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Danyeli LV, Sen ZD, Colic L, Opel N, Refisch A, Blekic N, Macharadze T, Kretzschmar M, Munk MJ, Gaser C, Speck O, Walter M, Li M. Cortical thickness of the posterior cingulate cortex is associated with the ketamine-induced altered sense of self: An ultra-high field MRI study. J Psychiatr Res 2024; 172:136-143. [PMID: 38382237 DOI: 10.1016/j.jpsychires.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
Subanesthetic doses of ketamine induce an antidepressant effect within hours in individuals with treatment-resistant depression while it furthermore induces immediate but transient psychotomimetic effects. Among these psychotomimetic effects, an altered sense of self has specifically been associated with the antidepressant response to ketamine as well as psychedelics. However, there is plenty of variation in the extent of the drug-induced altered sense of self experience that might be explained by differences in basal morphological characteristics, such as cortical thickness. Regions that have been previously associated with a psychedelics-induced sense of self and with ketamine's mechanism of action, are the posterior cingulate cortex (PCC) and the pregenual anterior cingulate cortex (pgACC). In this randomized, placebo-controlled, double-blind cross-over magnetic resonance imaging study, thirty-five healthy male participants (mean age ± standard deviation (SD) = 25.1 ± 4.2 years) were scanned at 7 T. We investigated whether the cortical thickness of two DMN regions, the PCC and the pgACC, are associated with disembodiment and experience of unity scores, which were used to index the ketamine-induced altered sense of self. We observed a negative correlation between the PCC cortical thickness and the disembodiment scores (R = -0.54, p < 0.001). In contrast, no significant association was found between the pgACC cortical thickness and the ketamine-induced altered sense of self. In the context of the existing literature, our findings highlight the importance of the PCC as a structure involved in the mechanism of ketamine-induced altered sense of self that seems to be shared with different antidepressant agents with psychotomimetic effects operating on different classes of transmitter systems.
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Affiliation(s)
- Lena Vera Danyeli
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany; Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Halle-Jena-Magdeburg, Germany
| | - Zümrüt Duygu Sen
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Halle-Jena-Magdeburg, Germany
| | - Lejla Colic
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Halle-Jena-Magdeburg, Germany; German Center for Mental Health (DZPG), partner site Halle-Jena-Magdeburg, Germany
| | - Nils Opel
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Halle-Jena-Magdeburg, Germany; German Center for Mental Health (DZPG), partner site Halle-Jena-Magdeburg, Germany
| | - Alexander Refisch
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Halle-Jena-Magdeburg, Germany
| | - Nikolai Blekic
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
| | - Tamar Macharadze
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany; Department Systems Physiology of Learning, Leibniz Institute for Neurobiology, Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Germany; Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Moritz Kretzschmar
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - MatthiasH J Munk
- Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany; Systems Neurophysiology, Department of Biology, Darmstadt University of Technology, Darmstadt, Germany
| | - Christian Gaser
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Halle-Jena-Magdeburg, Germany; German Center for Mental Health (DZPG), partner site Halle-Jena-Magdeburg, Germany; Department of Neurology, Jena University Hospital, Jena, Germany
| | - Oliver Speck
- Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Halle-Jena-Magdeburg, Germany; German Center for Mental Health (DZPG), partner site Halle-Jena-Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Germany; Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany; Department of Biomedical Magnetic Resonance, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany; Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Halle-Jena-Magdeburg, Germany; German Center for Mental Health (DZPG), partner site Halle-Jena-Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Germany; Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany.
| | - Meng Li
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Halle-Jena-Magdeburg, Germany.
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Kowark A, Keszei AP, Schneider G, Pilge S, Schneider F, Obert DP, Georgii MT, Heim M, Rossaint R, Ziemann S, van Waesberghe J, Czaplik M, Pühringer FK, Minarski C, May V, Malisi T, Drexler B, Ring CM, Engler P, Tilly R, Bischoff P, Frey U, Wittmann M, Soehle M, Saller T, Kienbaum P, Kretzschmar M, Coburn M. Preoperative Midazolam and Patient-Centered Outcomes of Older Patients: The I-PROMOTE Randomized Clinical Trial. JAMA Surg 2024; 159:129-138. [PMID: 38117527 PMCID: PMC10733850 DOI: 10.1001/jamasurg.2023.6479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/13/2023] [Indexed: 12/21/2023]
Abstract
Importance The effect of oral midazolam premedication on patient satisfaction in older patients undergoing surgery is unclear, despite its widespread use. Objective To determine the differences in global perioperative satisfaction in patients with preoperative administration of oral midazolam compared with placebo. Design, Setting, and Participants This double-blind, parallel-group, placebo-controlled randomized clinical trial was conducted in 9 German hospitals between October 2017 and May 2019 (last follow-up, June 24, 2019). Eligible patients aged 65 to 80 years who were scheduled for elective inpatient surgery for at least 30 minutes under general anesthesia and with planned extubation were enrolled. Data were analyzed from November 2019 to December 2020. Interventions Patients were randomized to receive oral midazolam, 3.75 mg (n = 309), or placebo (n = 307) 30 to 45 minutes prior to anesthesia induction. Main Outcomes and Measures The primary outcome was global patient satisfaction evaluated using the self-reported Evaluation du Vécu de l'Anesthésie Generale (EVAN-G) questionnaire on the first postoperative day. Key secondary outcomes included sensitivity and subgroup analyses of the primary outcome, perioperative patient vital data, adverse events, serious complications, and cognitive and functional recovery up to 30 days postoperatively. Results Among 616 randomized patients, 607 were included in the primary analysis. Of these, 377 (62.1%) were male, and the mean (SD) age was 71.9 (4.4) years. The mean (SD) global index of patient satisfaction did not differ between the midazolam and placebo groups (69.5 [10.7] vs 69.6 [10.8], respectively; mean difference, -0.2; 95% CI, -1.9 to 1.6; P = .85). Sensitivity (per-protocol population, multiple imputation) and subgroup analyses (anxiety, frailty, sex, and previous surgical experience) did not alter the primary results. Secondary outcomes did not differ, except for a higher proportion of patients with hypertension (systolic blood pressure ≥160 mm Hg) at anesthesia induction in the placebo group. Conclusion and Relevance A single low dose of oral midazolam premedication did not alter the global perioperative patient satisfaction of older patients undergoing surgery or that of patients with anxiety. These results may be affected by the low dose of oral midazolam. Further trials-including a wider population with commonplace low-dose intravenous midazolam and plasma level measurements-are needed. Trial Registration ClinicalTrials.gov Identifier: NCT03052660.
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Affiliation(s)
- Ana Kowark
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Department of Anesthesiology, Medical Faculty University Hospital RWTH Aachen, Aachen, Germany
| | - András P. Keszei
- Center for Translational & Clinical Research Aachen, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Gerhard Schneider
- Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Munich, Germany
| | - Stefanie Pilge
- Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Munich, Germany
| | - Frederick Schneider
- Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Munich, Germany
| | - David P. Obert
- Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Munich, Germany
| | - Marie-Therese Georgii
- Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Munich, Germany
| | - Markus Heim
- Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Munich, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, Medical Faculty University Hospital RWTH Aachen, Aachen, Germany
| | - Sebastian Ziemann
- Department of Anesthesiology, Medical Faculty University Hospital RWTH Aachen, Aachen, Germany
| | - Julia van Waesberghe
- Department of Anesthesiology, Medical Faculty University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Czaplik
- Department of Anesthesiology, Medical Faculty University Hospital RWTH Aachen, Aachen, Germany
| | - Friedrich K. Pühringer
- Department for Anaesthesiology, Intensive Care, Emergency Medicine, Pain Therapy and Palliative Care, Kreiskliniken Reutlingen, Reutlingen, Germany
| | - Christian Minarski
- Department for Anaesthesiology, Intensive Care, Emergency Medicine, Pain Therapy and Palliative Care, Kreiskliniken Reutlingen, Reutlingen, Germany
| | - Verena May
- Department for Anaesthesiology, Intensive Care, Emergency Medicine, Pain Therapy and Palliative Care, Kreiskliniken Reutlingen, Reutlingen, Germany
| | - Tobias Malisi
- Department for Anaesthesiology, Intensive Care, Emergency Medicine, Pain Therapy and Palliative Care, Kreiskliniken Reutlingen, Reutlingen, Germany
| | - Berthold Drexler
- Department of Anaesthesiology and Intensive Care, University Hospital Tübingen, Tübingen, Germany
| | - Carmen Maria Ring
- Department of Anaesthesiology and Intensive Care, University Hospital Tübingen, Tübingen, Germany
| | - Phillip Engler
- Department of Anaesthesiology and Intensive Care, University Hospital Tübingen, Tübingen, Germany
- Department of Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Roman Tilly
- Department of Anaesthesiology and Intensive Care, University Hospital Tübingen, Tübingen, Germany
| | - Petra Bischoff
- Department of Anaesthesiology, Surgical Intensive Care, Pain and Palliative Care, Marien Hospital Herne, University Hospital of Ruhr University Bochum, Herne, Germany
| | - Ulrich Frey
- Department of Anaesthesiology, Surgical Intensive Care, Pain and Palliative Care, Marien Hospital Herne, University Hospital of Ruhr University Bochum, Herne, Germany
| | - Maria Wittmann
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Martin Soehle
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Thomas Saller
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Peter Kienbaum
- Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Moritz Kretzschmar
- Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Mark Coburn
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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Bindra JK, Niklas J, Jeong Y, Jasper AW, Kretzschmar M, Kern J, Utschig LM, Poluektov OG. Coherences of Photoinduced Electron Spin Qubit Pair States in Photosystem I. J Phys Chem B 2023; 127:10108-10117. [PMID: 37980604 DOI: 10.1021/acs.jpcb.3c06658] [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: 11/21/2023]
Abstract
This publication presents the first comprehensive experimental study of electron spin coherences in photosynthetic reaction center proteins, specifically focusing on photosystem I (PSI). The ultrafast electron transfer in PSI generates spin-correlated radical pairs (SCRPs), which are entangled spin pairs formed in well-defined spin states (Bell states). Since their discovery in our group in the 1980s, SCRPs have been extensively used to enhance our understanding of structure-function relationships in photosynthetic proteins. More recently, SCRPs have been utilized as tools for quantum sensing. Electron spin decoherence poses a significant challenge in realizing practical applications of electron spin qubits, particularly the creation of quantum entanglement between multiple electron spins. This work is focused on the systematic characterization of decoherence in SCRPs of PSI. These decoherence times were measured as electron spin echo decay times, termed phase memory times (TM), at various temperatures. Decoherence was recorded on both transient SCRP states P700+A1- and thermalized states. Our study reveals that TM exhibits minimal dependence on the biological species, biochemical treatment, and paramagnetic species. The analysis indicates that nuclear spin diffusion and instantaneous diffusion mechanisms alone cannot explain the observed decoherence. As a plausible explanation we discuss the assumption that the low-temperature dynamics of methyl groups in the protein surrounding the unpaired electron spin centers is the main factor governing the loss of the spin coherence in PSI.
