.
What is known already
FSH action is essential for the initiation and maintenance of human spermatogenesis. One well-studied SNP, FSHB c.-211G>T (rs10835638), is associated with FSHB mRNA transcription and directly affects FSH serum levels, testicular volume and spermatogenesis. Carriers of a T-allele in this promoter are diagnosed with functional secondary hypogonadism with isolated FSH deficiency.
Other genetic variants, for example at the FSHR have been shown to slightly modulate FSH action, however the clinical impact in these variants seems to
be low. The so far identified FSH-associated SNPs revealed an impact of up to 2.3 % on FSH serum level variance.
Study design, size, duration
A Genome wide association study (GWAS) was performed on a clinically well characterized cohort of 742 men with unexplained infertility (discovery study). Of the nine identified SNPs, validation was performed for rs11031005 and the already described rs10835638 in an independent cohort of 1123 men with unexplained infertility (validation study).
Participants/materials, setting, methods
Patients were retrospectively selected from our CeRA database Androbase® applying strict selection criteria; DNA was isolated from stored EDTA-blood samples. Informative genetic variants were identified using Illumina PsychArray v1.3. Illumina®GenomeStudio v2.0, PLINK v1.90 and R 3.6.3 were used to perform quantitative association analysis based on normalized FSH values. The validation study was performed using TaqMan PCR for SNP detection and R 3.6.3 for quantitative association to analyze the impact of each SNP on FSH level.
Main results and the role of chance
Imputation of the GWAS data revealed 94 SNPs with suggestive significance (p < 8.56e-06) and nine SNPs (including rs10835638) with genome-wide significance (p < 4.28e-07). The nine SNPs are all located at the FSHB locus on Chromosome 11p.14.1 and are in high linkage disequilibrium (LD). The validation study of 1123 patients with unexplained infertility for the SNPs rs11003005 and rs10835638 revealed a significant association with FSH (p = 4.71e-06 and p = 5.55e-07) and FSH/LH ratio (p = 2.08e-12 and p = 6.4e-12).The nine significant SNPs accounted for 3.60 –4.65 % variance in FSH serum level each in the entire discovery cohort. In an oligozoospermic subgroup (n = 249) this effect was increased to 4.89 – 6.95 %.
This the first GWAS in men with unexplained infertility. This study shows that not one single SNP, but rather a genomic region has an impact on FSH serum level in men with unexplained male infertility. This effect is even more pronounced in the more severe phenotype of oligozoospermic men.
Limitations, reasons for caution
The study is restricted to men with unexplained infertility, which might cause a selection bias. Validation and functional evaluation of the eight newly identified SNPs in independent cohorts would emphasize the results more. The sample size of 742 limits detection of loci with smaller effect on FSH levels.
Wider implications of the findings
The determination of one of the nine SNPs can improve diagnostic precision in identifying men with secondary functional hypogonadism with isolated FSH deficiency. An oligozoospermic subgroup of these men would putatively benefit from FSH treatment and has to be proven in randomized controlled trials.
Trial registration number
German Research Foundation CRU326
Collapse
Affiliation(s)
- M Schubert
- Centre of Reproductive Medicine and Andrology CeRA- University Münster, Department of Clinical and Surgical Andrology, Münster, Germany
| | - L Pérez Lanuza
- University Childreńs Hospital Münster, Department of Pediatric Hematology and Oncology, Münster, Germany
| | - M Wöste
- University of Münster, Institute of Medical Informatics, Münster, Germany
| | - M Dugas
- University of Münster, Institute of Medical Informatics, Münster, Germany
| | - Y Rassam
- Centre of Reproductive Medicine and Andrology CeRA- University Münster, Department of Clinical and Surgical Andrology, Münster, Germany
| | - S Heilmann-Heimbach
- University of Bonn- School of Medicine & University Hospital Bonn, Institute of Human Genetics, Bonn, Germany
| | - F Tüttelmann
- University of Münster, Institute of Reproductive Genetics, Münster, Germany
| | - S Kliesch
- Centre of Reproductive Medicine and Andrology CeRA- University Münster, Department of Clinical and Surgical Andrology, Münster, Germany
| | - J Gromoll
- Centre of Reproductive Medicine and Andrology CeRA- University of Münster, Institute of Reproductive and Regenerative Biology, Münster, Germany
| |
Collapse
|
30
|
Zipser CM, Deuel JW, Held JPO, Ernst J, Schubert M, Weller M, Luft AR, von Känel R, Boettger S. Economic Impact of Poststroke Delirium and Associated Risk Factors: Findings From a Prospective Cohort Study. Stroke 2021; 52:3325-3334. [PMID: 34233463 DOI: 10.1161/strokeaha.120.033005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Delirium is a common severe complication of stroke. We aimed to determine the cost-of-illness and risk factors of poststroke delirium (PSD). METHODS This prospective single-center study included n=567 patients with acute stroke from a hospital-wide delirium cohort study and the Swiss Stroke Registry in 2014. Delirium was determined by Delirium Observation Screening Scale or Intensive Care Delirium Screening Checklist 3 times daily during the first 3 days of admission. Costs reflected the case-mix index and diagnosis-related groups from 2014 and were divided into nursing, physician, and total costs. Factors associated with PSD were assessed with multiple regression analysis. Partial correlations and quantile regression were performed to assess costs and other factors associated with PSD. RESULTS The incidence of PSD was 39.0% (221/567). Patients with delirium were older than non-PSD (median 76 versus 70 years; P<0.001), 52% male (115/221) versus 62% non-PSD (214/346) and hospitalized longer (mean 11.5 versus 9.3 days; P<0.001). Dementia was the most relevant predisposing factor for PSD (odds ratio, 16.02 [2.83-90.69], P=0.002). Moderate to severe stroke (National Institutes of Health Stroke Scale score 16-20) was the most relevant precipitating factor (odds ratio, 36.10 [8.15-159.79], P<0.001). PSD was a strong predictor for 3-month mortality (odds ratio, 15.11 [3.33-68.53], P<0.001). Nursing and total costs were nearly twice as high in PSD (P<0.001). There was a positive correlation between total costs and admission National Institutes of Health Stroke Scale (correlation coefficient, 0.491; P<0.001) and length of stay (correlation coefficient, 0.787; P<0.001) in all patients. Quantile regression revealed rising nursing and total costs associated with PSD, higher National Institutes of Health Stroke Scale, and longer hospital stay (all P<0.05). CONCLUSIONS PSD was associated with greater stroke severity, prolonged hospitalization, and increased nursing and total costs. In patients with severe stroke, dementia, or seizures, PSD is anticipated, and additional costs are associated with hospitalization.
