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Wendel-Garcia PD, Moser A, Jeitziner MM, Aguirre-Bermeo H, Arias-Sanchez P, Apolo J, Roche-Campo F, Franch-Llasat D, Kleger GR, Schrag C, Pietsch U, Filipovic M, David S, Stahl K, Bouaoud S, Ouyahia A, Fodor P, Locher P, Siegemund M, Zellweger N, Cereghetti S, Schott P, Gangitano G, Wu MA, Alfaro-Farias M, Vizmanos-Lamotte G, Ksouri H, Gehring N, Rezoagli E, Turrini F, Lozano-Gómez H, Carsetti A, Rodríguez-García R, Yuen B, Weber AB, Castro P, Escos-Orta JO, Dullenkopf A, Martín-Delgado MC, Aslanidis T, Perez MH, Hillgaertner F, Ceruti S, Franchitti Laurent M, Marrel J, Colombo R, Laube M, Fogagnolo A, Studhalter M, Wengenmayer T, Gamberini E, Buerkle C, Buehler PK, Keiser S, Elhadi M, Montomoli J, Guerci P, Fumeaux T, Schuepbach RA, Jakob SM, Que YA, Hilty MP, Hilty MP, Wendel-Garcia P, Schuepbach RA, Montomoli J, Guerci P, Fumeaux T, Bouaoud S, Ouyahia A, Abdoun M, Rais M, Alfaro-Farias M, Vizmanos-Lamotte G, Caballero A, Tschoellitsch T, Meier J, Aguirre-Bermeo H, Arias-Sanchez P, Apolo J, Martinez LA, Tirapé-Castro H, Galal I, Tharwat S, Abdehaleem I, Jurkolow G, Guerci P, Novy E, Losser MR, Wengenmayer T, Zotzmann V, David S, Stahl K, Seeliger B, Welte T, Aslanidis T, Korsos A, Ahmed LA, Hashim HT, Nikandish R, Carsetti A, Casarotta E, Giaccaglia P, Rezoagli E, Giacomini M, Magliocca A, Bolondi G, Potalivo A, Fogagnolo A, Salvi L, Wu MA, Cogliati C, Colombo R, Catena E, Turrini F, Simonini MS, Fabbri S, Montomoli J, Gamberini E, Gangitano G, Bitondo MM, Maciopinto F, de Camillis E, Venturi M, Bocci MG, Antonelli M, Alansari A, Abusalama A, Omar O, Binnawara M, Alameen H, Elhadi M, Alhadi A, Arhaym A, Gommers D, Ince C, Jayyab M, Alsharif M, Rodríguez-García R, Gámez-Zapata J, Taboada-Fraga X, Castro P, Fernandez J, Reverter E, Lander-Azcona A, Escós-Orta J, Martín-Delgado MC, Algaba-Calderon A, Roche-Campo F, Franch-Llasat D, Concha P, Sauras-Colón E, Lozano-Gómez H, Zalba-Etayo B, Montes MP, Michot MP, Klarer A, Ensner R, Schott P, Urech S, Siegemund M, Zellweger N, Gebhard CE, Hollinger A, Merki L, Lambert A, Laube M, Jeitziner MM, Moser A, Que YA, Jakob SM, Wiegand J, Yuen B, Lienhardt-Nobbe B, Westphalen A, Salomon P, Hillgaertner F, Sieber M, Dullenkopf A, Barana G, Ksouri H, Sridharan GO, Cereghetti S, Boroli F, Pugin J, Grazioli S, Bürkle C, Marrel J, Brenni M, Fleisch I, Perez MH, Ramelet AS, Weber AB, Gerecke P, Christ A, Ceruti S, Glotta A, Biggiogero M, Marquardt K, Hübner T, Neff T, Redecker H, Fumeaux T, Moret-Bochatay M, Betello M, zu Bentrup FM, Studhalter M, Stephan M, Gehring N, Selz D, Kleger GR, Schrag C, Pietsch U, Filipovic M, Ristic A, Heise A, Franchitti Laurent M, Laurent JC, Gaspert T, Haberthuer C, Fodor P, Locher P, Garcia PDW, Hilty MP, Schuepbach R, Keiser S, Heuberger D, Bartussek J, Bühler P, Brugger S, Kleinert EM, Fehlbier KJ, Danial A, Almousa M, Abdulbaki Y, Sannah K, Colak E, Marczin N, Al-Ameri S. Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry. Crit Care 2022; 26:199. [PMID: 35787726 PMCID: PMC9254551 DOI: 10.1186/s13054-022-04065-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/10/2022] [Indexed: 12/22/2022] Open
Abstract
Background It remains elusive how the characteristics, the course of disease, the clinical management and the outcomes of critically ill COVID-19 patients admitted to intensive care units (ICU) worldwide have changed over the course of the pandemic. Methods Prospective, observational registry constituted by 90 ICUs across 22 countries worldwide including patients with a laboratory-confirmed, critical presentation of COVID-19 requiring advanced organ support. Hierarchical, generalized linear mixed-effect models accounting for hospital and country variability were employed to analyse the continuous evolution of the studied variables over the pandemic. Results Four thousand forty-one patients were included from March 2020 to September 2021. Over this period, the age of the admitted patients (62 [95% CI 60–63] years vs 64 [62–66] years, p < 0.001) and the severity of organ dysfunction at ICU admission decreased (Sequential Organ Failure Assessment 8.2 [7.6–9.0] vs 5.8 [5.3–6.4], p < 0.001) and increased, while more female patients (26 [23–29]% vs 41 [35–48]%, p < 0.001) were admitted. The time span between symptom onset and hospitalization as well as ICU admission became longer later in the pandemic (6.7 [6.2–7.2| days vs 9.7 [8.9–10.5] days, p < 0.001). The PaO2/FiO2 at admission was lower (132 [123–141] mmHg vs 101 [91–113] mmHg, p < 0.001) but showed faster improvements over the initial 5 days of ICU stay in late 2021 compared to early 2020 (34 [20–48] mmHg vs 70 [41–100] mmHg, p = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4–7]% vs 20 [14–29], p < 0.001) and non-invasive mechanical ventilation (14 [11–18]% vs 24 [17–33]%, p < 0.001) throughout the pandemic increased concomitant to a decrease in invasive mechanical ventilation (82 [76–86]% vs 74 [64–82]%, p < 0.001). The ICU mortality (23 [19–26]% vs 17 [12–25]%, p < 0.001) and length of stay (14 [13–16] days vs 11 [10–13] days, p < 0.001) decreased over 19 months of the pandemic. Conclusion Characteristics and disease course of critically ill COVID-19 patients have continuously evolved, concomitant to the clinical management, throughout the pandemic leading to a younger, less severely ill ICU population with distinctly different clinical, pulmonary and inflammatory presentations than at the onset of the pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04065-2.