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Affiliation(s)
- Jasleen K Bindra
- Chemical Sciences and Engineering Division, Argonne National Laboratory, 9700 South Cass Avenue, Lemont, Illinois 60439, United States
| | - Jens Niklas
- Chemical Sciences and Engineering Division, Argonne National Laboratory, 9700 South Cass Avenue, Lemont, Illinois 60439, United States
| | - Yeonjun Jeong
- Chemical Sciences and Engineering Division, Argonne National Laboratory, 9700 South Cass Avenue, Lemont, Illinois 60439, United States
| | - Ahren W Jasper
- Chemical Sciences and Engineering Division, Argonne National Laboratory, 9700 South Cass Avenue, Lemont, Illinois 60439, United States
| | - Moritz Kretzschmar
- Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, United States
| | - Jan Kern
- Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, United States
| | - Lisa M Utschig
- Chemical Sciences and Engineering Division, Argonne National Laboratory, 9700 South Cass Avenue, Lemont, Illinois 60439, United States
| | - Oleg G Poluektov
- Chemical Sciences and Engineering Division, Argonne National Laboratory, 9700 South Cass Avenue, Lemont, Illinois 60439, United States
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Sen ZD, Chand T, Danyeli LV, Kumar VJ, Colic L, Li M, Yemisken M, Javaheripour N, Refisch A, Opel N, Macharadze T, Kretzschmar M, Ozkan E, Deliano M, Walter M. Author Correction: The effect of ketamine on affective modulation of the startle reflex and its resting-state brain correlates. Sci Rep 2023; 13:15836. [PMID: 37739990 PMCID: PMC10516868 DOI: 10.1038/s41598-023-42343-3] [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: 09/24/2023] Open
Affiliation(s)
- Zümrüt Duygu Sen
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany
- German Center for Mental Health (DZPG), Halle-Jena-Magdeburg Site, Jena, Germany
| | - Tara Chand
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
- Department of Clinical Psychology, Friedrich Schiller University Jena, Am Steiger 3-1, 07743, Jena, Germany
- Jindal Institute of Behavioural Sciences, O. P. Jindal Global University (Sonipat), Haryana, India
| | - Lena Vera Danyeli
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany
| | | | - Lejla Colic
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
- German Center for Mental Health (DZPG), Halle-Jena-Magdeburg Site, Jena, Germany
| | - Meng Li
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
- German Center for Mental Health (DZPG), Halle-Jena-Magdeburg Site, Jena, Germany
| | - Merve Yemisken
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
| | - Nooshin Javaheripour
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
| | - Alexander Refisch
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
| | - Nils Opel
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- German Center for Mental Health (DZPG), Halle-Jena-Magdeburg Site, Jena, Germany
| | - Tamar Macharadze
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty, Otto-Von-Guericke-Universität Magdeburg, Magdeburg, Germany
- Department Systems Physiology of Learning, Leibniz Institute for Neurobiology, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Moritz Kretzschmar
- Department of Anesthesiology and Intensive Care Medicine, OVGU, Magdeburg, Germany
| | - Esra Ozkan
- Koç University Research Center for Translational Medicine, Istanbul, Turkey
| | - Matthias Deliano
- Center for Behavioral Brain Sciences, Magdeburg, Germany.
- Leibniz Institute for Neurobiology, Magdeburg, Combinatorial NeuroImaging Core Facility, Brenneckestraße 6, 39118, Magdeburg, Germany.
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany.
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany.
- Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany.
- German Center for Mental Health (DZPG), Halle-Jena-Magdeburg Site, Jena, Germany.
- Leibniz Institute for Neurobiology, Magdeburg, Germany.
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany.
- Center for Behavioral Brain Sciences, Magdeburg, Germany.
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Sen ZD, Chand T, Danyeli LV, Kumar VJ, Colic L, Li M, Yemisken M, Javaheripour N, Refisch A, Opel N, Macharadze T, Kretzschmar M, Ozkan E, Deliano M, Walter M. The effect of ketamine on affective modulation of the startle reflex and its resting-state brain correlates. Sci Rep 2023; 13:13323. [PMID: 37587171 PMCID: PMC10432502 DOI: 10.1038/s41598-023-40099-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023] Open
Abstract
Ketamine is a rapid-acting antidepressant that also influences neural reactivity to affective stimuli. However, the effect of ketamine on behavioral affective reactivity is yet to be elucidated. The affect-modulated startle reflex paradigm (AMSR) allows examining the valence-specific aspects of behavioral affective reactivity. We hypothesized that ketamine alters the modulation of the startle reflex during processing of unpleasant and pleasant stimuli and weakens the resting-state functional connectivity (rsFC) within the modulatory pathway, namely between the centromedial nucleus of the amygdala and nucleus reticularis pontis caudalis. In a randomized, double-blind, placebo-controlled, cross-over study, thirty-two healthy male participants underwent ultra-high field resting-state functional magnetic resonance imaging at 7 T before and 24 h after placebo and S-ketamine infusions. Participants completed the AMSR task at baseline and one day after each infusion. In contrast to our hypothesis, ketamine infusion did not impact startle potentiation during processing of unpleasant stimuli but resulted in diminished startle attenuation during processing of pleasant stimuli. This diminishment significantly correlated with end-of-infusion plasma levels of ketamine and norketamine. Furthermore, ketamine induced a decrease in rsFC within the modulatory startle reflex pathway. The results of this first study on the effect of ketamine on the AMSR suggest that ketamine might attenuate the motivational significance of pleasant stimuli in healthy participants one day after infusion.
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Affiliation(s)
- Zümrüt Duygu Sen
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany
- German Center for Mental Health (DZPG), Halle-Jena-Magdeburg Site, Jena, Germany
| | - Tara Chand
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
- Department of Clinical Psychology, Friedrich Schiller University Jena, Am Steiger 3-1, 07743, Jena, Germany
- Jindal Institute of Behavioural Sciences, O. P. Jindal Global University (Sonipat), Haryana, India
| | - Lena Vera Danyeli
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany
| | | | - Lejla Colic
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
- German Center for Mental Health (DZPG), Halle-Jena-Magdeburg Site, Jena, Germany
| | - Meng Li
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
- German Center for Mental Health (DZPG), Halle-Jena-Magdeburg Site, Jena, Germany
| | - Merve Yemisken
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
| | - Nooshin Javaheripour
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
| | - Alexander Refisch
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
| | - Nils Opel
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- German Center for Mental Health (DZPG), Halle-Jena-Magdeburg Site, Jena, Germany
| | - Tamar Macharadze
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty, Otto-Von-Guericke-Universität Magdeburg, Magdeburg, Germany
- Department Systems Physiology of Learning, Leibniz Institute for Neurobiology, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Moritz Kretzschmar
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty, Otto-Von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Esra Ozkan
- Koç University Research Center for Translational Medicine, Istanbul, Turkey
| | - Matthias Deliano
- Center for Behavioral Brain Sciences, Magdeburg, Germany.
- Leibniz Institute for Neurobiology, Magdeburg, Combinatorial NeuroImaging Core Facility, Brenneckestraße 6, 39118, Magdeburg, Germany.
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany.
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany.
- Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany.
- German Center for Mental Health (DZPG), Halle-Jena-Magdeburg Site, Jena, Germany.
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany.
- Center for Behavioral Brain Sciences, Magdeburg, Germany.
- Leibniz Institute for Neurobiology, Magdeburg, Germany.
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Brinkers M, Istel M, Kretzschmar M, Pfau G, Meyer F. Status of inpatient pain therapy using the example of a general and abdominal surgery normal ward - a prospective questionnaire study to review a pain therapy algorithm ("real-world data"). Innov Surg Sci 2023; 8:73-82. [PMID: 38058774 PMCID: PMC10696937 DOI: 10.1515/iss-2023-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/10/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives The mean pain intensity for inpatient consultations, for example in cancer patients, is known. However, the proportion of necessary consultations in the total volume of patients of a ward or a hospital, the general pain intensity in a surgical ward and the relationship between pain medication, length of stay and therapeutic success are unknown. The aim of the study was to examine surgical patients in a single normal ward subclassified into various groups (-/+ surgery, ICU stay, cancer, consultation for pain therapy etc.) during half a year with regard to their pain. For this purpose, the pain score (NAS) was recorded daily for each patient during the entire hospital stay and the change was assessed over the clinical course. Methods In 2017, all consecutive new admissions to a normal ward of general surgery at a university hospital ("tertiary center") were monitored over half a year according to a standardized procedure. Pain severity (measured by the "Numeric rating scale" [NRS] respectively "Visual analogue scale" [VAS]) from admission to discharge was recorded, as well as the length of stay and the administered medication. Patient groups were sub-classified as surgery, intensive care unit, cancer and pain consultation. An algorithm in two parts (part 1, antipyretics and piritramide; part 2, WHO-scheme and psychotropic drugs), which was defined years before between surgeons and pain therapists, was pursued and consequently used as a basis for the evaluation of the therapeutic success. Results 269 patients were included in the study. The mean pain intensity of all patients at admission was VAS 2.2. Most of the groups (non-cancer, intensive care unit [ICU], non-ICU, surgical intervention (=Operation [OP]), non-OP, pain intensity greater than VAS 3) were significantly reduced in pain at discharge. An exception in this context was patients with cancer-associated pain and, thus, initiated pain consultation. Conclusions Since three quarters of the consultation patients also reported cancer pain, it might be possible that the lack of treatment success in both the consultation and cancer groups is associated with cancer in these patients. However, it can be shown that the successfully treated groups (without ICU-based course) had a mean length of stay from 4.2 ± 3.9 up to 8.4 ± 8.1 days (d), while the two unsuccessfully treated groups experienced a longer stay (mean"cancer", 11.1 ± 9.4 d; mean"consulation", 14.2 ± 10.3 d). Twenty-one consultation patients, in whom it had been intended to improve pain intensity, could not be successfully treated despite adapted therapy - this can be considered a consequence of the low number of patients. Since the consultation patients were the only patient group treated with part 2 of the algorithm, it can be concluded that part 1 of the algorithm is sufficient for a mean length of stay up to 9 days. For all patients above this time point, a pain consultation with adaption of medical treatment should be considered.