Collapse
Affiliation(s)
- Carl Moritz Zipser
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Switzerland. (C.M.Z., R.v.K.).,Department of Neurology and Neurophysiology, University of Zurich, Balgrist University Hospital, Switzerland (C.M.Z.)
| | - Jeremy Werner Deuel
- Department of Haematology and MRC - Wellcome Stem Cell Institute, University of Cambridge, Jeffrey Cheah Biomedical Centre, United Kingdom (J.W.D.)
| | - Jeremia Philipp Oskar Held
- Department of Neurology, Vascular Neurology and Rehabilitation, University of Zurich, University Hospital Zurich, Switzerland. (J.P.O.H., M.W., A.R.L.)
| | - Jutta Ernst
- Center of Clinical Nursing Science, University of Zurich, University Hospital Zurich, Switzerland. (J.E.)
| | - Maria Schubert
- Zurich University of Applied Science, School of Health Professions, Winterthur, Switzerland (M.S.)
| | - Michael Weller
- Department of Neurology, Vascular Neurology and Rehabilitation, University of Zurich, University Hospital Zurich, Switzerland. (J.P.O.H., M.W., A.R.L.)
| | - Andreas Rüdiger Luft
- Department of Neurology, Vascular Neurology and Rehabilitation, University of Zurich, University Hospital Zurich, Switzerland. (J.P.O.H., M.W., A.R.L.).,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.R.L.)
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Switzerland. (C.M.Z., R.v.K.)
| | - Soenke Boettger
- University of Zurich, University Hospital Zurich, Switzerland (S.B.)
| |
Collapse
|
31
|
Giger R, Schmid M, Schubert A, Nisa L, Mueller S, Schubert M. P-120 Benefit of a multiprofessional preoperative information day for head and neck cancer patients after complex surgery. Oral Oncol 2021. [DOI: 10.1016/s1368-8375(21)00407-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
32
|
Schubert M, Pérez Lanuza L, Wöste M, Dugas M, Rassam Y, Heilmann-Heimbach S, Tüttelmann F, Kliesch S, Gromoll J. Identifying a genomic region at Chromosome 11p.14.1 that is associated to FSH serum level in men with unexplained male infertility. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00883-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
33
|
Schubert M, Gassner FJ, Huemer M, Höpner JP, Akimova E, Steiner M, Egle A, Greil R, Zaborsky N, Geisberger R. AID Contributes to Accelerated Disease Progression in the TCL1 Mouse Transplant Model for CLL. Cancers (Basel) 2021; 13:cancers13112619. [PMID: 34073525 PMCID: PMC8198502 DOI: 10.3390/cancers13112619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/27/2021] [Revised: 05/11/2021] [Accepted: 05/21/2021] [Indexed: 12/01/2022] Open
Abstract
Simple Summary Cancers, such as chronic lymphocytic leukemia, frequently acquire consecutive somatic mutations in the genome, which contribute to disease progression and treatment resistance. Activation-induced deaminase is an enzyme responsible for generating the highly diverse B cell repertoire but it can also induce substantial collateral damage within the genome of cells. Hence, it is important to assess whether AID contributes to cancer mutations and to the course of disease. This research shows that AID contributes to the acquisition of somatic cancer-specific mutations in a mouse model for chronic lymphocytic leukemia reflected in prolonged overall survival of leukemic mice lacking AID expression. These data should initiate future studies to assess the effect of AID inhibition on the occurrence of drug resistance. Abstract Adaptive somatic mutations conferring treatment resistance and accelerated disease progression is still a major problem in cancer therapy. Additionally in CLL, patients receiving novel, efficient drugs frequently become treatment refractory and eventually relapse. Activation-induced deaminase (AID) is a cytosine deaminase that catalyzes somatic hypermutation of genomic DNA at the immunoglobulin locus in activated B cells. As considerable off-target mutations by AID have been discerned in chronic lymphocytic leukemia, it is essential to investigate to which extent these mutations contribute to disease progression to estimate whether AID inhibition could counteract drug resistance mechanisms. In this study, we examined the TCL1 mouse model for CLL on an AID pro- and deficient background by comparing disease development and mutational landscapes. We provide evidence that AID contributes to the acquisition of somatic cancer-specific mutations also in the TCL1 model and accelerates CLL development particularly in the transplant setting. We conclude that AID is directly determining the fitness of the CLL clone, which prompts further studies to assess the effect of AID inhibition on the occurrence of drug resistance.
Collapse
Affiliation(s)
- Maria Schubert
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (M.S.); (F.J.G.); (M.H.); (J.P.H.); (E.A.); (M.S.); (A.E.); (R.G.); (N.Z.)
| | - Franz Josef Gassner
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (M.S.); (F.J.G.); (M.H.); (J.P.H.); (E.A.); (M.S.); (A.E.); (R.G.); (N.Z.)
| | - Michael Huemer
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (M.S.); (F.J.G.); (M.H.); (J.P.H.); (E.A.); (M.S.); (A.E.); (R.G.); (N.Z.)
- Department of Biosciences, Paris Lodron University of Salzburg, 5020 Salzburg, Austria
| | - Jan Philip Höpner
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (M.S.); (F.J.G.); (M.H.); (J.P.H.); (E.A.); (M.S.); (A.E.); (R.G.); (N.Z.)
- Department of Biosciences, Paris Lodron University of Salzburg, 5020 Salzburg, Austria
| | - Ekaterina Akimova
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (M.S.); (F.J.G.); (M.H.); (J.P.H.); (E.A.); (M.S.); (A.E.); (R.G.); (N.Z.)