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Feyen L, Freyhardt P, Schott P, Wullstein C, Dimitriou-Zarra A, Katoh M. Embolization of Hemorrhoidal Arteries: A Novel Endovascular Therapy Option for the Treatment of Hemorrhoidal Disease. ROFO-FORTSCHR RONTG 2021; 194:266-271. [PMID: 34794188 DOI: 10.1055/a-1662-5487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hemorrhoids are a widespread disease. Treatment options range from dietary measures to open surgery. A novel treatment approach is the embolization of the hemorrhoidal arteries. METHOD A review was performed based on a selective literature search in PubMed representing the current state of research. The keywords "hemorrhoid" and "embolization" and "emborrhoid" were used. In addition, technical details of the hemorrhoidal embolization procedure are explained. RESULTS AND CONCLUSION Embolization of hemorrhoidal arteries is a safe treatment, which allows efficient symptom control even in patients with contraindications for open surgery. KEY POINTS · Embolization of hemorrhoidal arteries is a new approach to the treatment of hemorrhoids.. · Embolization of hemorrhoidal arteries is feasible in patients with contraindications for open surgery such as hypercoaguable states and contraindications for general anesthesia.. · The endovascular approach causes no rectal and anal trauma and associated complications can be avoided.. · The treatment of bleeding hemorrhoids seems to be particularly effective.. · No ischemic complications have been reported so far when coils as well as particles were used.. CITATION FORMAT · Feyen L, Freyhardt P, Schott P et al. Hämorrhoidenembolisation: Eine neue minimalinvasive endovaskuläre Therapieoption bei Hämorrhoidalleiden. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1662-5487.
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Affiliation(s)
- Ludger Feyen
- Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Krefeld, Germany
| | - Patrick Freyhardt
- School of Medicine, University Witten-Herdecke Faculty of Health, Witten, Germany.,Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Krefeld, Germany
| | - Peter Schott
- Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Krefeld, Germany
| | - Christoph Wullstein
- Department of General, Abdominal and Minimally Invasive Surgery, HELIOS Klinikum Krefeld, Germany
| | | | - Marcus Katoh
- Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Krefeld, Germany
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3
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Montomoli J, Romeo L, Moccia S, Bernardini M, Migliorelli L, Berardini D, Donati A, Carsetti A, Bocci MG, Wendel Garcia PD, Fumeaux T, Guerci P, Schüpbach RA, Ince C, Frontoni E, Hilty MP, Vizmanos-Lamotte G, Tschoellitsch T, Meier J, Aguirre-Bermeo H, Apolo J, Martínez A, Jurkolow G, Delahaye G, Novy E, Losser MR, Wengenmayer T, Rilinger J, Staudacher DL, David S, Welte T, Stahl K, Pavlos” “A, Aslanidis T, Korsos A, Babik B, Nikandish R, Rezoagli E, Giacomini M, Nova A, Fogagnolo A, Spadaro S, Ceriani R, Murrone M, Wu MA, Cogliati C, Colombo R, Catena E, Turrini F, Simonini MS, Fabbri S, Potalivo A, Facondini F, Gangitano G, Perin T, Grazia Bocci M, Antonelli M, Gommers D, Rodríguez-García R, Gámez-Zapata J, Taboada-Fraga X, Castro P, Tellez A, Lander-Azcona A, Escós-Orta J, Martín-Delgado MC, Algaba-Calderon A, Franch-Llasat D, Roche-Campo F, Lozano-Gómez H, Zalba-Etayo B, Michot MP, Klarer A, Ensner R, Schott P, Urech S, Zellweger N, Merki L, Lambert A, Laube M, Jeitziner MM, Jenni-Moser B, Wiegand J, Yuen B, Lienhardt-Nobbe B, Westphalen A, Salomon P, Drvaric I, Hillgaertner F, Sieber M, Dullenkopf A, Petersen L, Chau I, Ksouri H, Sridharan GO, Cereghetti S, Boroli F, Pugin J, Grazioli S, Rimensberger PC, Bürkle C, Marrel J, Brenni M, Fleisch I, Lavanchy J, Perez MH, Ramelet AS, Weber AB, Gerecke P, Christ A, Ceruti S, Glotta A, Marquardt K, Shaikh K, Hübner T, Neff T, Redecker H, Moret-Bochatay M, Bentrup FZ, Studhalter M, Stephan M, Brem J, Gehring N, Selz D, Naon D, Kleger GR, Pietsch U, Filipovic M, Ristic A, Sepulcri M, Heise A, Franchitti Laurent M, Laurent JC, Wendel Garcia PD, Schuepbach R, Heuberger D, Bühler P, Brugger S, Fodor P, Locher P, Camen G, Gaspert T, Jovic M, Haberthuer C, Lussman RF, Colak E. Machine learning using the extreme gradient boosting (XGBoost) algorithm predicts 5-day delta of SOFA score at ICU admission in COVID-19 patients. J Intensive Med 2021; 1:110-116. [PMID: 36785563 PMCID: PMC8531027 DOI: 10.1016/j.jointm.2021.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/20/2021] [Accepted: 09/06/2021] [Indexed: 02/08/2023]
Abstract
Background Accurate risk stratification of critically ill patients with coronavirus disease 2019 (COVID-19) is essential for optimizing resource allocation, delivering targeted interventions, and maximizing patient survival probability. Machine learning (ML) techniques are attracting increased interest for the development of prediction models as they excel in the analysis of complex signals in data-rich environments such as critical care. Methods We retrieved data on patients with COVID-19 admitted to an intensive care unit (ICU) between March and October 2020 from the RIsk Stratification in COVID-19 patients in the Intensive Care Unit (RISC-19-ICU) registry. We applied the Extreme Gradient Boosting (XGBoost) algorithm to the data to predict as a binary outcome the increase or decrease in patients' Sequential Organ Failure Assessment (SOFA) score on day 5 after ICU admission. The model was iteratively cross-validated in different subsets of the study cohort. Results The final study population consisted of 675 patients. The XGBoost model correctly predicted a decrease in SOFA score in 320/385 (83%) critically ill COVID-19 patients, and an increase in the score in 210/290 (72%) patients. The area under the mean receiver operating characteristic curve for XGBoost was significantly higher than that for the logistic regression model (0.86 vs. 0.69, P < 0.01 [paired t-test with 95% confidence interval]). Conclusions The XGBoost model predicted the change in SOFA score in critically ill COVID-19 patients admitted to the ICU and can guide clinical decision support systems (CDSSs) aimed at optimizing available resources.