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Affiliation(s)
- Michael Brinkers
- Division of Pain Therapy, Department of Anesthesiology and Intensive Care Medicine, University Hospital at Magdeburg, Magdeburg, Germany
| | - Mandy Istel
- Department of Cardiology, University Hospital at Magdeburg, Magdeburg, Germany
| | - Moritz Kretzschmar
- Division of Pain Therapy, Department of Anesthesiology and Intensive Care Medicine, University Hospital at Magdeburg, Magdeburg, Germany
| | - Giselher Pfau
- Division of Pain Therapy, Department of Anesthesiology and Intensive Care Medicine, University Hospital at Magdeburg, Magdeburg, Germany
| | - Frank Meyer
- Department of General, Abdominal, Vascular and Transplant Surgery, University Hospital at Magdeburg, Magdeburg, Germany
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Danyeli LV, Sen ZD, Colic L, Kurzweil L, Gensberger-Reigl S, Macharadze T, Götting F, Refisch A, Liebe T, Chand T, Kretzschmar M, Wagner G, Opel N, Jollant F, Speck O, Munk MHJ, Li M, Walter M. Correction: Association of the delayed changes in glutamate levels and functional connectivity with the immediate network effects of S-ketamine. Transl Psychiatry 2023; 13:73. [PMID: 36854748 PMCID: PMC9974949 DOI: 10.1038/s41398-023-02377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Affiliation(s)
- Lena Vera Danyeli
- grid.275559.90000 0000 8517 6224Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany ,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany ,grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany
| | - Zümrüt Duygu Sen
- grid.275559.90000 0000 8517 6224Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany ,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany ,grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany ,Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany
| | - Lejla Colic
- grid.275559.90000 0000 8517 6224Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany ,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany ,Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany ,German Center for Mental Health (DZPG), Site Halle-Jena-Magdeburg, Germany
| | - Lisa Kurzweil
- grid.5330.50000 0001 2107 3311Food Chemistry, Department of Chemistry and Pharmacy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sabrina Gensberger-Reigl
- grid.5330.50000 0001 2107 3311Food Chemistry, Department of Chemistry and Pharmacy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Tamar Macharadze
- grid.5807.a0000 0001 1018 4307Department of Anesthesiology and Intensive Care Medicine, Medical Faculty, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany ,grid.418723.b0000 0001 2109 6265Department Systems Physiology of Learning, Leibniz Institute for Neurobiology, Magdeburg, Germany ,grid.452320.20000 0004 0404 7236Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Florian Götting
- grid.275559.90000 0000 8517 6224Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany ,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
| | - Alexander Refisch
- grid.275559.90000 0000 8517 6224Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Thomas Liebe
- grid.275559.90000 0000 8517 6224Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany ,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
| | - Tara Chand
- grid.275559.90000 0000 8517 6224Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany ,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany ,grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany ,grid.9613.d0000 0001 1939 2794Department of Clinical Psychology, Friedrich Schiller University, Jena, Germany
| | - Moritz Kretzschmar
- grid.5807.a0000 0001 1018 4307Department of Anesthesiology and Intensive Care Medicine, Medical Faculty, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Gerd Wagner
- grid.275559.90000 0000 8517 6224Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany ,Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany
| | - Nils Opel
- grid.275559.90000 0000 8517 6224Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany ,Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany ,German Center for Mental Health (DZPG), Site Halle-Jena-Magdeburg, Germany
| | - Fabrice Jollant
- grid.275559.90000 0000 8517 6224Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany ,grid.460789.40000 0004 4910 6535School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France ,grid.413784.d0000 0001 2181 7253Department of psychiatry, CHU Bicêtre, APHP, Le Kremlin-Bicêtre, France ,grid.463845.80000 0004 0638 6872Inserm, CESP, MOODS team, Le Kremlin-Bicêtre, France ,grid.411165.60000 0004 0593 8241Department of psychiatry, CHU Nîmes, Nîmes, France ,grid.14709.3b0000 0004 1936 8649Department of Psychiatry, McGill University, Montreal, Canada
| | - Oliver Speck
- Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany ,German Center for Mental Health (DZPG), Site Halle-Jena-Magdeburg, Germany ,grid.452320.20000 0004 0404 7236Center for Behavioral Brain Sciences, Magdeburg, Germany ,grid.418723.b0000 0001 2109 6265Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany ,grid.5807.a0000 0001 1018 4307Department of Biomedical Magnetic Resonance, Otto von Guericke University, Magdeburg, Germany
| | - Matthias H. J. Munk
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany ,grid.6546.10000 0001 0940 1669Systems Neurophysiology, Department of Biology, Darmstadt University of Technology, Darmstadt, Germany
| | - Meng Li
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany. .,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany. .,Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany.
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany. .,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany. .,Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany. .,Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany. .,German Center for Mental Health (DZPG), Site Halle-Jena-Magdeburg, Germany. .,Center for Behavioral Brain Sciences, Magdeburg, Germany. .,Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany. .,Max Planck Institute for Biological Cybernetics, Tübingen, Germany.
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Breitling C, Kretzschmar M. [Ultrasound Guided Regional Anesthesia in Thoracic Surgery]. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:417-427. [PMID: 35728592 DOI: 10.1055/a-1494-4387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Perioperative analgesia plays an important role in thoracic surgery, regarding not only patient satisfaction, but also in preventing postoperative complications such as pneumonia. Ultrasound-guided thoracic wall blocks close the gap between opiate based and neuraxial pain management concepts.The following article explores the different ultrasound-guided approaches to anesthetize the thoracic wall, ranging from the ventral blocks such as parasternal or PECS I/II, followed by the lateral blocks (i.e. serratus anterior), up to the dorsal approaches including the paravertebral, erector spinae plane, and retrolaminar block.In summary, the anterolateral blocks are supplementary blocks in an opiate sparing, multimodal anaesthesia concept, whereas the dorsal procedures, as they include visceral anaesthesia, are an alternative to neuraxial anaesthesia, as they have a comparable analgetic potency. For minimally invasive thoracic surgery, where due to risk-benefit considerations epidural anaesthesia is omitted, thoracic wall blocks can be utilized in a single shot or a continuous, catheter-based approach.
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Brinkers M, Pfau G, Ritz W, Meyer F, Kretzschmar M. What does low psychological distress mean in patients with no mental disorders and different pains of the musculoskeletal system? Scand J Pain 2022; 22:298-304. [PMID: 34655513 DOI: 10.1515/sjpain-2021-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/30/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study is to define the different levels of psychological distress in patients suffering from pain and functional disorders of the musculoskeletal system. METHODS This investigation was conducted as a retrospective study of 60 patients randomly selected of a German specialized orthopaedic hospital within the year 2016, whose therapeutic approaches are based on a non-surgical orthopaedic multimodal approach of manual therapy. All patients were suffering from pain and functional disorders of the musculoskeletal system. Two groups were formed: one without and one with additional mental disorders according to ICD-10. The impairment score (ISS) according to Schepank was determined. RESULTS The somatic sub score of the ISS was the highest sub score in both patient groups. The cumulative value of the ISS score of patients with both a mental disorder and pain in the musculoskeletal system was higher than for patients without concomitant mental disorder. For patients without concomitant mental disorder, the cumulative ISS exceeded the test criteria for mentally healthy individuals. CONCLUSIONS Patients without mental disorder but with chronic pain of the locomotoric system receive a psychological pain management program, as it is part of the billing code OPS 8-977 to the health insurance companies in Germany. However, the data show that these patients also have a substantial somatic subscore and a cumulative ISS above the level of healthy individuals. The absence of psychological disorders (according to ICD-10) in patients with pain of the musculoskeletal system should not lead to the assumption that these patients are psychologically inconspicuous. Subsyndromal mental findings (below ICD-10) can be one aspect of a mental disorder presenting with primarily somatic symptoms. In this case, patients would benefit from a psychotherapeutic program in a similar way as the patients with mental disorders according to ICD-10.
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Affiliation(s)
- Michael Brinkers
- Department of Anaesthesiology and Intensive Care Medicine, Division of Pain Therapy, University Hospital at Magdeburg, Magdeburg, Germany
| | - Giselher Pfau
- Department of Anaesthesiology and Intensive Care Medicine, Division of Pain Therapy, University Hospital at Magdeburg, Magdeburg, Germany
| | - Wolfgang Ritz
- Department of Manual Medicine, "Sana Kliniken Sommerfeld", Kremmen, Germany
| | - Frank Meyer
- Department of General, Abdominal, Vascular, and Transplant Surgery, University Hospital at Magdeburg, Magdeburg, Germany
| | - Moritz Kretzschmar
- Department of Anaesthesiology and Intensive Care Medicine, Division of Pain Therapy, University Hospital at Magdeburg, Magdeburg, Germany
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Kazarovytska F, Kretzschmar M, Lamberty P, Rees J, Knausenberger J, Imhoff R. From moral disaster to moral entitlement – The impact of success in dealing with a perpetrator past on perceived ingroup morality and claims for historical closure. J Soc Polit Psych 2022. [DOI: 10.5964/jspp.8337] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Germany’s past is marked not only by the atrocities of the Holocaust, but also by a history of collective attempts to come to terms with these crimes. The present paper focuses on the previously rarely explored consequences of perceived success in dealing with a perpetrator past for the moral ingroup-image and the demand for an end to the discussion of this chapter of history (i.e., demand for historical closure). In one correlational study (N = 982) and three experimental studies (N = 904), we found robust evidence for a positive association between perceived success in dealing with the Nazi past and perceived ingroup morality. The results on the assumed influence of success on claims for historical closure, mediated by morality, were only partly supportive and inconsistent, particularly when controlling for political orientation and collective narcissism. However, final single-paper meta-analyses revealed a significant association between perceived ingroup morality and demand for historical closure (K = 5), as well as a small but significant effect of success (vs. failure) on demand for historical closure (K = 4), even when accounting for political orientation. Implications for understanding ethical self-views in historical perpetrator groups and recurring debates about a ‘Schlussstrich’ on the German Nazi past are discussed.