- Department of Biosciences, Paris Lodron University of Salzburg, 5020 Salzburg, Austria
| | - Markus Steiner
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (M.S.); (F.J.G.); (M.H.); (J.P.H.); (E.A.); (M.S.); (A.E.); (R.G.); (N.Z.)
| | - Alexander Egle
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (M.S.); (F.J.G.); (M.H.); (J.P.H.); (E.A.); (M.S.); (A.E.); (R.G.); (N.Z.)
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (M.S.); (F.J.G.); (M.H.); (J.P.H.); (E.A.); (M.S.); (A.E.); (R.G.); (N.Z.)
| | - Nadja Zaborsky
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (M.S.); (F.J.G.); (M.H.); (J.P.H.); (E.A.); (M.S.); (A.E.); (R.G.); (N.Z.)
| | - Roland Geisberger
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (M.S.); (F.J.G.); (M.H.); (J.P.H.); (E.A.); (M.S.); (A.E.); (R.G.); (N.Z.)
- Correspondence:
| |
Collapse
|
34
|
Sansone A, Schubert M, Tüttelmann F, Krallmann C, Zitzmann M, Kliesch S, Gromoll J. Pituitary response to GnRH stimulation tests in different FSHB-211 G/T genotypes. Hum Reprod 2021; 36:1376-1382. [PMID: 33704441 DOI: 10.1093/humrep/deab033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/14/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Does pituitary response to a GnRH stimulation test differ according to the different FSHB-211 G/T genotypes? SUMMARY ANSWER The promoter polymorphism FSHB-211 G > T affects the pituitary response to exogenous GnRH stimulation by reducing FSH and increasing LH outputs. WHAT IS KNOWN ALREADY The FSHB-211 G > T single nucleotide polymorphism (SNP) is known to affect pituitary FSH output by impairing the transcriptional activity of FSHB. STUDY DESIGN, SIZE, DURATION This was a cross-sectional, retrospective study on 67 male subjects (mean age: 24.6 ± 10.3 years) undergoing a GnRH stimulation test for diagnostic purposes in cases of secondary hypogonadism. PARTICIPANTS/MATERIALS, SETTING, METHODS A GnRH stimulation test was performed by administering an i.v. bolus of 100 µg of the GnRH-analogue gonadorelin acetate to all patients, with blood samples drawn from the cubital vein immediately prior to injection (T0) and 30 (T1) and 45 minutes (T2) after. Clinical and genetic data were retrieved from a computerized database. Linear longitudinal mixed-effect models were used to assess the effects of SNP genotype on FSH and LH levels over time via additive and recessive models. MAIN RESULTS AND THE ROLE OF CHANCE An overall marked increase in serum FSH and LH following administration i.v. of 100 µg of an LHRH-analogue was found (P < 0.0001 for linear trend, both models). Peak levels of LH were significantly higher in TT carriers than in GT and GG carriers (P = 0.012); no significant between-groups difference was found concerning stimulated FSH levels. In both the additive and recessive model, the main effect of T allele(s) did not reach statistical significance concerning FSH levels (P = 0.9502 and P = 0.8576, respectively), yet interaction effects over time demonstrated an attenuated response in T-allele carriers compared to the GG-allele carriers (P = 0.0219 and P = 0.0276). Main and interaction effects for LH were significant in both the additive (P = 0.0022 and P = 0.0013, respectively) and recessive model (P = 0.0025 and P = 0.0016, respectively). LIMITATIONS, REASONS FOR CAUTION Given the retrospective nature of the study and the small number of TT carriers, results should be interpreted with caution. WIDER IMPLICATIONS OF THE FINDINGS The FSHB c.-211G>T polymorphism might result in an impaired response to endogenous, as well as exogenous, GnRH stimulation. This finding might contribute to the clinical phenotype of reduced testicular volume and sperm count for patients carrying one or two T alleles. STUDY FUNDING/COMPETING INTEREST(S) Parts of the study were supported by the German Research Foundation (CRU326 Male Germ Cells). On behalf of all authors, the corresponding author states that there is no conflict of interest. TRIAL REGISTRATION NUMBER NA.
Collapse
Affiliation(s)
- Andrea Sansone
- Centre of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany.,Chair in Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Maria Schubert
- Centre of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - Frank Tüttelmann
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | - Claudia Krallmann
- Centre of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - Michael Zitzmann
- Centre of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - Sabine Kliesch
- Centre of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - Jörg Gromoll
- Centre of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| |
Collapse
|
35
|
Akimova E, Gassner FJ, Schubert M, Rebhandl S, Arzt C, Rauscher S, Tober V, Zaborsky N, Greil R, Geisberger R. SAMHD1 restrains aberrant nucleotide insertions at repair junctions generated by DNA end joining. Nucleic Acids Res 2021; 49:2598-2608. [PMID: 33591315 PMCID: PMC7969033 DOI: 10.1093/nar/gkab051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 12/15/2022] Open
Abstract
Aberrant end joining of DNA double strand breaks leads to chromosomal rearrangements and to insertion of nuclear or mitochondrial DNA into breakpoints, which is commonly observed in cancer cells and constitutes a major threat to genome integrity. However, the mechanisms that are causative for these insertions are largely unknown. By monitoring end joining of different linear DNA substrates introduced into HEK293 cells, as well as by examining end joining of CRISPR/Cas9 induced DNA breaks in HEK293 and HeLa cells, we provide evidence that the dNTPase activity of SAMHD1 impedes aberrant DNA resynthesis at DNA breaks during DNA end joining. Hence, SAMHD1 expression or low intracellular dNTP levels lead to shorter repair joints and impede insertion of distant DNA regions prior end repair. Our results reveal a novel role for SAMHD1 in DNA end joining and provide new insights into how loss of SAMHD1 may contribute to genome instability and cancer development.