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Affiliation(s)
- Jonathan Montomoli
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini 47923, Italy
| | - Luca Romeo
- Department of Information Engineering, Università Politecnica delle Marche, Ancona 60131, Italy
| | - Sara Moccia
- Department of Information Engineering, Università Politecnica delle Marche, Ancona 60131, Italy,The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa 56127, Italy
| | - Michele Bernardini
- Department of Information Engineering, Università Politecnica delle Marche, Ancona 60131, Italy
| | - Lucia Migliorelli
- Department of Information Engineering, Università Politecnica delle Marche, Ancona 60131, Italy
| | - Daniele Berardini
- Department of Information Engineering, Università Politecnica delle Marche, Ancona 60131, Italy
| | - Abele Donati
- Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona 60126, Italy,Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Andrea Carsetti
- Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona 60126, Italy,Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Maria Grazia Bocci
- Department of Anaesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | | | - Thierry Fumeaux
- Swiss Society of Intensive Care Medicine, Basel 4001, Switzerland
| | - Philippe Guerci
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Nancy, Nancy 54511, France
| | - Reto Andreas Schüpbach
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich 8091, Switzerland
| | - Can Ince
- Department of Intensive Care Erasmus MC, University Medical Center Rotterdam, Rotterdam, 3015 GD, Netherlands,Corresponding author: Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Emanuele Frontoni
- Department of Information Engineering, Università Politecnica delle Marche, Ancona 60131, Italy
| | - Matthias Peter Hilty
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich 8091, Switzerland
| | - RISC-19-ICU InvestigatorsAlfaro-FariasMarioMDVizmanos-LamotteGerardoMD, PhDTschoellitschThomasMDMeierJensMDAguirre-BermeoHernánMD, PhDApoloJaninaBScMartínezAlbertoMDJurkolowGeoffreyMDDelahayeGauthierMDNovyEmmanuelMDLosserMarie-ReineMD, PhDWengenmayerTobiasMDRilingerJonathanMDStaudacherDawid L.MDDavidSaschaMDWelteTobiasMDStahlKlausMDPavlos”“AgiosAslanidisTheodorosMD, PhDKorsosAnitaMDBabikBarnaMD, PhDNikandishRezaMDRezoagliEmanueleMD, PhDGiacominiMatteoMDNovaAliceMDFogagnoloAlbertoMDSpadaroSavinoMD, PhDCerianiRobertoMDMurroneMartinaMDWuMaddalena A.MDCogliatiChiaraMDColomboRiccardoMDCatenaEmanueleMDTurriniFabrizioMD, MScSimoniniMaria SoleMDFabbriSilviaMDPotalivoAntonellaMDFacondiniFrancescaMDGangitanoGianfilippoMDPerinTizianaMDGrazia BocciMariaMDAntonelliMassimoMDGommersDiederikMD, PhDRodríguez-GarcíaRaquelMDGámez-ZapataJorgeMDTaboada-FragaXianaMDCastroPedroMDTellezAdrianMDLander-AzconaArantxaMDEscós-OrtaJesúsMDMartín-DelgadoMaria C.MDAlgaba-CalderonAngelaMDFranch-LlasatDiegoMDRoche-CampoFerranMD, PhDLozano-GómezHerminiaMDZalba-EtayoBegoñaMD, PhDMichotMarc P.MDKlarerAlexanderEnsnerRolfMDSchottPeterMDUrechSeverinMDZellwegerNuriaMerkiLukasMDLambertAdrianaMDLaubeMarcusMDJeitzinerMarie M.RN, PhDJenni-MoserBeatriceRN, MScWiegandJanMDYuenBerndMDLienhardt-NobbeBarbaraWestphalenAndreaMDSalomonPetraMDDrvaricIrisMDHillgaertnerFrankMDSieberMarianneDullenkopfAlexanderMDPetersenLinaMDChauIvanMDKsouriHatemMD, PhDSridharanGovind OliverMDCereghettiSaraMDBoroliFilippoMDPuginJeromeMD, PhDGrazioliSergeMDRimensbergerPeter C.MDBürkleChristianMDMarrelJulienMDBrenniMirkoMDFleischIsabelleMDLavanchyJeromeMDPerezMarie-HeleneMDRameletAnne-SylvieMDWeberAnja BaltussenMDGereckePeterMDChristAndreasMDCerutiSamueleMDGlottaAndreaMDMarquardtKatharinaMDShaikhKarimMDHübnerTobiasMDNeffThomasMDRedeckerHermannMDMoret-BochatayMalloryMDBentrupFriederikeMeyer zuMD, MBAStudhalterMichaelMDStephanMichaelMDBremJanMDGehringNadineMDSelzDanielaMDNaonDidierMDKlegerGian-RetoMDPietschUrsMDFilipovicMiodragMDRisticAnetteMDSepulcriMichaelMDHeiseAntjeMDFranchitti LaurentMarileneMDLaurentJean-ChristopheMDWendel GarciaPedro D.MScSchuepbachRetoMDHeubergerDorotheaPhDBühlerPhilippMDBruggerSilvioMD, PhDFodorPatriciaMDLocherPascalMDCamenGiovanniMDGaspertTomislavMDJovicMarijaMDHaberthuerChristophMDLussmanRoger F.MDColakElifMD
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Feyen L, Schott P, Ochmann H, Katoh M, Haage P, Freyhardt P. Value of machine learning to predict functional outcome of endovascular treatment for acute ischaemic stroke of the posterior circulation. Neuroradiol J 2021; 35:363-369. [PMID: 34609913 DOI: 10.1177/19714009211049088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Clinical outcomes vary considerably among individuals with vessel occlusion of the posterior circulation. In the present study we evaluated machine learning algorithms in their ability to discriminate between favourable and unfavourable outcomes in patients with endovascular treatment of acute ischaemic stroke of the posterior circulation. METHODS This retrospective study evaluated three algorithms (generalised linear model, K-nearest neighbour and random forest) to predict functional outcomes at dismissal of 30 patients with acute occlusion of the basilar artery who were treated with thrombectomy. Input variables encompassed baseline as well as peri and postprocedural data. Favourable outcome was defined as a modified Rankin scale score of 0-2 and unfavourable outcome was defined as a modified Rankin scale score of 3-6. The performance of the algorithms was assessed with the area under the receiver operating curve and with confusion matrixes. RESULTS Successful reperfusion was achieved in 83%, with 30% of the patients having a favourable outcome. The area under the curve was 0.93 for the random forest model, 0.86 for the K-nearest neighbour model and 0.78 for the generalised linear model. The accuracy was 0.69 for the generalised linear model and 0.84 for the random forest and the K nearest neighbour models. CONCLUSION Favourable and unfavourable outcomes at dismissal of patients with acute ischaemic stroke of the posterior circulation can be predicted immediately after the follow-up non-enhanced computed tomography using machine learning.