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11
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Hirschberger G, Lifshin U, Dellus V, Shuster B, Kretzschmar M. German desire for historical closure indirectly affects Israelis' intergroup attitudes. Euro J Social Psych 2021. [DOI: 10.1002/ejsp.2772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
| | - Uri Lifshin
- Baruch Ivcher School of Psychology IDC Herzliya Herzliya Israel
| | - Veronika Dellus
- Baruch Ivcher School of Psychology IDC Herzliya Herzliya Israel
| | - Baillie Shuster
- Baruch Ivcher School of Psychology IDC Herzliya Herzliya Israel
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12
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Schneider F, Schulz CM, May M, Schneider G, Ernst C, Jacob M, Zacharowski K, Hachenberg T, Schmidt M, Kretzschmar M, Graf B, Kees MG, Pawlik M, Sander M, Koch C, Zoller M, Heim M. The association of the anesthesiologist’s academic and educational status with self-confidence, self-rated knowledge and objective knowledge in rational antibiotic application. BMC Res Notes 2020; 13:161. [PMID: 32188509 PMCID: PMC7079461 DOI: 10.1186/s13104-020-05010-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/11/2020] [Indexed: 11/15/2022] Open
Abstract
Objective This study aimed to investigate the association of anesthetists’ academic and educational status with self-confidence, self-rated knowledge and objective knowledge about rational antibiotic application. Therefore, anesthetists in Germany were asked about their self-confidence, self-rated knowledge and objective knowledge on antibiotic therapy via the Multiinstitutional Reconnaissance of practice with Multiresistant bacteria (MR2) survey. Other analysis from the survey have been published elsewhere, before. Results 361 (52.8%) questionnaires were completed by specialists and built the study group. In overall analysis the Certification in Intensive Care (CIC) was significantly associated with self-confidence (p < 0.001), self-rated knowledge (p < 0.001) and objective knowledge (p = 0.029) about antibiotic prescription. Senior consultant status was linked to self-confidence (p < 0.001) and self-rated knowledge (p = 0.005) but not objective knowledge. Likewise, working on Intensive Care Unit (ICU) during the last 12 months was significantly associated with self-rated knowledge and self-confidence (all p < 0.001). In a logistic regression model, senior consultant status was not associated with any tested influence factor. This analysis unveiled that CIC and working on ICU were more associated with anesthesiologists’ self-confidence and self-rated knowledge than senior consultant status. However, neither of the characteristics was thoroughly associated with objective knowledge.
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Bergmann A, Schilling T, Perchiazzi G, Kretzschmar M, Hedenstierna G, Hachenberg T, Larsson A. Effect of remote ischemic preconditioning on exhaled nitric oxide concentration in piglets during and after one-lung ventilation. Respir Physiol Neurobiol 2020; 276:103426. [DOI: 10.1016/j.resp.2020.103426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/26/2020] [Accepted: 02/24/2020] [Indexed: 12/19/2022]
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Schneider F, Schulz CM, May M, Schneider G, Jacob M, Mutlak H, Pawlik M, Zoller M, Kretzschmar M, Koch C, Kees MG, Burger M, Lebentrau S, Novotny A, Hübler M, Koch T, Heim M. [Is the discipline associated with self-confidence in handling rational antibiotic prescription? : Results from the MR2 study in German hospitals]. Anaesthesist 2020; 69:162-169. [PMID: 32055886 DOI: 10.1007/s00101-020-00736-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/12/2019] [Accepted: 01/14/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Besides public awareness and specialist knowledge and training of physicians, their self-confidence plays a key role for clinical decision-making in the respective area. OBJECTIVE This exploratory study investigated the influence of the discipline on differences in self-confidence in dealing with antibiotics and in the self-rated knowledge. METHODS In 2015 the multi-institutional reconnaissance of practice with multiresistant bacteria (MR2) questionnaire containing items on antibiotic prescription and multiresistant pathogens was sent out to 1061 physicians working in departments for internal medicine, general surgery, gynecology and obstetrics and urology. In 2017 a similar MR2 survey was sent to 1268 specialist and assistant physicians in anesthesiology in Germany. Besides demographic data 4 items on self-confidence in the use of antibiotic treatment and 11 items concerning self-rated knowledge about rational antibiotic therapy and multiresistant pathogens were included in the present analysis. Logistic regression analysis, the χ2-test and the Kruskal-Wallis test were used for statistical analysis of the influence of the discipline on these items. RESULTS The response rates were 43% (456 out of 1061) from the non-anesthetists and 56% (705 out of 1268) from the anesthetists. Of the non-anesthetists 44% and 57% of the anesthetists had had no advanced training on antibiotic stewardship during the year before the study. In the overall analysis anesthetists (mean±SD: 2.53±0.54) were significantly less self-confident about antibiotics than colleagues from other departments (internal medicine: 3.10±0.50, general surgery: 2.97±0.44, gynecology and obstetrics: 3.12±0.42 and urology: 3.15±0.44) in the unadjusted (all p<0.001) and adjusted comparison. The analysis of self-rated knowledge about rational antibiotic prescription showed similar results. Senior consultant status and advanced training in infectiology were significantly associated with self-confidence and self-rated knowledge about antibiotics. CONCLUSION Anesthetists showed significantly less self-confidence in dealing with antibiotics than colleagues from other disciplines. Advanced training on a rational prescription of antibiotics was associated with a greater self-confidence, so that the implementation of compulsory courses on rational antibiotic stewardship in the respective residency curriculum needs to be considered.
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Affiliation(s)
- F Schneider
- Fakultät für Medizin, Klinik für Anästhesiologie und Intensivmedizin, Technische Universität München, München, Deutschland. .,Klinik für Anästhesiologie und Intensivmedizin, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - C M Schulz
- Fakultät für Medizin, Klinik für Anästhesiologie und Intensivmedizin, Technische Universität München, München, Deutschland
| | - M May
- Urologische Klinik, St. Elisabeth-Klinikum Straubing, Straubing, Deutschland
| | - G Schneider
- Fakultät für Medizin, Klinik für Anästhesiologie und Intensivmedizin, Technische Universität München, München, Deutschland
| | - M Jacob
- Klinik für Anästhesiologie, Operative Intensivmedizin und Schmerzmedizin, Klinikum St. Elisabeth Straubing, Straubing, Deutschland
| | - H Mutlak
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt, Deutschland
| | - M Pawlik
- Klinik für Anästhesiologie, Krankenhaus St. Josef Regensburg, Regensburg, Deutschland
| | - M Zoller
- Klinik für Anästhesiologie der Universität München, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - M Kretzschmar
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - C Koch
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - M G Kees
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - M Burger
- Urologische Klinik, Caritas St. Josef Krankenhaus, Universität Regensburg, Regensburg, Deutschland
| | - S Lebentrau
- Urologische Klinik, Ruppiner Kliniken GmbH, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - A Novotny
- Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Technische Universität München, München, Deutschland
| | - M Hübler
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - T Koch
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - M Heim
- Fakultät für Medizin, Klinik für Anästhesiologie und Intensivmedizin, Technische Universität München, München, Deutschland
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Kretzschmar M, Heilmeier U, Foreman S, Joseph G, McCulloch C, Nevitt M, Link T. Central osteophytes develop in cartilage with abnormal structure and composition: data from the Osteoarthritis Initiative cohort. Skeletal Radiol 2019; 48:1357-1365. [PMID: 30739145 PMCID: PMC8176650 DOI: 10.1007/s00256-019-3166-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/10/2019] [Accepted: 01/16/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the natural history of central osteophytes (COs) by analyzing the structure and matrix composition of CO-associated cartilage using 3-T MRI at and 1-3 years before the onset of COs. MATERIALS AND METHODS Baseline, 4- and 6-year knee MRIs of 400 participants in the Osteoarthritis Initiative were screened for the appearance of new COs. Twenty-eight subjects developed 31 COs. Using MRIs at CO onset and 1-3 years before CO onset, cartilage T2 values were calculated for the local cartilage preceding COs and the surrounding cartilage. Cartilage lesions local to the site of COs and bone marrow edema like lesions (BMELs) subjacent to COs were graded using whole organ MRI scores (WORMS). Wilcoxon tests were used to compare T2 values from the local and the surrounding cartilage at each time point and to compare T2 and WORMS between time points. Knee symptoms were recorded during this period. RESULTS All subjects showed local cartilage lesions before the development of COs. Mean cartilage WORMS increased from 1.56 ± 0.66 a period of 3 years before to 2.39 ± 0.75 with onset of COs (p = 0.008). Local T2 values in the area of the later-appearing COs were significantly higher compared with T2 values of the surrounding cartilage 3 (p = 0.044) and 2 years earlier (p = 0.031) and with the onset of COs (p = 0.025). No significant increase in symptoms was found with the onset of COs. CONCLUSION This study provides evidence that focal cartilage structural and compositional degeneration precedes COs. No significant aggravation of knee symptoms was reported during the evolution of COs.
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Affiliation(s)
- M. Kretzschmar
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - U. Heilmeier
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - S. Foreman
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - G.B. Joseph
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - C.E. McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - M.C. Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - T.M. Link
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
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Kowark A, Rossaint R, Keszei AP, Bischoff P, Czaplik M, Drexler B, Kienbaum P, Kretzschmar M, Rex C, Saller T, Schneider G, Soehle M, Coburn M. Impact of PReOperative Midazolam on OuTcome of Elderly patients (I-PROMOTE): study protocol for a multicentre randomised controlled trial. Trials 2019; 20:430. [PMID: 31307505 PMCID: PMC6632125 DOI: 10.1186/s13063-019-3512-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/10/2019] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Premedication of surgical patients with benzodiazepines has become questionable regarding risk-benefit ratio and lack of evidence. Though preoperative benzodiazepines might alleviate preoperative anxiety, a higher risk for adverse events is described, particularly for elderly patients (≥ 65 years). Several German hospitals already withhold benzodiazepine premedication from elderly patients, though evidence for this approach is lacking. The patient-centred outcome known as global postoperative patient satisfaction is recognised as a substantial quality indicator of anaesthesia care incorporated by the American Society of Anesthesiologists. Therefore, we aim to assess whether the postoperative patient satisfaction after premedication with placebo compared to the preoperative administration of 3.75 mg midazolam in elderly patients differs. METHODS This study is a multicentre, randomised, placebo-controlled, double-blinded, two-arm parallel, interventional trial, conducted in nine German hospitals. In total 614 patients (≥ 65-80 years of age) undergoing elective surgery with general anaesthesia will be randomised to receive either 3.75 mg midazolam or placebo. The primary outcome (global patient satisfaction) will be assessed with the validated EVAN-G questionnaire on the first postoperative day. Secondary outcomes will be assessed until the first postoperative day and then 30 days after surgery. They comprise among other things: functional and cognitive recovery, postoperative delirium, health-related quality of life assessment, and mortality or new onset of serious cardiac or pulmonary complications, acute stroke, or acute kidney injury. Analysis will adhere to the intention-to-treat principle. The primary outcome will be analysed with the use of mixed linear models including treatment effect and study centre as factors and random effects for blocks. Exploratory adjusted and subgroup analyses of the primary and secondary outcomes with regard to gender effects, frailty, pre-operative anxiety level, patient demographics, and surgery experience will also be performed. DISCUSSION This is, to the best of our knowledge, the first study analysing patient satisfaction after premedication with midazolam in elderly patients. In conclusion, this study will provide high-quality data for the decision-making process regarding premedication in elderly surgical patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT03052660 . Registered on 14 February 2017. EudraCT 2016-004555-79 .