Collapse
Affiliation(s)
- Ekaterina Akimova
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR); Cancer Cluster Salzburg, 5020 Salzburg, Austria.,Department of Biosciences, Paris Lodron University of Salzburg, 5020 Salzburg, Austria
| | - Franz Josef Gassner
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR); Cancer Cluster Salzburg, 5020 Salzburg, Austria
| | - Maria Schubert
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR); Cancer Cluster Salzburg, 5020 Salzburg, Austria
| | - Stefan Rebhandl
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR); Cancer Cluster Salzburg, 5020 Salzburg, Austria
| | - Claudia Arzt
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR); Cancer Cluster Salzburg, 5020 Salzburg, Austria
| | - Stefanie Rauscher
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR); Cancer Cluster Salzburg, 5020 Salzburg, Austria.,Department of Biosciences, Paris Lodron University of Salzburg, 5020 Salzburg, Austria
| | - Vanessa Tober
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR); Cancer Cluster Salzburg, 5020 Salzburg, Austria.,Department of Biosciences, Paris Lodron University of Salzburg, 5020 Salzburg, Austria
| | - Nadja Zaborsky
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR); Cancer Cluster Salzburg, 5020 Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR); Cancer Cluster Salzburg, 5020 Salzburg, Austria
| | - Roland Geisberger
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR); Cancer Cluster Salzburg, 5020 Salzburg, Austria
| |
Collapse
|
36
|
Aprea I, Raidt J, Höben IM, Loges NT, Nöthe-Menchen T, Pennekamp P, Olbrich H, Kaiser T, Biebach L, Tüttelmann F, Horvath J, Schubert M, Krallmann C, Kliesch S, Omran H. Defects in the cytoplasmic assembly of axonemal dynein arms cause morphological abnormalities and dysmotility in sperm cells leading to male infertility. PLoS Genet 2021; 17:e1009306. [PMID: 33635866 PMCID: PMC7909641 DOI: 10.1371/journal.pgen.1009306] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/10/2020] [Indexed: 12/14/2022] Open
Abstract
Axonemal protein complexes, such as outer (ODA) and inner (IDA) dynein arms, are responsible for the generation and regulation of flagellar and ciliary beating. Studies in various ciliated model organisms have shown that axonemal dynein arms are first assembled in the cell cytoplasm and then delivered into axonemes during ciliogenesis. In humans, mutations in genes encoding for factors involved in this process cause structural and functional defects of motile cilia in various organs such as the airways and result in the hereditary disorder primary ciliary dyskinesia (PCD). Despite extensive knowledge about the cytoplasmic assembly of axonemal dynein arms in respiratory cilia, this process is still poorly understood in sperm flagella. To better define its clinical relevance on sperm structure and function, and thus male fertility, further investigations are required. Here we report the fertility status in different axonemal dynein preassembly mutant males (DNAAF2/ KTU, DNAAF4/ DYX1C1, DNAAF6/ PIH1D3, DNAAF7/ZMYND10, CFAP300/C11orf70 and LRRC6). Besides andrological examinations, we functionally and structurally analyzed sperm flagella of affected individuals by high-speed video- and transmission electron microscopy as well as systematically compared the composition of dynein arms in sperm flagella and respiratory cilia by immunofluorescence microscopy. Furthermore, we analyzed the flagellar length in dynein preassembly mutant sperm. We found that the process of axonemal dynein preassembly is also critical in sperm, by identifying defects of ODAs and IDAs in dysmotile sperm of these individuals. Interestingly, these mutant sperm consistently show a complete loss of ODAs, while some respiratory cilia from the same individual can retain ODAs in the proximal ciliary compartment. This agrees with reports of solely one distinct ODA type in sperm, compared to two different ODA types in proximal and distal respiratory ciliary axonemes. Consistent with observations in model organisms, we also determined a significant reduction of sperm flagellar length in these individuals. These findings are relevant to subsequent studies on the function and composition of sperm flagella in PCD patients and non-syndromic infertile males. Our study contributes to a better understanding of the fertility status in PCD-affected males and should help guide genetic and andrological counselling for affected males and their families. Impaired male fertility is a major issue and affects several men worldwide. Patients may present with reduced number or complete absence of sperm in the ejaculate, as well as functional and/or morphological sperm defects compromising sperm motility. Despite several diagnostic efforts, the underlying causes of these defects often remain unknown („idiopathic“). The beating of sperm flagella as well as motile cilia, such as those of the respiratory tract, is driven by dynein-based motor protein complexes, namely outer and inner dynein arms. In motile cilia these protein complexes are known to be first assembled in the cytoplasm and then delivered into the cilium. In sperm, this process is still poorly understood. Here we analyze sperm cells of male individuals with mutations in distinct genes encoding factors involved in the preassembly of these motor protein complexes. Consistent with defects in their respiratory ciliated cells, these individuals also demonstrate defects in sperm flagella that cause male infertility due to immotile sperm, with a reduction of flagellar length. Our results strengthen the assumption that the preassembly process of outer and inner dynein arms is clinically relevant also in sperm and provide knowledge that should guide genetic and andrological counselling for a subgroup of men with idiopathic infertility.