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Affiliation(s)
- Ludger Feyen
- Department of Diagnostic and Interventional Radiology, 27664HELIOS Klinikum Krefeld, Helios Klinikum Krefeld, Germany.,University Witten/Herdecke, Faculty of Health, School of Medicine, Germany.,Department of Diagnostic and Interventional Radiology, Helios University Hospital Wuppertal, Germany
| | - Peter Schott
- Department of Diagnostic and Interventional Radiology, 27664HELIOS Klinikum Krefeld, Helios Klinikum Krefeld, Germany
| | - Hendrik Ochmann
- Department of Diagnostic and Interventional Radiology, 27664HELIOS Klinikum Krefeld, Helios Klinikum Krefeld, Germany
| | - Marcus Katoh
- Department of Diagnostic and Interventional Radiology, 27664HELIOS Klinikum Krefeld, Helios Klinikum Krefeld, Germany
| | - Patrick Haage
- University Witten/Herdecke, Faculty of Health, School of Medicine, Germany.,Department of Diagnostic and Interventional Radiology, Helios University Hospital Wuppertal, Germany
| | - Patrick Freyhardt
- Department of Diagnostic and Interventional Radiology, 27664HELIOS Klinikum Krefeld, Helios Klinikum Krefeld, Germany.,Department of Diagnostic and Interventional Radiology, Helios University Hospital Wuppertal, Germany
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Tschischka A, Schott P, Freyhardt P, Mamopoulos A, Gäbel G, Katoh M. Completion of Target Vessel Stenting After FEVAR via Snare Technique in a Patient with Tortuous Right Renal Artery. Innovations (Phila) 2021; 16:559-561. [PMID: 34494911 DOI: 10.1177/15569845211042639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Target vessel catheterization remains challenging in patients with complex anatomies. Fenestrated endovascular aneurysm repair (FEVAR) is an established technique to treat aortic aneurysms. In this case report, we treated a juxtarenal aneurysm using FEVAR. Initial attempts to complete the target vessel stenting were unsuccessful because of an unfavorable orifice and tortuosity of the right renal artery. The completion of FEVAR was achieved with a bifemoral approach using a snare system, which aligned the tip of a steerable sheath at the level of the fenestration for the right renal artery to create a stable condition. Control angiography and computed tomography confirmed a successful stenting of the target vessel and the sealing of the fenestration without an endoleak.
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Affiliation(s)
- Alexander Tschischka
- 27664 Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Krefeld, Germany
| | - Peter Schott
- 27664 Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Krefeld, Germany
| | - Patrick Freyhardt
- 27664 Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Krefeld, Germany
| | | | - Gabor Gäbel
- 27664 Department of Vascular Surgery, HELIOS Klinikum Krefeld, Germany
| | - Marcus Katoh
- 27664 Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Krefeld, Germany
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Wendel Garcia PD, Aguirre-Bermeo H, Buehler PK, Alfaro-Farias M, Yuen B, David S, Tschoellitsch T, Wengenmayer T, Korsos A, Fogagnolo A, Kleger GR, Wu MA, Colombo R, Turrini F, Potalivo A, Rezoagli E, Rodríguez-García R, Castro P, Lander-Azcona A, Martín-Delgado MC, Lozano-Gómez H, Ensner R, Michot MP, Gehring N, Schott P, Siegemund M, Merki L, Wiegand J, Jeitziner MM, Laube M, Salomon P, Hillgaertner F, Dullenkopf A, Ksouri H, Cereghetti S, Grazioli S, Bürkle C, Marrel J, Fleisch I, Perez MH, Baltussen Weber A, Ceruti S, Marquardt K, Hübner T, Redecker H, Studhalter M, Stephan M, Selz D, Pietsch U, Ristic A, Heise A, Meyer Zu Bentrup F, Franchitti Laurent M, Fodor P, Gaspert T, Haberthuer C, Colak E, Heuberger DM, Fumeaux T, Montomoli J, Guerci P, Schuepbach RA, Hilty MP, Roche-Campo F. Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort. Crit Care 2021; 25:175. [PMID: 34034782 PMCID: PMC8146172 DOI: 10.1186/s13054-021-03580-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/15/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Uncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates. METHODS Subanalysis of a prospective, multinational registry of critically ill COVID-19 patients. Patients were subclassified into standard oxygen therapy ≥10 L/min (SOT), high-flow oxygen therapy (HFNC), noninvasive positive-pressure ventilation (NIV), and early IMV, according to the respiratory support strategy employed at the day of admission to ICU. Propensity score matching was performed to ensure comparability between groups. RESULTS Initially, 1421 patients were assessed for possible study inclusion. Of these, 351 patients (85 SOT, 87 HFNC, 87 NIV, and 92 IMV) remained eligible for full analysis after propensity score matching. 55% of patients initially receiving noninvasive respiratory support required IMV. The intubation rate was lower in patients initially ventilated with HFNC and NIV compared to those who received SOT (SOT: 64%, HFNC: 52%, NIV: 49%, p = 0.025). Compared to the other respiratory support strategies, NIV was associated with a higher overall ICU mortality (SOT: 18%, HFNC: 20%, NIV: 37%, IMV: 25%, p = 0.016). CONCLUSION In this cohort of critically ill patients with COVID-19, a trial of HFNC appeared to be the most balanced initial respiratory support strategy, given the reduced intubation rate and comparable ICU mortality rate. Nonetheless, considering the uncertainty and stress associated with the COVID-19 pandemic, SOT and early IMV represented safe initial respiratory support strategies. The presented findings, in agreement with classic ARDS literature, suggest that NIV should be avoided whenever possible due to the elevated ICU mortality risk.