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Affiliation(s)
- Ana Kowark
- Department of Anaesthesiology, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Rolf Rossaint
- Department of Anaesthesiology, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - András P Keszei
- Center for Translational & Clinical Research Aachen (CTC-A), Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Petra Bischoff
- Department of Anaesthesiology, Surgical Intensive Care, Pain and Palliative Care, Marien Hospital Herne, University Hospital of Ruhr University Bochum, Herne, Germany
| | - Michael Czaplik
- Department of Anaesthesiology, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Berthold Drexler
- Department of Anaesthesiology and Intensive Care, University Hospital Tübingen, Tübingen, Germany
| | - Peter Kienbaum
- Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Moritz Kretzschmar
- Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Christopher Rex
- Department for Anaesthesiology, Intensive Care, Emergency Medicine, Pain Therapy and Palliative Care, Kreiskliniken Reutlingen, Reutlingen, Germany
| | - Thomas Saller
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Gerhard Schneider
- Department of Anaesthesiology, Technical University of Munich (TUM), Munich, Germany
| | - Martin Soehle
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Mark Coburn
- Department of Anaesthesiology, Medical Faculty RWTH Aachen University, Aachen, Germany.
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Kretzschmar M, Nevitt MC, Schwaiger BJ, Joseph GB, McCulloch CE, Link TM. Spatial distribution and temporal progression of T2 relaxation time values in knee cartilage prior to the onset of cartilage lesions - data from the Osteoarthritis Initiative (OAI). Osteoarthritis Cartilage 2019; 27:737-745. [PMID: 30802496 PMCID: PMC6482329 DOI: 10.1016/j.joca.2018.10.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 10/02/2018] [Accepted: 10/11/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate compositional changes of knee cartilage at the site of newly appearing cartilage lesions and the surrounding cartilage 1-4 years prior to lesion onset using quantitative T2-measurements. METHODS Fifty-seven cartilage plates with newly appearing cartilage lesions from 45 knees (cases) and 52 plates from 26 control knees from the Osteoarthritis Initiative (OAI) cohort (controls) were evaluated. Using MRI T2-mapping, composition of local (the site of future lesions) and surrounding cartilage (remainder of the cartilage plate) was assessed 1-4 years prior to lesion onset. Analogous cartilage ROIs in control plates without cartilage lesions were assessed over 1-4 years. Mixed models were used to compare T2-means and change rates between local and surrounding cartilage within cases and controls, and to compare change rates in local and surrounding cartilage between cases and controls, adjusting for covariates. RESULTS Four years prior to lesion onset, we found that local cartilage ROIs had higher T2-values compared to the surrounding cartilage. No such differences were found in control plates. In cases mean local T2-values were persistantly elevated compared to the surrounding cartilage prior to lesion onset reaching significance 1 year prior (+2.94 ms, p = 0.012). T2-values of the surrounding cartilage were also persistantly higher in cases compared to controls, reaching significance 2 years prior to lesion onset (+3.61 ms, p = 0.003). CONCLUSION The findings of our study support the concept of compositional cartilage changes as a mechanism for cartilage degradation and that both diffuse and focal changes of cartilage composition within a cartilage plate precede the development of cartilage lesions.
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Affiliation(s)
- M Kretzschmar
- Musculoskeletal and Quantitative Imaging Group (MQIR), Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - MC Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - BJ Schwaiger
- Musculoskeletal and Quantitative Imaging Group (MQIR), Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - GB Joseph
- Musculoskeletal and Quantitative Imaging Group (MQIR), Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - CE McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - TM Link
- Musculoskeletal and Quantitative Imaging Group (MQIR), Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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Bredow J, Kretzschmar M, Wunderlich G, Dörr W, Pohl T, Franke WG, Kotzerke J. Therapy of malignant ascites in vivo by 211At-labelled microspheres. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1624060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Aim: Determination of the biological effect of the alpha emitter 211At on cellular level as well as the assessment of dosimetric data in a tumour model in vivo. Methods: Transplantation of malignant ascitic cells in mice intraperitoneally and estimation of tumour characteristics (doubling time of the cells, mean survival of the animals following an i.p. application of a defined tumour cell number). 211At labelled human serum albumine microspheres B-20 (MSP) of variing activity were injected into tumour bearing mice intraperitoneally. The effectiveness of the therapy was evaluated by means of determination of the duration of cell cycle arrest as well as the microscopic analysis of the rate of abnormal mitotic cells due to radiation induced damage. Furthermore, dose dependence of survival was evaluated. Results: Three days following the intraperitoneally application of 8 x 106 tumour cells, 50-600 kBq 211At-MSP were applied into the abdominal cavity. Considering the volume of ascites at this time and the administered activity, dose calculations were performed. An activity of 50 kBq caused a dose of 0.84 Gy. The increase of radiation induced effect on ascitic tumour cells was correlated with the dose. Between the duration of the cell cycle arrest and the administered activity, a directly proportional correlation was found. The mean survival of non-treated animals was 16.9 ± 3.7 days. The prolongation of the survival was proportional to the activity administered. Using a dosage of 10 Gy, five animals out of 16 survived. Conclusion: Therapy of malignant ascitic cells using 211At-MSP was effective in vivo. For tumour therapy, the 211At represents a highly effective alternative to usually applied beta emitters.
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Citarda S, Decaudain A, Galland R, Kretzschmar M, Poux J, Guerraoui A, Lino-Daniel M, Hallonet P, Serusclat P, Caillette-Beaudoin A. Surveillance des plaies podologiques et patients hémodialysés : importance du diabète. Nephrol Ther 2017. [DOI: 10.1016/j.nephro.2017.08.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hofmann F, Heilmeier U, Mbapte Wamba J, Joseph G, Darakananda K, Callan J, Neumann J, Kretzschmar M, Nevitt M, McCulloch C, Liu F, Lynch J, Link T. MRT-basierte, semi-quantitative Analyse des Kniegelenks eignet sich zur Vorhersage der Implantation von Knie-Totalendoprothesen. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- F Hofmann
- Klinikum rechts der Isar, Technische Universität München, Institut für diagnostische und interventionelle Radiologie, München
| | - U Heilmeier
- University of California, San Francisco, Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, San Francisco
| | - J Mbapte Wamba
- University of California, San Francisco, Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, San Francisco
| | - G Joseph
- University of California, San Francisco, Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, San Francisco
| | - K Darakananda
- University of California, San Francisco, Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, San Francisco
| | - J Callan
- University of California, San Francisco, Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, San Francisco
| | - J Neumann
- University of California, San Francisco, Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, San Francisco
| | - M Kretzschmar
- University of California, San Francisco, Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, San Francisco
| | - M Nevitt
- University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco
| | - C McCulloch
- University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco
| | - F Liu
- University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco
| | - J Lynch
- University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco
| | - T Link
- University of California, San Francisco, Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, San Francisco
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Kretzschmar M, Heilmeier U, Yu A, Joseph G, Liu F, Solka M, McCulloch C, Nevitt M, Link T. Longitudinal analysis of cartilage T2 relaxation times and joint degeneration in African American and Caucasian American women over an observation period of 6 years - data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2016; 24:1384-91. [PMID: 26970285 PMCID: PMC4955659 DOI: 10.1016/j.joca.2016.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 01/04/2016] [Accepted: 03/03/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate the change in cartilage T2 values and structural degeneration in knee joints over 72 months in women of African American (AA) vs Caucasian American (CA) ethnicity. METHODS Knee 3T magnetic resonance imaging (MRIs) from baseline, 24, 48 and 72 months visits of 100 AA and 100 CA women from the Osteoarthritis Initiative (OAI) were assessed for cartilage T2 values and whole-organ magnetic resonance imaging (WORMS) score. Subjects were pair-matched by age, body mass index (BMI), Kellgren-Lawrence (KL) score, clinical site and subcohort within the OAI. We compared the rate of change in whole knee cartilage T2 values and WORMS cartilage, bone marrow edema pattern (BMEP) and meniscus scores between the two ethnic groups using mixed random effects models. RESULTS At 24 and 48 months 60 subjects and at 72 months 45 subjects per group were available for analysis resulting in 38 complete pairs with data of all time points. Compared to CA, cartilage T2 values in AA increased at a significantly faster rate at baseline (AA: 0.45 ms/y, CA: 0.35 ms/y, P = 0.029) and averaged over 6 years (AA: 0.36 ms/y, CA: 0.27 ms/y, P = 0.039) with changes in both groups reaching a plateau by 48 months. Cartilage, meniscus and BMEP scores tended to increase in both groups during follow up, but rates of change did not differ by ethnicity. CONCLUSION Cartilage T2 values increased faster over 72 months in AA than CA, however changes in WORMS cartilage, meniscus and BMEP scores did not differ. T2 values may be able to distinguish ethnicity-related differences of cartilage degeneration at an early stage before differences in structural joint degeneration appear.