Collapse
Affiliation(s)
- Isabella Aprea
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Johanna Raidt
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Inga Marlena Höben
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Niki Tomas Loges
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Tabea Nöthe-Menchen
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Petra Pennekamp
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Heike Olbrich
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Thomas Kaiser
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Luisa Biebach
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Frank Tüttelmann
- Institute of Reproductive Genetics, University of Muenster, Muenster, Germany
| | - Judit Horvath
- Institute of Human Genetics, University Hospital Muenster, Muenster, Germany
| | - Maria Schubert
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University Hospital Muenster, Muenster, Germany
| | - Claudia Krallmann
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University Hospital Muenster, Muenster, Germany
| | - Sabine Kliesch
- Institute of Human Genetics, University Hospital Muenster, Muenster, Germany
| | - Heymut Omran
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
- * E-mail:
| |
Collapse
|
37
|
Hupp M, Pfender N, Vallotton K, Rosner J, Friedl S, Zipser CM, Sutter R, Klarhöfer M, Spirig JM, Betz M, Schubert M, Freund P, Farshad M, Curt A. The Restless Spinal Cord in Degenerative Cervical Myelopathy. AJNR Am J Neuroradiol 2021; 42:597-609. [PMID: 33541903 DOI: 10.3174/ajnr.a6958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 10/12/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The spinal cord is subject to a periodic, cardiac-related movement, which is increased at the level of a cervical stenosis. Increased oscillations may exert mechanical stress on spinal cord tissue causing intramedullary damage. Motion analysis thus holds promise as a biomarker related to disease progression in degenerative cervical myelopathy. Our aim was characterization of the cervical spinal cord motion in patients with degenerative cervical myelopathy. MATERIALS AND METHODS Phase-contrast MR imaging data were analyzed in 55 patients (37 men; mean age, 56.2 [SD,12.0] years; 36 multisegmental stenoses) and 18 controls (9 men, P = .368; mean age, 62.2 [SD, 6.5] years; P = .024). Parameters of interest included the displacement and motion pattern. Motion data were pooled on the segmental level for comparison between groups. RESULTS In patients, mean craniocaudal oscillations were increased manifold at any level of a cervical stenosis (eg, C5 displacement: controls [n = 18], 0.54 [SD, 0.16] mm; patients [n = 29], monosegmental stenosis [n = 10], 1.86 [SD, 0.92] mm; P < .001) and even in segments remote from the level of the stenosis (eg, C2 displacement: controls [n = 18], 0.36 [SD, 0.09] mm; patients [n = 52]; stenosis: C3, n = 21; C4, n = 11; C5, n = 18; C6, n = 2; 0.85 [SD, 0.46] mm; P < .001). Motion at C2 differed with the distance to the next stenotic segment and the number of stenotic segments. The motion pattern in most patients showed continuous spinal cord motion throughout the cardiac cycle. CONCLUSIONS Patients with degenerative cervical myelopathy show altered spinal cord motion with increased and ongoing oscillations at and also beyond the focal level of stenosis. Phase-contrast MR imaging has promise as a biomarker to reveal mechanical stress to the cord and may be applicable to predict disease progression and the impact of surgical interventions.
Collapse
Affiliation(s)
- M Hupp
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - N Pfender
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - K Vallotton
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - J Rosner
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.).,Department of Neurology (J.R.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - S Friedl
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - C M Zipser
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | | | - M Klarhöfer
- Siemens Healthcare AG (M.K.), Zurich, Switzerland
| | - J M Spirig
- University Spine Center Zurich (J.M.S., M.B., M.F., A.C.), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - M Betz
- University Spine Center Zurich (J.M.S., M.B., M.F., A.C.), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - M Schubert
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - P Freund
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.)
| | - M Farshad
- University Spine Center Zurich (J.M.S., M.B., M.F., A.C.), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - A Curt
- From the Spinal Cord Injury Center (M.H., N.P., K.V., J.R., S.F., C.M.Z., M.S., P.F., A.C.).,University Spine Center Zurich (J.M.S., M.B., M.F., A.C.), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| |
Collapse
|
38
|
Behm C, Nemec M, Blufstein A, Schubert M, Rausch-Fan X, Andrukhov O, Jonke E. Interleukin-1β Induced Matrix Metalloproteinase Expression in Human Periodontal Ligament-Derived Mesenchymal Stromal Cells under In Vitro Simulated Static Orthodontic Forces. Int J Mol Sci 2021; 22:ijms22031027. [PMID: 33498591 PMCID: PMC7864333 DOI: 10.3390/ijms22031027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 12/19/2022] Open
Abstract
The periodontal ligament (PDL) responds to applied orthodontic forces by extracellular matrix (ECM) remodeling, in which human periodontal ligament-derived mesenchymal stromal cells (hPDL-MSCs) are largely involved by producing matrix metalloproteinases (MMPs) and their local inhibitors (TIMPs). Apart from orthodontic forces, the synthesis of MMPs and TIMPs is influenced by the aseptic inflammation occurring during orthodontic treatment. Interleukin (IL)-1β is one of the most abundant inflammatory mediators in this process and crucially affects the expression of MMPs and TIMPs in the presence of cyclic low-magnitude orthodontic tensile forces. In this study we aimed to investigate, for the first time, how IL-1β induced expression of MMPs, TIMPs and how IL-1β in hPDL-MSCs was changed after applying in vitro low-magnitude orthodontic tensile strains in a static application mode. Hence, primary hPDL-MSCs were stimulated with IL-1β in combination with static tensile strains (STS) with 6% elongation. After 6- and 24 h, MMP-1, MMP-2, TIMP-1 and IL-1β expression levels were measured. STS alone had no influence on the basal expression of investigated target genes, whereas IL-1β caused increased expression of these genes. In combination, they increased the gene and protein expression of MMP-1 and the gene expression of MMP-2 after 24 h. After 6 h, STS reduced IL-1β-induced MMP-1 synthesis and MMP-2 gene expression. IL-1β-induced TIMP-1 gene expression was decreased by STS after 6- and 24-h. At both time points, the IL-1β-induced gene expression of IL-1β was increased. Additionally, this study showed that fetal bovine serum (FBS) caused an overall suppression of IL-1β-induced expression of MMP-1, MMP-2 and TIMP-1. Further, it caused lower or opposite effects of STS on IL-1β-induced expression. These observations suggest that low-magnitude orthodontic tensile strains may favor a more inflammatory and destructive response of hPDL-MSCs when using a static application form and that this response is highly influenced by the presence of FBS in vitro.
Collapse
Affiliation(s)
- Christian Behm
- Division of Orthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (C.B.); (M.N.); (E.J.)
- Competence Center for Periodontal Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (M.S.)
| | - Michael Nemec
- Division of Orthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (C.B.); (M.N.); (E.J.)
| | - Alice Blufstein
- Competence Center for Periodontal Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (M.S.)
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria;
| | - Maria Schubert
- Competence Center for Periodontal Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (M.S.)
| | - Xiaohui Rausch-Fan
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria;
| | - Oleh Andrukhov
- Competence Center for Periodontal Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (A.B.); (M.S.)