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Affiliation(s)
- Pedro D Wendel Garcia
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.,The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland
| | | | - Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Mario Alfaro-Farias
- Unidad de Cuidados Intensivos, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| | - Bernd Yuen
- Interdisziplinaere Intensivstation, Spital Buelach, Buelach, Switzerland
| | - Sascha David
- Department of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany
| | - Thomas Tschoellitsch
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH and Johannes Kepler University, Linz, Austria
| | - Tobias Wengenmayer
- Department of Medicine III - Interdisciplinary Medical Intensive Care, Medical Center University of Freiburg, Freiburg, Germany
| | - Anita Korsos
- Departement of Anaethesiology and Intensive Care, University of Szeged, Szeged, Hungary
| | - Alberto Fogagnolo
- Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Gian-Reto Kleger
- Medizinische Intensivstation, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Maddalena A Wu
- Department of Internal Medicine, ASST Fatebenefratelli Sacco - "Luigi Sacco" Hospital, Milan, Italy
| | - Riccardo Colombo
- Division of Anesthesia and Intensive Care, ASST Fatebenefratelli Sacco - "Luigi Sacco" Hospital, Milan, Italy
| | - Fabrizio Turrini
- Internal Medicine, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | | | - Emanuele Rezoagli
- Department of Anesthesia and Intensive Care Medicine, Policlinico San Marco, Gruppo Ospedaliero San Donato, Bergamo, Italy
| | - Raquel Rodríguez-García
- Servicio de Medicina intensiva, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | - Herminia Lozano-Gómez
- Unidad de Cuidados Intensivos, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Rolf Ensner
- Klinik für Operative Intensivmedizin, Kantonsspital Aarau, Aarau, Switzerland
| | - Marc P Michot
- Medizinische Intensivstation, Kantonsspital Aarau, Aarau, Switzerland
| | - Nadine Gehring
- Intensivstation, Kantonsspital Schaffhausen, Schaffhausen, Switzerland
| | - Peter Schott
- Institut fuer Anesthaesie und Intensivmedizin, Zuger Kantonsspital AG, Baar, Switzerland
| | - Martin Siegemund
- Department Intensivmedizin, Universitaetsspital Basel, Basel, Switzerland
| | - Lukas Merki
- Intensivmedizin, St. Claraspital, Basel, Switzerland
| | - Jan Wiegand
- Interdisziplinaere Intensivmedizin, Lindenhofspital, Bern, Switzerland
| | - Marie M Jeitziner
- Department of Intensive Care Medicine, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Marcus Laube
- Department Intensive Care Medicine, Spitalzentrum Biel, Biel, Switzerland
| | - Petra Salomon
- Intensivstation, Regionalspital Emmental AG, Burgdorf, Switzerland
| | | | - Alexander Dullenkopf
- Institut fuer Anaesthesie und Intensivmedizin, Spital Thurgau, Frauenfeld, Switzerland
| | - Hatem Ksouri
- Soins Intensifs, Hopital cantonal de Fribourg, Fribourg, Switzerland
| | - Sara Cereghetti
- Division of Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
| | - Serge Grazioli
- Division of Neonatal and Pediatric Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Julien Marrel
- Institut für Anaesthesiologie Intensivmedizin & Rettungsmedizin, See-Spital Horgen & Kilchberg, Horgen, Switzerland
| | - Isabelle Fleisch
- Soins Intensifs, Hirslanden Clinique Cecil, Lausanne, Switzerland
| | - Marie-Helene Perez
- Pediatric Intensive Care Unit, University Hospital Lausanne, Lausanne, Switzerland
| | | | - Samuele Ceruti
- Dipartimento Area Critica, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Katharina Marquardt
- Interdisziplinaere Intensivstation, Spital Maennedorf AG, Maennedorf, Switzerland
| | - Tobias Hübner
- Institut fuer Anaesthesie und Intensivmedizin, Spital Thurgau, Muensterlingen, Switzerland
| | - Hermann Redecker
- Intensivmedizin, Schweizer Paraplegikerzentrum Nottwil, Nottwil, Switzerland
| | - Michael Studhalter
- Intensivmedizin & Intermediate Care, Kantonsspital Olten, Olten, Switzerland
| | | | - Daniela Selz
- Anaesthesie Intensivmedizin Schmerzmedizin, Spital Schwyz, Schwyz, Switzerland
| | - Urs Pietsch
- Departement of Anesthesiology and Intensive Care Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Anette Ristic
- Departement for Intensive Care Medicine, Kantonsspital Nidwalden, Stans, Switzerland
| | - Antje Heise
- Intensivstation, Spital Simmental-Thun-Saanenland AG, Thun, Switzerland
| | | | | | - Patricia Fodor
- Interdisziplinaere Intensivstation, Stadtspital Triemli, Zurich, Switzerland
| | - Tomislav Gaspert
- Abteilung für Anaesthesiologie und Intensivmedizin, Hirslanden Klinik Im Park, Zurich, Switzerland
| | - Christoph Haberthuer
- Institut für Anaesthesiologie und Intensivmedizin, Klinik Hirslanden, Zurich, Switzerland
| | - Elif Colak
- General Surgery, Samsun Training and Research Hospital, Samsun, Turkey
| | - Dorothea M Heuberger
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Thierry Fumeaux
- The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland.,Soins intensifs, Groupement Hospitalier de l'Ouest Lémanique, Hôpital de Nyon, Nyon, Switzerland
| | - Jonathan Montomoli
- The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland.,Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Philippe Guerci
- The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland.,Department of Anesthesiology and Critical Care Medicine, University Hospital of Nancy, Nancy, France
| | - Reto A Schuepbach
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.,The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland
| | - Matthias P Hilty
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.,The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland
| | - Ferran Roche-Campo
- Servicio de Medicina intensiva, Hospital Verge de la Cinta, Carrer de les Esplanetes 44, 43500, Tortosa, Tarragona, Spain.