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Affiliation(s)
- M. Kretzschmar
- Musculoskeletal and Quantitative Imaging Research Group Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - U.R. Heilmeier
- Musculoskeletal and Quantitative Imaging Research Group Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - A. Yu
- Musculoskeletal and Quantitative Imaging Research Group Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA,Department of Radiology, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing China
| | - G.B. Joseph
- Musculoskeletal and Quantitative Imaging Research Group Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - F. Liu
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - M. Solka
- Musculoskeletal and Quantitative Imaging Research Group Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - C.E. McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - M.C. Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - T.M. Link
- Musculoskeletal and Quantitative Imaging Research Group Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
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Kretzschmar M, Lin W, Nardo L, Joseph GB, Dunlop DD, Heilmeier U, Nevitt MC, Alizai H, McCulloch CE, Lynch JA, Link TM. Association of Physical Activity Measured by Accelerometer, Knee Joint Abnormalities, and Cartilage T2 Measurements Obtained From 3T Magnetic Resonance Imaging: Data From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2016; 67:1272-1280. [PMID: 25777255 DOI: 10.1002/acr.22586] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 02/10/2015] [Accepted: 03/10/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To study the cross-sectional association between physical activity measured with an accelerometer, structural knee abnormalities, and cartilage T2 values assessed with 3T magnetic resonance imaging (MRI). METHODS We included 274 subjects from the Osteoarthritis Initiative cohort without definite radiographic osteoarthritis (Kellgren/Lawrence grades 0 and 1) and with at most mild pain, stiffness, and functional limitation in the study knee (Western Ontario and McMaster Universities Osteoarthritis Index scale 0-1), which had not limited their activity due to knee pain. Physical activity was measured over 7 days with an ActiGraph GT1M accelerometer. Subjects were categorized by quartile of physical activity based on the average daily minutes of moderate to vigorous physical activity (mv-PA). MRI images of the right knee (at 48-month visit) were assessed for structural abnormalities using a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS) and for T2 relaxation times derived from segmented cartilage of 4 femorotibial regions and the patella. WORMS grades and T2 measurements were compared between activity quartiles using a linear regression model. Covariates included age, sex, body mass index, knee injury, family history of knee replacement, knee symptoms, hip and ankle pain, and daily wear time of the accelerometer. RESULTS Higher mv-PA was associated with increased severity (P = 0.0087) and number of lesions of the medial meniscus (P = 0.0089) and with severity of bone marrow edema lesions (P = 0.0053). No association between cartilage lesions and mv-PA was found. T2 values of cartilage (loss, damage, and abnormalities) tended to be greater in the higher quartiles of mv-PA, but the differences were nonsignificant. CONCLUSION In knees without radiographic osteoarthritis in subjects with no or mild knee pain, higher physical activity levels were associated with increases in meniscal and bone marrow edema pattern lesions.
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Affiliation(s)
| | - W Lin
- University of California, San Francisco
| | - L Nardo
- University of California, San Francisco
| | | | - D D Dunlop
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - H Alizai
- University of California, San Francisco
| | | | - J A Lynch
- University of California, San Francisco
| | - T M Link
- University of California, San Francisco
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Claudi C, Gersing A, Kretzschmar M, Schwaiger B, Joseph G, Dunlop D, Nevitt M, McCulloch C, Link T. Der Zusammenhang von körperlicher Aktivität gemessen mittels Akzelerometers und morphologischen Kniegelenksveränderungen sowie quantitativen T2-Werten des Knorpels über 24 Monate. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Maas O, Joseph GB, Sommer G, Wild D, Kretzschmar M. Association between cartilage degeneration and subchondral bone remodeling in patients with knee osteoarthritis comparing MRI and (99m)Tc-DPD-SPECT/CT. Osteoarthritis Cartilage 2015; 23:1713-20. [PMID: 26028141 DOI: 10.1016/j.joca.2015.05.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 04/13/2015] [Accepted: 05/20/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this retrospective cross-sectional study was to investigate the association between cartilage lesions assessed with 3T-MRI and remodeling of the subchondral bone detected by (99m)Tc-DPD-SPECT/CT. DESIGN (99m)Tc-DPD-SPECT/CT and MRI of 27 knees of 25 patients with chronic knee pain and risk factors for osteoarthritis (OA) were evaluated by one nuclear physician and one radiologist. Six regions of the knee (in total 162 regions in 27 knees) were assessed according to structural joint lesions graded with a modified Whole Organ MR imaging score (WORMS) and according to subchondral (99m)Tc-DPD-SPECT uptake. Relationships between regional WORMS scores and uptake were quantified using general estimating equations. In a secondary analysis the uptake sum with the WORMS sum per joint was compared using Spearman correlations. RESULTS Elevated subchondral uptake was significantly associated with the grade of cartilage lesions (P < 0.0001). Mean uptake was significantly higher subjacent to full thickness cartilage lesions compared to partial thickness lesions (P < 0.0001). A similar association was observed between bone marrow edema pattern (BMEP) and cartilage lesions. The sum of uptakes per joint was positively correlated to the WORMS sum (rs = 0.42) and to the sum of cartilage lesions per joint (rs = 0.50). CONCLUSION Both functional and structural changes of the subchondral bone in terms of scintigraphic osseous activity and the presence and degree of BMEP were significantly associated with cartilage lesions in patients with OA of the knee. This association was pronounced with full thickness lesions, indicating a possible protective effect of the cartilage layer for the subjacent bone.
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Affiliation(s)
- O Maas
- Division of Nuclear Medicine, University of Basel Hospital, Basel, Switzerland.
| | - G B Joseph
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
| | - G Sommer
- Division of Nuclear Medicine, University of Basel Hospital, Basel, Switzerland.
| | - D Wild
- Division of Nuclear Medicine, University of Basel Hospital, Basel, Switzerland.
| | - M Kretzschmar
- Division of Nuclear Medicine, University of Basel Hospital, Basel, Switzerland; Department of Radiology, University of Basel Hospital, Basel, Switzerland; Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
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Bouwknegt M, Havelaar A, Neslo R, de Roda Husman AM, Hogerwerf L, van Steenbergen J, Kretzschmar M, Ciotti M, Cassini A, Suk JE. Ranking infectious disease risks to support preparedness prioritization in the European Union. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv167.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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YU A, Heilmeier U, Kretzschmar M, Joseph G, Liu F, Liebl H, McCulloch C, Nevitt M, Lane NE, Link T. Racial differences in biochemical knee cartilage composition between African-American and Caucasian-American women with 3 T MR-based T2 relaxation time measurements--data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2015; 23:1595-604. [PMID: 25937026 PMCID: PMC4646660 DOI: 10.1016/j.joca.2015.04.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 03/09/2015] [Accepted: 04/21/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether knee cartilage composition differs between African-American and Caucasian-American women at risk for Osteoarthritis (OA) using in vivo 3 T MRI T2 relaxation time measurements. METHODS Right knee MRI studies of 200 subjects (100 African-American women, and 100 closely matched Caucasian-American women) were selected from the Osteoarthritis Initiative (OAI). Knee cartilage was segmented in the patellar (PAT), medial and lateral femoral (MF/LF), and medial and lateral tibial compartments (MT/LT)). Mean T2 relaxation time values per compartment and per whole joint cartilage were generated and analyzed spatially via laminar and grey-level co-occurrence matrix (GLCM) texture methods. Presence and severity of cartilage lesions per compartment were graded using a modified WORMS grading. Statistical analysis employed paired t- and McNemar testing. RESULTS While African-American women and Caucasian-Americans had similar WORMS cartilage lesion scores (P = 0.970), African-Americans showed significantly lower mean T2 values (∼1 ms difference; ∼0.5SD) than Caucasian-Americans in the whole knee cartilage (P < 0.001), and in the subcompartments (LF: P = 0.001, MF: P < 0.001, LT: P = 0.019, MT: P = 0.001) and particularly in the superficial cartilage layer (whole cartilage: P < 0.001, LF: P < 0.001, MF: P < 0.001, LT: P = 0.003, MT: P < 0.001). T2 texture parameters were also significantly lower in the whole joint cartilage of African-Americans than in Caucasian-Americans (variance: P = 0.001; contrast: P = 0.018). In analyses limited to matched pairs with no cartilage lesions in a given compartment, T2 values remained significantly lower in African-Americans. CONCLUSION Using T2 relaxation time as a biomarker for the cartilage collagen network, our findings suggest racial differences in the biochemical knee cartilage composition between African-American and Caucasian-American women.
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Affiliation(s)
- A. YU
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA,Department of Radiology, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing China
| | - U. Heilmeier
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - M. Kretzschmar
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - G.B. Joseph
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - F. Liu
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | - H. Liebl
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA,Institut für diagnostische und interventionelle Radiologie, Technische Universitaet Muenchen, Munich, Germany
| | - C.E. McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | - M.C. Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | - Nancy E. Lane
- Center for Healthy Aging, University of California Davis, Davis, CA USA
| | - T.M. Link
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
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Kretzschmar M, Schilling T, Vogt A, Rothen HU, Borges JB, Hachenberg T, Larsson A, Baumgardner JE, Hedenstierna G. Multiple inert gas elimination technique by micropore membrane inlet mass spectrometry--a comparison with reference gas chromatography. J Appl Physiol (1985) 2013; 115:1107-18. [PMID: 23869066 DOI: 10.1152/japplphysiol.00072.2013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The mismatching of alveolar ventilation and perfusion (VA/Q) is the major determinant of impaired gas exchange. The gold standard for measuring VA/Q distributions is based on measurements of the elimination and retention of infused inert gases. Conventional multiple inert gas elimination technique (MIGET) uses gas chromatography (GC) to measure the inert gas partial pressures, which requires tonometry of blood samples with a gas that can then be injected into the chromatograph. The method is laborious and requires meticulous care. A new technique based on micropore membrane inlet mass spectrometry (MMIMS) facilitates the handling of blood and gas samples and provides nearly real-time analysis. In this study we compared MIGET by GC and MMIMS in 10 piglets: 1) 3 with healthy lungs; 2) 4 with oleic acid injury; and 3) 3 with isolated left lower lobe ventilation. The different protocols ensured a large range of normal and abnormal VA/Q distributions. Eight inert gases (SF6, krypton, ethane, cyclopropane, desflurane, enflurane, diethyl ether, and acetone) were infused; six of these gases were measured with MMIMS, and six were measured with GC. We found close agreement of retention and excretion of the gases and the constructed VA/Q distributions between GC and MMIMS, and predicted PaO2 from both methods compared well with measured PaO2. VA/Q by GC produced more widely dispersed modes than MMIMS, explained in part by differences in the algorithms used to calculate VA/Q distributions. In conclusion, MMIMS enables faster measurement of VA/Q, is less demanding than GC, and produces comparable results.