- Correspondence:
| | - Erwin Jonke
- Division of Orthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria; (C.B.); (M.N.); (E.J.)
| |
Collapse
|
39
|
Kirwan M, Schubert M. Missed or rationed nursing care: Where to now for the nurse manager? J Nurs Manag 2020; 28:1767-1769. [DOI: 10.1111/jonm.13078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Marcia Kirwan
- School of Nursing, Psychotherapy and Community Health Dublin City University Dublin Ireland
| | - Maria Schubert
- School of Health Professions Institute of Nursing ZHAW Zurich University of Applied Science Winterthur Switzerland
| |
Collapse
|
40
|
Longhini J, Papastavrou E, Efstathiou G, Andreou P, Stemmer R, Ströhm C, Schubert M, de Wolf-Linder S, Palese A. Strategies to prevent missed nursing care: An international qualitative study based upon a positive deviance approach. J Nurs Manag 2020; 29:572-583. [PMID: 33090604 DOI: 10.1111/jonm.13176] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 11/28/2022]
Abstract
AIM To identify the strategies to prevent missed nursing care (MNC) that can be implemented by nurse managers/directors on a daily basis. BACKGROUND Only few recommendations have been established to date aiming at supporting nurse managers/ directors in preventing MNC. However, several strategies are implemented on a daily basis, suggesting that a body of tacit, practical and wise knowledge is already in place. METHOD(S) An international qualitative descriptive study based on the positive deviance approach conducted in 2019-2020 and reported according to the Consolidated Criteria for Reporting Qualitative Research. A purposeful sample of 35 nurse managers/directors working in hospitals in Cyprus, Italy, Germany and Switzerland was involved. Codes were extracted from each country, and a thematic analysis was performed at the transnational level to identify strategies and interventions preformed to prevent MNC. RESULTS Eight strategies and 22 interventions, mainly with preventive intent and designed at the hospital level, affecting both the processes and the structural dimensions, have been reported as effective in preventing MNC. CONCLUSION Nurse leaders are involved daily in implementing strategies to minimise MNC at the nursing and at the hospital system levels, integrated with each other. IMPLICATIONS FOR NURSING MANAGEMENT Preventing MNC should be a core value of the entire hospital, and not merely a nursing issue. Therefore, complex interventions at the system level are required.
Collapse
Affiliation(s)
- Jessica Longhini
- Department of Medical Sciences, School of Nursing, University of Udine, Udine, Italy
| | - Evridiki Papastavrou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Georgios Efstathiou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.,Nursing Services, Ministry of Health, Nicosia, Cyprus
| | | | | | | | - Maria Schubert
- School of Health Professions, Zurich University of Applied Science, Winterthur, Switzerland
| | - Susanne de Wolf-Linder
- School of Health Professions, Zurich University of Applied Science, Winterthur, Switzerland
| | - Alvisa Palese
- Department of Medical Sciences, School of Nursing, University of Udine, Udine, Italy
| |
Collapse
|
41
|
Schubert M, Ausserhofer D, Bragadóttir H, Rochefort CM, Bruyneel L, Stemmer R, Andreou P, Leppée M, Palese A. Interventions to prevent or reduce rationing or missed nursing care: A scoping review. J Adv Nurs 2020; 77:550-564. [PMID: 33089553 DOI: 10.1111/jan.14596] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 01/02/2020] [Revised: 08/15/2020] [Accepted: 08/27/2020] [Indexed: 11/26/2022]
Abstract
AIMS To collate and synthesize published research on interventions developed and tested to prevent or reduce the rates of rationed or missed nursing care in healthcare institutions. BACKGROUND Rationed and missed nursing care has been widely studied, including its predictors and associations with patient and nurse outcomes. DESIGN Scoping review. DATA SOURCES We searched for eligible studies, published between 1980-2019, in six electronic databases. REVIEW METHODS Researchers independently screened the abstracts of the retrieved studies using the inclusion and exclusion criteria. The decision of whether or not to include any given study was consensus-based. RESULTS The search yielded 1,815 records, of which 13 were included. Three studies reported structural interventions, namely increased nurse staffing and improved nursing teamwork, both resulted in significant reductions in the rates of rationed or missed nursing care. The remaining 10 studies reported on process interventions: four concerned reminders (via technology or designated persons) and seven described interventions to change or optimize the relevant care processes. All 10 process interventions contributed to significant reductions in the rates of missed nursing care. CONCLUSIONS The results of the scoping review indicate that specific interventions can positively influence the performance of a selected nursing care activity, for example fall prevention. There is no evidence of a global reduction of rationed and missed nursing care through these interventions. IMPACT Clinicians, managers and researchers can use the results for adapting and implementing interventions to reduce rationed and missed nursing care.
Collapse
Affiliation(s)
- Maria Schubert
- School of Health Professions, ZHAW - Zurich University of Applied Science, Institute of Nursing, Winterthur, Switzerland
| | - Dietmar Ausserhofer
- Nursing Science, Faculty of Medicine, Department of Public Health, University of Basel, Basel, Switzerland.,Claudiana College of Health-Care Professions, Bolzano, Italy
| | - Helga Bragadóttir
- Faculty of Nursing, School of Health Sciences and Landspítali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Christian M Rochefort
- School of Nursing, Faculty of Medicine and Health Sciences - Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CR-CHUS), University of Sherbrooke, Longueuil, Canada
| | - Luk Bruyneel
- Department for Public Health and Primary Care, KU Leuven - University of Leuven, Leuven Institute for Healthcare Policy, Leuven, Belgium
| | - Renate Stemmer
- Faculty of Health and Nursing, Catholic University of Applied Sciences Mainz, Mainz, Germany
| | | | - Marcel Leppée
- Project Department, Institute for Healthy Ageing, Zagreb, Croatia
| | - Alvisa Palese
- Department of Medical Science, University Udine, Udine, Italy
| | | |
Collapse
|
42
|
Rassam Y, Gromoll J, Kliesch S, Schubert M. Testicular Microlithiasis Is Associated with Impaired Spermatogenesis in Patients with Unexplained Infertility. Urol Int 2020; 104:610-616. [DOI: 10.1159/000508584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/10/2020] [Indexed: 11/19/2022]
|
43
|
Schubert M, Kaldewey S, Pérez Lanuza L, Krenz H, Dugas M, Berres S, Kliesch S, Wistuba J, Gromoll J. Does the FSHB c.-211G>T polymorphism impact Sertoli cell number and the spermatogenic potential in infertile patients? Andrology 2020; 8:1030-1037. [PMID: 32096339 DOI: 10.1111/andr.12777] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 12/04/2019] [Revised: 01/23/2020] [Accepted: 02/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND A genetic variant within the FSHB gene can deviate FSH action on spermatogenesis. The c.-211G>T FSHB single nucleotide polymorphism impacts FSHB transcription and biosynthesis due to interference with the LHX3 transcription factor binding. This SNP was previously shown to be strongly associated with lowered testicular volume, reduced sperm counts, and decreased FSH levels in patients carrying one or two T-alleles. OBJECTIVE To determine the impact of the SNP FSHB c.-211G>T on Sertoli cell (SC) number, Sertoli cell workload (SCWL) and thereby spermatogenic potential. MATERIAL AND METHODS Testicular biopsies of 31 azoospermic, homozygous T patients (26 non-obstructive azoospermia (NOA), and five obstructive azoospermia (OA)) were matched to patients with GG genotype. Marker proteins for SC (SOX9), spermatogonia (MAGE A4), and round spermatids (CREM) were used for semi-automatical quantification by immunofluorescence. SCWL (number of germ cells served by one SC) was determined and an unbiased clustering on the patient groups performed. RESULTS Quantification of SC number in NOA patients did not yield significant differences when stratified by FSHB genotype. SC numbers are also not significantly different between FSHB genotypes for the OA patient group and between NOA and OA groups. SCWL in the NOA patient cohort is significantly reduced when compared to the OA control patients; however, in neither group an effect of the genotype could be observed. The cluster analysis of the whole study cohort yielded two groups only, namely NOA and OA, and no clustering according to the FSHB genotype. DISCUSSION AND CONCLUSION The FSHB c.-211G>T polymorphism does not affect SC numbers or SCWL, thereby in principle maintaining the spermatogenic potential. The previously observed clinical phenotype for the FSHB genotype might therefore be caused by a hypo-stimulated spermatogenesis and not due to a decreased SC number.