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Nef HM, Elsässer A, Möllmann H, Abdel-Hadi M, Bauer T, Brück M, Eggebrecht H, Ehrlich JR, Ferrari MW, Fichtlscherer S, Hink U, Hölschermann H, Kacapor R, Koeth O, Korboukov S, Lamparter S, Laspoulas AJ, Lehmann R, Liebetrau C, Plücker T, Pons-Kühnemann J, Schächinger V, Schieffer B, Schott P, Schulze M, Teupe C, Vasa-Nicotera M, Weber M, Weinbrenner C, Werner G, Hamm CW, Dörr O. Impact of the COVID-19 pandemic on cardiovascular mortality and catherization activity during the lockdown in central Germany: an observational study. Clin Res Cardiol 2020; 110:292-301. [PMID: 33219854 PMCID: PMC7680078 DOI: 10.1007/s00392-020-01780-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
Aims During the COVID-19 pandemic, hospital admissions for cardiac care have declined. However, effects on mortality are unclear. Thus, we sought to evaluate the impact of the lockdown period in central Germany on overall and cardiovascular deaths. Simultaneously we looked at catheterization activities in the same region. Methods and results Data from 22 of 24 public health-authorities in central Germany were aggregated during the pandemic related lockdown period and compared to the same time period in 2019. Information on the total number of deaths and causes of death, including cardiovascular mortality, were collected. Additionally, we compared rates of hospitalization (n = 5178) for chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and out of hospital cardiac arrest (OHCA) in 26 hospitals in this area. Data on 5,984 deaths occurring between March 23, 2020 and April 26, 2020 were evaluated. In comparison to the reference non-pandemic period in 2019 (deaths: n = 5832), there was a non-significant increase in all-cause mortality of 2.6% [incidence rate ratio (IRR) 1.03, 95% confidence interval (CI) 0.99–1.06; p = 0.16]. Cardiovascular and cardiac mortality increased significantly by 7.6% (IRR 1.08, 95%-CI 1.01–1.14; p = 0.02) and by 11.8% (IRR 1.12, 95%-CI 1.05–1.19; p < 0.001), respectively. During the same period, our data revealed a drop in cardiac catherization procedures. Conclusion During the COVID-19-related lockdown a significant increase in cardiovascular mortality was observed in central Germany, whereas catherization activities were reduced. The mechanisms underlying both of these observations should be investigated further in order to better understand the effects of a pandemic-related lockdown and social-distancing restrictions on cardiovascular care and mortality. Graphic abstract ![]()
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Affiliation(s)
- Holger M Nef
- Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Klinikstrasse 33, 35392, Giessen, Germany. .,Department of Cardiology, Herz-Kreislauf-Zentrum Klinikum Hersfeld-Rotenburg, Rotenburg, Germany.
| | | | - Helge Möllmann
- St.-Johannes-Hospital Klinik Für Innere Medizin I, Dortmund, Germany
| | | | - Timm Bauer
- Department of Cardiology, Sana Klinikum Offenbach, Offenbach, Germany
| | - Martin Brück
- Department of Cardiology, Lahn-Dill-Kliniken, Klinikum Wetzlar, Wetzlar, Germany
| | - Holger Eggebrecht
- Department of Cardiology, Agaplesion Frankfurter Diakonie Kliniken, Frankfurt, Germany
| | - Joachim R Ehrlich
- Department of Cardiology, St. Josefs-Hospital Wiesbaden, Wiesbaden, Germany
| | - Markus W Ferrari
- Department of Cardiology, Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, Herz-Kreislauf-Zentrum Klinikum Hersfeld-Rotenburg, Rotenburg, Germany
| | - Ulrich Hink
- Department of Cardiology, Klinikum Frankfurt Höchst, Frankfurt am Main, Germany
| | | | - Rifat Kacapor
- Department of Cardiology, Kliniken Des Main-Taunus-Kreises, Bad Soden am Taunus, Germany
| | - Oliver Koeth
- Department of Cardiology, GPR Gesundheits- Und Pflegezentrum Rüsselsheim, Rüsselsheim, Germany
| | | | - Steffen Lamparter
- Department of Cardiology, Diakonie-Krankenhaus Wehrda, Marburg, Germany
| | - Alexander J Laspoulas
- Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Klinikstrasse 33, 35392, Giessen, Germany
| | - Ralf Lehmann
- Department of Cardiology, Asklepios Kliniken Langen, Langen, Germany
| | | | - Tobias Plücker
- Department of Cardiology, Eichhof-Stiftung Lauterbach, Lauterbach, Germany
| | - Jörn Pons-Kühnemann
- Justus Liebig University Giessen, Medical Statistics, Institute of Medical Informatics, Giessen, Germany
| | | | - Bernhard Schieffer
- Department of Internal Medicine/Cardiology and Angiology, University Hospital of Marburg, Marburg, Germany
| | - Peter Schott
- Department of Cardiology, Klinikum Werra Meissner GmbH, Eschwege, Germany
| | - Matthias Schulze
- Department of Cardiology, Asklepios Schwalm-Eder-Kliniken, Schwalmstadt, Germany
| | - Claudius Teupe
- Department of Cardiology, Krankenhaus Sachsenhausen, Frankfurt am Main, Germany
| | | | - Michael Weber
- Department of Cardiology, Kreisklinik Groß-Umstadt, Groß-Umstadt, Germany
| | | | - Gerald Werner
- Department of Cardiology, Klinikum Darmstadt, Darmstadt, Germany
| | - Christian W Hamm
- Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Klinikstrasse 33, 35392, Giessen, Germany.,Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Oliver Dörr
- Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Klinikstrasse 33, 35392, Giessen, Germany
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8
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Volland C, Schott P, Didié M, Männer J, Unsöld B, Toischer K, Schmidt C, Urlaub H, Nickels K, Knöll R, Schmidt A, Guan K, Hasenfuß G, Seidler T. Control of p21Cip by BRCA1-associated protein is critical for cardiomyocyte cell cycle progression and survival. Cardiovasc Res 2020; 116:592-604. [PMID: 31286143 DOI: 10.1093/cvr/cvz177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/05/2018] [Revised: 05/26/2019] [Accepted: 07/05/2019] [Indexed: 01/24/2023] Open
Abstract
AIMS Identifying the key components in cardiomyocyte cell cycle regulation is of relevance for the understanding of cardiac development and adaptive and maladaptive processes in the adult myocardium. BRCA1-associated protein (BRAP) has been suggested as a cytoplasmic retention factor for several proteins including Cyclin-dependent-kinase inhibitor p21Cip. We observed profound expressional changes of BRAP in early postnatal myocardium and investigated the impact of BRAP on cardiomyocyte cell cycle regulation. METHODS AND RESULTS General knockout of Brap in mice evoked embryonic lethality associated with reduced myocardial wall thickness and lethal cardiac congestion suggesting a prominent role for BRAP in cardiomyocyte proliferation. αMHC-Cre driven cardiomyocyte-specific knockout of Brap also evoked lethal cardiac failure shortly after birth. Likewise, conditional cardiomyocyte-specific Brap deletion using tamoxifen-induced knockout in adult mice resulted in marked ventricular dilatation and heart failure 3 weeks after induction. Several lines of evidence suggest that Brap deletion evoked marked inhibition of DNA synthesis and cell cycle progression. In cardiomyocytes with proliferative capacity, this causes developmental arrest, whereas in adult hearts loss of BRAP-induced apoptosis. This is explained by altered signalling through p21Cip which we identify as the link between BRAP and cell cycle/apoptosis. BRAP deletion enhanced p21Cip expression, while BRAP overexpression in cardiomyocyte-specific transgenic mice impeded p21Cip expression. That was paralleled by enhanced nuclear Ki-67 expression and DNA synthesis. CONCLUSION By controlling p21Cip activity BRAP expression controls cell cycle activity and prevents developmental arrest in developing cardiomyocytes and apoptosis in adult cardiomyocytes.