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Affiliation(s)
- Moritz Kretzschmar
- Department of Surgical Sciences, Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
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Rijckevorsel GGV, Whelan J, Kretzschmar M, Siedenburg E, Sonder G, Geskus R, Coutinho R, Hoek AVD. P3.420 Targeted Vaccination Programme Successful in Reducing Acute Hepatitis B in Men Having Sex with Men in Amsterdam, the Netherlands. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lucht A, Shah M, Kretzschmar M. P3.132 Could HIV Serosorting Explain Increases in Syphilis Prevalence Among Men Who Have Sex with Men? - A Mathematical Modelling Study. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wiewiorski M, Miska M, Kretzschmar M, Studler U, Bieri O, Valderrabano V. Delayed gadolinium-enhanced MRI of cartilage of the ankle joint: results after autologous matrix-induced chondrogenesis (AMIC)-aided reconstruction of osteochondral lesions of the talus. Clin Radiol 2013; 68:1031-8. [PMID: 23809267 DOI: 10.1016/j.crad.2013.04.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 04/22/2013] [Accepted: 04/30/2013] [Indexed: 12/28/2022]
Abstract
AIM To assess cartilage quality using delayed gadolinium-enhanced magnetic resonance imaging after repair of osteochondral lesions of the talus using autologous matrix-induced chondrogenesis (AMIC). MATERIALS AND METHODS A three-dimensional (3D) spoiled gradient-echo (SGE) sequence at 3 T was used to obtain quantitative T1 relaxation times before and after Gd-DTPA2 (Magnevist, 0.2 mM/kg bod weight) administration to assess 23 cases of AMIC-aided repair of osteochondral lesions of the talus. Delta relaxation rates (ΔR1) for reference cartilage (RC) and repair tissue (RT), and the relative delta relaxation rate (rΔR1) were calculated. The morphological appearance of the cartilage RT was graded on sagittal dual-echo steady-state (DESS) views according to the "magnetic resonance observation of cartilage repair tissue" (MOCART) protocol. The study was approved by the institutional review board and written consent from each patient was obtained. RESULTS The AMIC cases had a mean T1 relaxation time of 1.194 s (SD 0.207 s) in RC and 1.470 s (SD 0.384 s) in RT before contrast medium administration. The contrast-enhanced T1 relaxation time decreased to 0.480 s (SD 0.114 s) in RC and 0.411 s (SD 0.096 s) in RT. There was a significant difference (p > 0.05) between the ΔR1 in RC (1.372 × 10(-3)/s, range 0.526-3.201 × 10(-3)/s, SD 0.666 × 10(-3)/s) and RT (1.856 × 10(-3)/s, range 0.93-3.336 × 10(-3)/s, SD 0.609 × 10(-3)/s). The mean rΔR1 was 1.49, SD 0.45). The mean MOCART score at follow-up was 62.6 points (range 30-95, SD 15.3). CONCLUSION The results of the present study suggest that repair cartilage resulting from AMIC-aided repair of osteochondral lesions of the talus has a significantly lower glycosaminoglycan (GAG) content than normal hyaline cartilage, but can be regarded as having hyaline-like properties.
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Affiliation(s)
- M Wiewiorski
- Orthopaedic Department, University of Basel Hospital, Basel, Switzerland.
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Schilling T, Kretzschmar M, Hachenberg T, Hedenstier-Na G, Kozian A. The immune response to one-lung-ventilation is not affected by repeated alveolar recruitment manoeuvres in pigs. Minerva Anestesiol 2013; 79:590-603. [PMID: 23449239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Acute lung injury after thoracic surgery relates to alveolar inflammation induced by one-lung ventilation (OLV) and surgical manipulation. However, alveolar recruitment manoeuvres (ARM), conventional ventilation, and airway manipulation may increase alveolar trauma. This study evaluates pulmonary immune effects of these co-factors in a porcine model. METHODS Twenty-two piglets (27.3 kg) were randomised to spontaneous breathing (N.=4), two-lung ventilation (TLV, N.=6), OLV with propofol (6 mg/kg/h, N.=6) or desflurane anesthesia (1MAC, N.=6). Mechanical ventilation settings were constant throughout the experiment: VT=10 mL/kg, FIO2=0.4, PEEP=5 cmH2O. OLV was performed by left-sided bronchial blockade. Thoracic surgery was simulated for 60 min. ARM (airway pressure of 40 mbar for 10 s) was applied before and after each airway manipulation. Cytokines and mRNA-expression were assessed by immunoassays and semi-quantitative RT-PCR in alveolar lavage fluids, serum and tissue samples prior to and after OLV (TLV in controls). RESULTS Repetitive ARM and TLV induced no significant proinflammatory effects. OLV enhanced cytokine release but less with desflurane inhalation than propofol infusion (median (IQR) [pg/mL], dependent lung): Interleukin-8: TLV 44 (17) to 68 (35), propofol 82 (17) to 494 (231), desflurane 89 (30) to 282 (44). Likewise, serum cytokines were different: tumour necrosis factor-a: TLV 37 (13) to 62 (7), propofol 55 (39) to 94 (60), desflurane 43 (33) to 41 (25). Expression of interleukin-8-mRNA increased after OLV, but mRNA expression was not modulated by anesthetics. CONCLUSION ARM, standard TLV and repetitive BAL do not additionally contribute to lung injury resulting from OLV for thoracic surgery in healthy porcine lungs. OLV induces expression of interleukin-8-mRNA in alveolar cells, which is not modulated by different anesthetic drugs.
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Affiliation(s)
- T Schilling
- Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Germany.
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Pfau G, Brinkers M, Treuheit T, Kretzschmar M, Sentürk M, Hachenberg T. Misoprostol as a therapeutic option for trigeminal neuralgia in patients with multiple sclerosis. Pain Med 2012; 13:1377-8. [PMID: 22925476 DOI: 10.1111/j.1526-4637.2012.01472.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sutton A, House T, Hope V, Ncube F, Wiessing L, Kretzschmar M. Modelling HIV in the injecting drug user population and the male homosexual population in a developed country context. Epidemics 2012; 4:48-56. [DOI: 10.1016/j.epidem.2011.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 12/13/2011] [Accepted: 12/14/2011] [Indexed: 10/14/2022] Open
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Swart AN, Tomasi M, Kretzschmar M, Havelaar AH, Diekmann O. The protective effects of temporary immunity under imposed infection pressure. Epidemics 2012; 4:43-7. [PMID: 22325013 DOI: 10.1016/j.epidem.2011.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 11/04/2011] [Accepted: 12/22/2011] [Indexed: 11/27/2022] Open
Abstract
The aim of this paper is to show in explicit detail that, due to the effects of waning and boosting of immunity, an increasing force of infection does not necessarily lead to an increase in the incidence of disease. Under certain conditions, a decrease of the force of infection may in fact lead to an increase of the incidence of disease. Thus we confirm and reinforce the conclusions from Águas et al. (2006), concerning pertussis. We do so, however, in the context of Campylobacter infections in humans deriving from animal reservoirs. For such an externally 'driven' epidemic we can ignore the transmission feedback cycle and treat the force of infection as a parameter. As this parameter is, to a certain extent, under public health control, our findings constitute an important warning: reducing exposure may not necessarily lead to a reduction in the occurrence of clinical illness. In a second part of the paper we relate the model parameters to the available data concerning campylobacteriosis.
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Affiliation(s)
- A N Swart
- National Institute of Public Health and The Environment, Bilthoven, The Netherlands.
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Veldman-Ariesen MJ, van Asten L, Haenen AP, Kretzschmar M, van Benthem BH. Mortality attributable to influenza-like illness, gastro-enteritis and pneumonia, results from the Dutch Sentinel Network for Surveillance of Infectious Disease (SNIV). BMC Proc 2011. [PMCID: PMC3239584 DOI: 10.1186/1753-6561-5-s6-p166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Eliseev S, Roux C, Blaum K, Block M, Droese C, Herfurth F, Kretzschmar M, Krivoruchenko MI, Minaya Ramirez E, Novikov YN, Schweikhard L, Shabaev VM, Simkovic F, Tupitsyn II, Zuber K, Zubova NA. Octupolar-excitation Penning-trap mass spectrometry for Q-value measurement of double-electron capture in (164)Er. Phys Rev Lett 2011; 107:152501. [PMID: 22107289 DOI: 10.1103/physrevlett.107.152501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Indexed: 05/31/2023]
Abstract
The theory of octupolar-excitation ion-cyclotron-resonance mass spectrometry is presented which predicts an increase of up to several orders of magnitude in resolving power under certain conditions. The new method has been applied for a direct Penning-trap mass-ratio determination of the (164)Er-(164)Dy mass doublet. (164)Er is a candidate for the search for neutrinoless double-electron capture. However, the measured Q(ϵϵ) value of 25.07(12) keV results in a half-life of 10(30) years for a 1 eV Majorana-neutrino mass.
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Affiliation(s)
- S Eliseev
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
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Mikolajczyk R, Damm O, Horn J, Kretzschmar M, Delere Y, Kaufmann AM, Krämer A, Greiner W. Wann werden wir die Auswirkungen der HPV-Impfung in Deutschland sehen können? Ergebnisse eines dynamischen Transmissionsmodells. Gesundheitswesen 2011. [DOI: 10.1055/s-0031-1283553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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McDonald S, Kretzschmar M, Hutchinson S, Goldberg D. P2-181 Reconstructing the historical incidence of hepatitis C infection among Scotland's IDUS. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976j.16] [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: 11/03/2022]
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40
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Schmid BV, van den Broek IVF, Op de Coul ELM, van Bergen JEAM, Fennema JSA, Gotz HM, Hoebe CJPA, Kretzschmar M. O1-S09.04 Modelled impact of changing participation rates on effectiveness of population based chlamydia screening. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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41
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Kretzschmar M, Schmid B, Low N, Heijne J. P1-S5.41 Quantifying the contribution of re-infection within partnerships to persistent spread of Chlamydia. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.219] [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: 11/03/2022]
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Schmid B, Over E, van den Broek I, de Coul EO, van Bergen J, Group C, Kretzschmar M, de Wit A. P5-S7.06 Chlamydia screening implementation in the Netherlands is not cost-effective. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.601] [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: 11/03/2022]
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van den Wijngaard CC, van Pelt W, Nagelkerke NJ, Kretzschmar M, Koopmans MP. Evaluation of syndromic surveillance in the Netherlands: its added value and recommendations for implementation. Euro Surveill 2011. [DOI: 10.2807/ese.16.09.19806-en] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- C C van den Wijngaard
- Rijksinstituut voor Volksgezondheid en Milieu (National Institute for Public Health and the Environment, RIVM), Bilthoven, the Netherlands
| | - W van Pelt
- Rijksinstituut voor Volksgezondheid en Milieu (National Institute for Public Health and the Environment, RIVM), Bilthoven, the Netherlands
| | - N J Nagelkerke
- United Arab Emirates University, Al-Ain, United Arab Emirates
| | - M Kretzschmar
- Rijksinstituut voor Volksgezondheid en Milieu (National Institute for Public Health and the Environment, RIVM), Bilthoven, the Netherlands
| | - M P Koopmans
- Rijksinstituut voor Volksgezondheid en Milieu (National Institute for Public Health and the Environment, RIVM), Bilthoven, the Netherlands
- Erasmus Medical Center, Rotterdam, the Netherlands
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van den Wijngaard CC, van Pelt W, Nagelkerke NJ, Kretzschmar M, Koopmans MP. Evaluation of syndromic surveillance in the Netherlands: its added value and recommendations for implementation. Euro Surveill 2011; 16:19806. [PMID: 21392486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
In the last decade, syndromic surveillance has increasingly been used worldwide for detecting increases or outbreaks of infectious diseases that might be missed by surveillance based on laboratory diagnoses and notifications by clinicians alone. There is, however, an ongoing debate about the feasibility of syndromic surveillance and its potential added value. Here we present our perspective on syndromic surveillance, based on the results of a retrospective analysis of syndromic data from six Dutch healthcare registries, covering 1999–2009 or part of this period. These registries had been designed for other purposes, but were evaluated for their potential use in signalling infectious disease dynamics and outbreaks. Our results show that syndromic surveillance clearly has added value in revealing the blind spots of traditional surveillance, in particular by detecting unusual, local outbreaks independently of diagnoses of specific pathogens, and by monitoring disease burden and virulence shifts of common pathogens. Therefore we recommend the use of syndromic surveillance for these applications.