Collapse
Affiliation(s)
- Maria Schubert
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - Sophie Kaldewey
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - Lina Pérez Lanuza
- Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - Henrike Krenz
- Institute of Medical Informatics-Informatics for Personalized Medicine, University of Münster, Münster, Germany
| | - Martin Dugas
- Institute of Medical Informatics-Informatics for Personalized Medicine, University of Münster, Münster, Germany
| | - Sven Berres
- Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - Sabine Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - Joachim Wistuba
- Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - Jörg Gromoll
- Institute of Reproductive and Regenerative Biology, Centre of Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| |
Collapse
|
44
|
Schubert M, Kopitz J, Knöller K. Low-sulphate water sample preparation for LSC detection of 35S avoiding sulphate precipitation. J Environ Radioact 2020; 213:106153. [PMID: 31983454 DOI: 10.1016/j.jenvrad.2019.106153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Abstract
Information about groundwater residence times is essential for evaluating appropriate groundwater abstraction rates and aquifer vulnerabilities and hence for sustainable groundwater management in general. Naturally occurring radionuclides are suitable tools for related investigations. While the applicability of several long-lived radionuclides for the investigation of long-term processes has been demonstrated frequently, residence times of less than one year are only scarcely discussed in the literature. That is due to the rather small number of applicable radionuclides that show adequately short half-lives. A promising approach for investigating sub-yearly residence times applies radioactive sulphur. 35S is continuously produced in the upper atmosphere from where it is transferred with the rain to the groundwater. As soon as the water enters the subsurface its 35S activity concentration decreases with an 87.4 day half-life. This makes 35S suitable for investigating sub-yearly groundwater residence times. However, the low 35S activities in natural waters require sulphate pre-concentration for 35S detection by means of liquid scintillation counting (LSC). That is usually done by sulphate extraction from large water samples with an anion-exchange resin (Amberlite IRA400, Cl-form), elution from the resin with NaCl, and precipitation as BaSO4. Our study aimed at optimizing the standard sample preparation procedure by avoiding the laborious precipitation step. We suggest (i) sulphate extraction using the exchange resin Amberlite IRA67 (OH-form), (ii) elution with ammonium hydroxide, (iii) evaporation of the eluate and (iv) dissolving the resulting dry precipitate in 2 ml H2O. In contrast to the standard approach our method results in a final sample solution of low ionic strength, which allows applying the water miscible scintillation cocktail Hionic-Fluor®. Since Hionic-Fluor accepts only aqueous solutions of low ionic strength the approach is applicable for waters with high 35S/32SO42- ratios, i.e., low total sulphate sample loads (e.g. rainwater).
Collapse
Affiliation(s)
- M Schubert
- UFZ - Helmholtz Centre for Environmental Research, Permoserstr. 15, 04318, Leipzig, Germany.