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Affiliation(s)
- Cornelia Volland
- Department of Cardiology and Pulmonology, Georg-August University, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Peter Schott
- Department of Cardiology and Pulmonology, Georg-August University, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Michael Didié
- Department of Cardiology and Pulmonology, Georg-August University, Robert-Koch Str. 40, 37075 Göttingen, Germany.,Department of Pharmacology, Georg-August University Göttingen, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen, 37075 Göttingen, Germany
| | - Jörg Männer
- Group Cardio-Embryology, Institute for Anatomy and Embryology, Georg-August University Göttingen, Göttingen, Germany
| | - Bernhard Unsöld
- Department of Cardiology and Pulmonology, Georg-August University, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Karl Toischer
- Department of Cardiology and Pulmonology, Georg-August University, Robert-Koch Str. 40, 37075 Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen, 37075 Göttingen, Germany
| | - Carla Schmidt
- Max-Planck-Institute for Biophysical Chemistry, Bioanalytical Mass Spectrometry Group, Göttingen, Germany
| | - Henning Urlaub
- Max-Planck-Institute for Biophysical Chemistry, Bioanalytical Mass Spectrometry Group, Göttingen, Germany.,Bioanalytics, Department of Clinical Chemistry, University Medical Center Göttingen, Göttingen, Germany
| | - Katrin Nickels
- Working Group on Cardiovascular Molecular Genetics, Heart Center, Department of Cardiology and Pulmonology, Göttingen, Germany
| | - Ralph Knöll
- Working Group on Cardiovascular Molecular Genetics, Heart Center, Department of Cardiology and Pulmonology, Göttingen, Germany
| | - Albrecht Schmidt
- Department of Cardiology and Pulmonology, Georg-August University, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Kaomei Guan
- Department of Cardiology and Pulmonology, Georg-August University, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pulmonology, Georg-August University, Robert-Koch Str. 40, 37075 Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen, 37075 Göttingen, Germany
| | - Tim Seidler
- Department of Cardiology and Pulmonology, Georg-August University, Robert-Koch Str. 40, 37075 Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen, 37075 Göttingen, Germany
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Katoh M, Schott P, Freyhardt P, Feyen L, Ziegler HR, Kraft C. [Transarterial Periarticular Embolization (TAPE): Indications and Initial Experience in Germany]. ROFO-FORTSCHR RONTG 2020; 192:1046-1052. [PMID: 32882726 DOI: 10.1055/a-1212-6149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this article is to demonstrate the potential indications, procedural technique and initial results of the transarterial periarticular embolization (TAPE). MATERIAL AND METHODS TAPE was performed in three patients with chronic pain in different joints. In the first case the patient suffered from osteoarthritis of the shoulder, in the second case from epicondylitis humeri ulnaris ("golfer-elbow") and in the third case from patellar tendinitis ("jumpers-knee"). Clinical as well as pain assessment was performed pre and post-interventionally. RESULTS TAPE was performed with technical success in all three patients. For vessel access, either a transradial or transfemoral access was chosen. The joint supplying vessels were catheterized superselectively with microcatheters and embolized with Imipenem/Cilastatin diluted in contrast medium. After embolization of the knee the patient demonstrated skin redness, which disappeared within one week. No further complications were noted. All patients reported significant pain relief within the first day after intervention. CONCLUSION TAPE is a novel therapy for the treatment of persistent, chronic joint pain and tendinopathies, supported by publications from institutes outside of Europe. The initial experiences made in our institute are encouraging and suggest that TAPE may have the potential as an adjunct therapy option for patients with therapy-resistant chronic joint and tendinopathy-pain. KEY POINTS · TAPE is a novel therapy for treatment of degenerative joint pain and tendinopathies. · TAPE is a technically challenging endovascular procedure and requires high interventional expertise. · TAPE may have the potential to develop to a minimally-invasive therapy option for patients with chronic joint pain. CITATION FORMAT · Katoh M, Schott P, Freyhardt P et al. Transarterial Periarticular Embolization (TAPE): Indications and Initial Experience in Germany. Fortschr Röntgenstr 2020; 192: 1046 - 1052.
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Affiliation(s)
- Marcus Katoh
- Department of Diagnostic and Interventional Radiology, HELIOS-Hospital Krefeld, Germany
| | - Peter Schott
- Department of Diagnostic and Interventional Radiology, HELIOS-Hospital Krefeld, Germany
| | - Patrick Freyhardt
- Department of Diagnostic and Interventional Radiology, HELIOS-Hospital Krefeld, Germany
| | - Ludger Feyen
- Department of Diagnostic and Interventional Radiology, HELIOS-Hospital Krefeld, Germany
| | | | - Clayton Kraft
- Department of Orthopaedic Surgery, Hand and Trauma Unit, HELIOS-Hospital Krefeld, Germany
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Schott P, Katoh M, Fischer N, Freyhardt P. Radiation Dose in Prostatic Artery Embolization Using Cone-Beam CT and 3D Roadmap Software. J Vasc Interv Radiol 2019; 30:1452-1458. [PMID: 31371137 DOI: 10.1016/j.jvir.2019.04.040] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To evaluate the radiation dose in patients undergoing prostatic artery embolization (PAE) using cone-beam CT and 3-dimensional (3D) guidance software. MATERIALS AND METHODS In this single-center retrospective study, 100 patients with benign prostatic hyperplasia (mean prostate volume, 83.6 mL ± 44.2; 69.4 ± 9.6 years of age; body mass index, 26.5 ± 4.2) were treated using PAE between October 2016 and April 2018. Informed consent was obtained from all participants included in the study. All patients received at least 1 intraprocedural cone-beam CT per side for evaluation of the vessel anatomy and software rendering of 3D guidance for catheter guidance. Digital subtraction angiography (DSA) was performed in the distal branches only. The total dose area product (DAP), along with the DAP attributed to fluoroscopy, DSA, and cone-beam CT, were assessed. RESULTS Bilateral embolization was achieved in 83 patients (83%). The average total DAP was 134.4 Gy ⋅ cm2 ± 69.5 (range, 44.7-410.9 Gy ⋅ cm2). Fluoroscopy, DSA, and cone-beam CT accounted for 35.5 Gy ⋅ cm2 ± 21.3 (range, 8.6-148.6 Gy ⋅ cm2) or 26.4% (percentage of total DAP), 58.2 Gy ⋅ cm2 ± 48.3 (range, 10.3-309.3 Gy ⋅ cm2) or 43.3%, and 40.7 Gy ⋅ cm2 ± 14.5 (range, 15.9-86.3 Gy ⋅ cm2) or 30.3%, respectively. Average procedure time was 89.4 ± 27.0 minutes, and the average fluoroscopy time was 30.9 ± 12.2 minutes. CONCLUSIONS Intraprocedural cone-beam CT in combination with 3D guidance software allows for identification and catheterization of the prostatic artery in PAE. Furthermore, the results of this trial indicate that this study protocol may lead to a low overall radiation dose.