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Affiliation(s)
- C C van den Wijngaard
- Rijksinstituut voor Volksgezondheid en Milieu (National Institute for Public Health and the Environment, RIVM), Bilthoven, the Netherlands.
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Kretzschmar M, Turner KME, Barton PM, Edmunds WJ, Low N. Predicting the population impact of chlamydia screening programmes: comparative mathematical modelling study. Sex Transm Infect 2009; 85:359-66. [PMID: 19454407 DOI: 10.1136/sti.2009.036251] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Published individual-based, dynamic sexual network modelling studies reach different conclusions about the population impact of screening for Chlamydia trachomatis. The objective of this study was to conduct a direct comparison of the effect of organised chlamydia screening in different models. METHODS Three models simulating population-level sexual behaviour, chlamydia transmission, screening and partner notification were used. Parameters describing a hypothetical annual opportunistic screening program in 16-24 year olds were standardised, whereas other parameters from the three original studies were retained. Model predictions of the change in chlamydia prevalence were compared under a range of scenarios. RESULTS Initial overall chlamydia prevalence rates were similar in women but not men and there were age and sex-specific differences between models. The number of screening tests carried out was comparable in all models but there were large differences in the predicted impact of screening. After 10 years of screening, the predicted reduction in chlamydia prevalence in women aged 16-44 years ranged from 4% to 85%. Screening men and women had a greater impact than screening women alone in all models. There were marked differences between models in assumptions about treatment seeking and sexual behaviour before the start of the screening intervention. CONCLUSIONS Future models of chlamydia transmission should be fitted to both incidence and prevalence data. This meta-modelling study provides essential information for explaining differences between published studies and increasing the utility of individual-based chlamydia transmission models for policy making.
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Affiliation(s)
- M Kretzschmar
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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Sutton AJ, Hope VD, Mathei C, Mravcik V, Sebakova H, Vallejo F, Suligoi B, Brugal MT, Ncube F, Wiessing L, Kretzschmar M. A comparison between the force of infection estimates for blood-borne viruses in injecting drug user populations across the European Union: a modelling study. J Viral Hepat 2008; 15:809-16. [PMID: 18761605 DOI: 10.1111/j.1365-2893.2008.01041.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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: 12/20/2022]
Abstract
A number of studies have been conducted in injecting drug user (IDU) populations in Europe, in which the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) was measured together with demographic and epidemiological information such as age and the age at first injection. A measure of the risk of becoming infected is the force of infection (FOI), defined as the per capita rate at which susceptible individuals acquire infection. The objective of this study was to estimate the FOI and its heterogeneity for HBV, HCV and HIV (where available) for IDU populations in a number of countries in Europe. Data were obtained from five countries: Belgium, the United Kingdom, Spain and Italy, and the Czech Republic, which provided two data sets. The model describes the prevalence of infection as a function of the FOI that may vary over time or duration of IDU. In addition to this, if two or more infections were being considered then a parameter describing the potential heterogeneity of the FOI within the IDU population was also estimated. The results here add to the growing evidence that new initiates to injecting are at an increased risk of blood-borne viral infection compared with more experienced IDUs. In addition, there is evidence of individual heterogeneity of FOI estimates within the overall IDU populations. This suggests that different proportions of individuals in each population are at increased risk of infection compared with the rest of the population. Future interventions should identify and target these individuals. Moreover, changes over time in individual heterogeneity estimates of IDU populations may provide an indicator for measuring intervention impacts.
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Affiliation(s)
- A J Sutton
- Ecology and Epidemiology Group, Department of Biological Sciences, University of Warwick, Coventry, UK.
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van Rossum TGJ, de Melker HE, Houweling H, Voordouw ACG, Meijer CJLM, Helmerhorst TJM, Kretzschmar M, Berkhof J, van der Noordaa J. [Vaccines against human papillomavirus (HPV); between registration and implementation]. Ned Tijdschr Geneeskd 2008; 152:987-992. [PMID: 18549172] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
--Each year, 600-700 women in the Netherlands are diagnosed with cervical cancer. Over the last 10 years, an average of 250 women have died annually due to cervical cancer. --Gardasil, the first vaccine for Human papillomavirus (HPV), was recently approved in Europe for the prevention of cervical cancer. --The availability of a vaccine for HPV prompts the question whether it should be included in the Dutch National Immunisation Programme. --At the end of 2006, the Medicines Evaluation Board, the Health Council of the Netherlands and the Centre for Infectious Disease Control of the National Institute for Public Health and the Environment organised a workshop for experts in the field to answer that question. --The HPV vaccine provides protection against HPV-16 and HPV-18, which cause approximately 70% of cervical cancers. --Because the efficacy of vaccination is only evident after many years, preserving good participation in the screening programme is essential. --The current screening could be improved by introducing an HPV test combined with self-sampling for women who do not participate in screening. --Vaccination is unarguably an important development. However, there are still several unanswered questions regarding vaccination and its actual protection, duration of protection, long-term safety and cost-effectiveness. --April 1st, 2008, the Health Council of the Netherlands had recommended including HPV vaccination in the National Immunisation Programme.
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Schilling T, Kozian A, Kretzschmar M, Huth C, Welte T, Bühling F, Hedenstierna G, Hachenberg T. Effects of propofol and desflurane anaesthesia on the alveolar inflammatory response to one-lung ventilation. Br J Anaesth 2007; 99:368-75. [PMID: 17621602 DOI: 10.1093/bja/aem184] [Citation(s) in RCA: 102] [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: 12/25/2022] Open
Abstract
BACKGROUND One-lung ventilation (OLV) induces a pro-inflammatory response including cytokine release and leucocyte recruitment in the ventilated lung. Whether volatile or i.v. anaesthetics differentially modulate the alveolar inflammatory response to OLV is unclear. METHODS Thirty patients, ASA II or III, undergoing open thoracic surgery were randomized to receive either propofol 4 mg kg(-1) h(-1) (n = 15) or 1 MAC desflurane in air (n = 15) during thoracic surgery. Analgesia was provided by i.v. infusion of remifentanil (0.25 microg kg(-1) min(-1)) in both groups. The patients were mechanically ventilated according to a standard protocol during two-lung ventilation and OLV. Fibre optic bronchoalveolar lavage (BAL) of the ventilated lung was performed before and after OLV and 2 h postoperatively. Alveolar cells, protein, tumour necrosis factor alpha (TNFalpha), interleukin (IL)-8, soluble intercellular adhesion molecule-1 (sICAM), IL10, and polymorphonuclear (PMN) elastase were determined in the BAL fluid. Data were analysed by parametric or non-parametric tests, as indicated. RESULTS In both groups, an increase in pro-inflammatory markers was found after OLV and 2 h postoperatively; however, the fraction of alveolar granulocytes (median 63.7 vs 31.1%, P < 0.05) was significantly higher in the propofol group compared with the desflurane group. The time courses of alveolar elastase, IL-8, and IL-10 differed between groups, and alveolar TNFalpha (7.4 vs 3.1 pg ml(-1), P < 0.05) and sICAM-1 (52.3 vs 26.3 ng ml(-1), P < 0.05) were significantly higher in the propofol group. CONCLUSIONS These data indicate that pro-inflammatory reactions during OLV were influenced by the type of general anaesthesia. Different patterns of alveolar cytokines may be a result of increased granulocyte recruitment during propofol anaesthesia.
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Affiliation(s)
- T Schilling
- Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Germany.
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George S, Baruah S, Blank B, Blaum K, Breitenfeldt M, Hager U, Herfurth F, Herlert A, Kellerbauer A, Kluge HJ, Kretzschmar M, Lunney D, Savreux R, Schwarz S, Schweikhard L, Yazidjian C. Ramsey method of separated oscillatory fields for high-precision penning trap mass spectrometry. Phys Rev Lett 2007; 98:162501. [PMID: 17501414 DOI: 10.1103/physrevlett.98.162501] [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: 12/07/2006] [Indexed: 05/15/2023]
Abstract
Ramsey's method of separated oscillatory fields is applied to the excitation of the cyclotron motion of short-lived ions in a Penning trap to improve the precision of their measured mass values. The theoretical description of the extracted ion-cyclotron-resonance line shape is derived and its correctness demonstrated experimentally by measuring the mass of the short-lived 38Ca nuclide with an uncertainty of 1.1 x 10(-8) using the Penning trap mass spectrometer ISOLTRAP at CERN. The mass of the superallowed beta emitter 38Ca contributes for testing the theoretical corrections of the conserved-vector-current hypothesis of the electroweak interaction. It is shown that the Ramsey method applied to Penning trap mass measurements yields a statistical uncertainty similar to that obtained by the conventional technique but 10 times faster. Thus the technique is a new powerful tool for high-precision mass measurements.
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Affiliation(s)
- S George
- GSI, Planckstrasse 1, 64291 Darmstadt, Germany.
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