| | - J Kopitz
- Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - K Knöller
- UFZ - Helmholtz Centre for Environmental Research, Theodor-Lieser-Str. 4, 06120, Halle, Germany
| |
Collapse
|
45
|
Schubert M, Bettex D, Steiger P, Schrch R, Haller A, Bogdanovic J, Garcia Nuez D, Schwarz U, Siegemund M. Implementation of a multiprofessional, multicomponent delirium management guideline in two intensive care units, and its effect on patient outcomes and nurse workload: a pre-post design retrospective cohort study. Swiss Med Wkly 2020; 150:w20185. [DOI: 10.4414/smw.2020.20185] [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: 11/19/2022] Open
Affiliation(s)
- Maria Schubert
- School of Health Professions, ZHAW Zurich University of Applied Science, Winterthur, Switzerland / Centre of Clinical Nursing Science, University Hospital Zurich, Switzerland
| | - Dominique Bettex
- Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Switzerland
| | - Peter Steiger
- Division of Surgical Intensive Care, University Hospital Zurich, Switzerland
| | - Roger Schrch
- Department of Entomology, Virginia Tech, Blacksburg, USA / Clinical Trial Unit, Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Alois Haller
- Centre for Intensive Care, Cantonal Hospital Winterthur, Switzerland
| | - Jasmina Bogdanovic
- Faculty of Medicine, Department Public Health, Institute of Nursing Science, University of Basel, Switzerland
| | - David Garcia Nuez
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Switzerland / Centre for Gender Variance, University Hospital Basel, Switzerland
| | - Urs Schwarz
- Division of Neurology, University of Zurich and University Hospital Zurich, Switzerland
| | - Martin Siegemund
- Intensive Care Unit, Department of Intensive Care Medicine, University Hospital Basel, Switzerland
| |
Collapse
|
46
|
Azizi S, Yadav A, Lau Y, Hampel U, Roy S, Schubert M. Hydrodynamic correlations for bubble columns from complementary UXCT and RPT measurements in identical geometries and conditions. Chem Eng Sci 2019. [DOI: 10.1016/j.ces.2019.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
47
|
Schubert M, Kopitz J, Knöller K. Improved approach for LSC detection of 35S aiming at its application as tracer for short groundwater residence times. J Environ Radioact 2019; 208-209:106022. [PMID: 31351333 DOI: 10.1016/j.jenvrad.2019.106022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/06/2019] [Revised: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 06/10/2023]
Abstract
The knowledge of groundwater residence times in (vulnerable) aquifers is essential for the sustainable management of the associated groundwater resources. A powerful tool for related investigations is the application of naturally occurring radioisotopes as water age indicators. However, due to the limited number of suitable (i.e. omnipresent, short-lived and easily detectable) radionuclides only few studies focus on groundwater ages below one year. A natural radionuclide that does have the potential to cover this time range is 35S (87.4 day half-life). 35S is continually produced in the upper atmosphere and transferred with the rain to the groundwater. Since no natural sources of 35S exist in the subsurface the decrease of the 35S activity concentration in such young groundwater can be used for the determination of its age. Still, 35S activities in precipitation (and hence even more in groundwater) are very low and necessitate appropriate analytical protocols based on liquid scintillation counting (LSC). This turns out to be challenging due to the required large sample volumes and due to potentially high SO42- loads of the samples, both limiting the range of possible applications of 35S as indicator for short groundwater residence times. In the paper we present an improved straightforward LSC based approach for the detection of 35S in natural water samples. We recommend using Insta-Gel Plus as scintillation cocktail for allowing a homogeneous suspension of 35S-containing BaSO4 in the cocktail. The recommended improvements in instrument setting concern the LSC (TriCarb 3170 Tr/SL) counting window, the pulse decay discriminator setting and the delay before burst setting. The settings allow measuring low activity concentrations of 35S, which was previously pre-concentrated from natural water samples, containing SO42- loads of up to 1500 mg with a reasonably high statistical reliability.
Collapse
Affiliation(s)
- M Schubert
- UFZ - Helmholtz Centre for Environmental Research, Permoserstr. 15, 04318, Leipzig, Germany.
| | - J Kopitz
- Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - K Knöller
- UFZ - Helmholtz Centre for Environmental Research, Theodor-Lieser-Str. 4, 06120, Halle, Germany
| |
Collapse
|
48
|
Buzzell A, Chamberlain JD, Eriks-Hoogland I, Hug K, Jordan X, Schubert M, Zwahlen M, Brinkhof MWG. All-cause and cause-specific mortality following non-traumatic spinal cord injury: evidence from a population-based cohort study in Switzerland. Spinal Cord 2019; 58:157-164. [PMID: 31591462 PMCID: PMC7007408 DOI: 10.1038/s41393-019-0361-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 12/20/2022]
Abstract
Study design Observational cohort study. Objective To benchmark all-cause and cause-specific mortality following NTSCI to the general population (GP). Setting Specialized rehabilitation centers in Switzerland. Methods Longitudinal data from the Swiss Spinal Cord Injury (SwiSCI) Medical Record study were probabilistically linked with cause of death (CoD) information from the Swiss National Cohort. Standardized mortality ratios (SMRs) were estimated for all-cause and cause-specific mortality. Competing risk frameworks were used to estimate the probability of death due to specific CoD. Results One thousand five hundred and one individuals were admitted for first rehabilitation with NTSCI between 1990–2011; CoD information was available for 454 individuals of the 525 individuals that died. Overall, the mortality rate for persons with NTSCI was 1.6 times greater than that of the GP. Deaths due to cardiovascular disease (39.8%), neoplasms (22%), and infection (9.9%) were most often reported. Individuals with an SCI due to a vascular etiology indicated the greatest burden of mortality from infection compared with the GP (SMR 5.4; 95% CI, 3.1 to 9.2). Conclusions Cause-specific SMRs varied according to etiology. This supports the need for targeted clinical care and follow-up. Cardiovascular disease, neoplasms, and infection, emerged as main causes of death following NTSCI and should thus be targets for future research and differential clinical management approaches.
Collapse
Affiliation(s)
- A Buzzell
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - J D Chamberlain
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.,Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland
| | | | - K Hug
- REHAB Basel, Basel, Switzerland
| | - X Jordan
- Clinique Romand de Réadaption, Sion, Switzerland
| | - M Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - M Zwahlen
- Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland
| | - M W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | | |
Collapse
|
49
|
Schubert M, Schanze T. Estimation of Sparse VAR Models with Artificial Neural Networks for the Analysis of Biosignals. Annu Int Conf IEEE Eng Med Biol Soc 2019; 2019:4623-4627. [PMID: 31946894 DOI: 10.1109/embc.2019.8857403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Vector autoregressive models (VAR models) are often used to model and to analyze multivariate time series, especially to provide short-term forecasts. A common method of estimating coefficients of these VAR models is solving the Yule- Walker equations. This work introduces and investigates a method to set up "sparse" VAR models, in order to obtain a comparable prognosis quality with significantly fewer coefficients. For this purpose, an artificial neural network was programmed in Python with TensorFlow. Sparsity arises from the implementation of regularization algorithms.Based on simulated data and an ECG, we show that a comparable prognosis quality can be achieved with significantly fewer coefficients. In addition, sparse VAR models can also be determined if the data would actually lead to an underdetermined system of equations. Thus, sparse VAR models may help to classify short epochs of biosignals, e.g. P-waves or QRS-complexes.
Collapse
|
50
|
Sohr J, Bieberle M, George G, Flechsig S, Kenig E, Schubert M, Hampel U. Comparative assessment of different image processing methods to determine the gas–liquid interfacial area in froth regimes of sandwich packings from ultrafast X-ray tomography image data. Chem Eng Res Des 2019. [DOI: 10.1016/j.cherd.2019.05.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|