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Affiliation(s)
- Peter Schott
- Institut für Diagnostische und Interventionelle Radiologie, Helios Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany.
| | - Marcus Katoh
- Institut für Diagnostische und Interventionelle Radiologie, Helios Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
| | - Nicolas Fischer
- Klinik für Urologie und Kinderurologie, Helios Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
| | - Patrick Freyhardt
- Institut für Diagnostische und Interventionelle Radiologie, Helios Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
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11
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Freyhardt P, von Beckerath O, Dörbecker R, Schott P, Aufmesser-Freyhardt B, Katoh M, Kröger K. Comparison of Endovascular and Open Carotid Artery Treatment in Germany: A Retrospective Analysis from 2010 to 2015. Cardiovasc Intervent Radiol 2019; 42:657-665. [DOI: 10.1007/s00270-018-2146-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/14/2018] [Indexed: 12/28/2022]
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12
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Schotola H, Sossalla ST, Renner A, Gummert J, Danner BC, Schott P, Toischer K. The contractile adaption to preload depends on the amount of afterload. ESC Heart Fail 2017; 4:468-478. [PMID: 29154423 PMCID: PMC5695189 DOI: 10.1002/ehf2.12164] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/27/2017] [Accepted: 03/15/2017] [Indexed: 11/21/2022] Open
Abstract
Aims The Frank–Starling mechanism (rapid response (RR)) and the secondary slow response (SR) are known to contribute to increases contractile performance. The contractility of the heart muscle is influenced by pre‐load and after‐load. Because of the effect of pre‐load vs. after‐load on these mechanisms in not completely understood, we studied the effect in isolated muscle strips. Methods and results Progressive stretch lead to an increase in shortening/force development under isotonic (only pre‐load) and isometric conditions (pre‐ and after‐load). Muscle length with maximal function was reached earlier under isotonic (Lmax‐isotonic) compared with isometric conditions (Lmax‐isometric) in nonfailing rabbit, in human atrial and in failing ventricular muscles. Also, SR after stretch from slack to Lmax‐isotonic was comparable under isotonic and isometric conditions (human: isotonic 10 ± 4%, isometric 10 ± 4%). Moreover, a switch from isotonic to isometric conditions at Lmax‐isometric showed no SR proving independence of after‐load. To further analyse the degree of SR on the total contractile performance at higher pre‐load muscles were stretched from slack to 98% Lmax‐isometric under isotonic conditions. Thereby, the SR was 60 ± 9% in rabbit and 51 ± 14% in human muscle strips. Conclusions This work shows that the acute contractile response largely depends on the degree and type of mechanical load. Increased filling of the heart elevates pre‐load and prolongs the isotonic part of contraction. The reduction in shortening at higher levels of pre‐load is thereby partially compensated by the pre‐load‐induced SR. After‐load shifts the contractile curve to a better ‘myofilament function’ by probably influencing thin fibers and calcium sensitivity, but has no effect on the SR.
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Affiliation(s)
- Hanna Schotola
- Department of Anesthesiology, Georg-August-University, Goettingen, Germany
| | - Samuel T Sossalla
- Department of Cardiology and Pneumology, Georg-August-University, Goettingen, Germany
| | - André Renner
- Department of Cardiothoracic Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - Jan Gummert
- Department of Cardiothoracic Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - Bernhard C Danner
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Goettingen, Germany
| | - Peter Schott
- Department of Cardiology and Pneumology, Georg-August-University, Goettingen, Germany
| | - Karl Toischer
- Department of Cardiology and Pneumology, Georg-August-University, Goettingen, Germany.,DZHK (German Center for Cardiovascular Research) partnersite Göttingen, Germany
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13
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Varnas K, Jureus A, Johnstrom P, Ahlgren C, Schott P, Schou M, Gruber S, Jerning E, Malmborg J, Halldin C, Afzelius L, Farde L. Integrated Strategy for Use of Positron Emission Tomography in Nonhuman Primates to Confirm Multitarget Occupancy of Novel Psychotropic Drugs: An Example with AZD3676. ACTA ACUST UNITED AC 2016; 358:464-71. [DOI: 10.1124/jpet.116.234146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/06/2016] [Indexed: 01/10/2023]
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14
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Mohamed BA, Asif AR, Schnelle M, Qasim M, Khadjeh S, Lbik D, Schott P, Hasenfuss G, Toischer K. Proteomic analysis of short-term preload-induced eccentric cardiac hypertrophy. J Transl Med 2016; 14:149. [PMID: 27234427 PMCID: PMC4884361 DOI: 10.1186/s12967-016-0898-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/07/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Hemodynamic load leads to cardiac hypertrophy and heart failure. While afterload (pressure overload) induces concentric hypertrophy, elevation of preload (volume overload) yields eccentric hypertrophy and is associated with a better outcome. Here we analysed the proteomic pattern of mice subjected to short-term preload. METHODS AND RESULTS Female FVB/N mice were subjected to aortocaval shunt-induced volume overload that leads to an eccentric hypertrophy (left ventricular weight/tibia length +31 %) with sustained systolic heart function at 1 week after operation. Two-dimensional gel electrophoresis (2-DE) followed by mass spectrometric analysis showed alteration in the expression of 25 protein spots representing 21 different proteins. 64 % of these protein spots were up-regulated and 36 % of the protein spots were consistently down-regulated. Interestingly, α-1-antitrypsin was down-regulated, indicating higher elastin degradation and possibly contributing to the early dilatation. In addition to contractile and mitochondrial proteins, polymerase I and transcript release factor protein (PTRF) was also up-regulated, possibly contributing to the preload-induced signal transduction. CONCLUSIONS Our findings reveal the proteomic changes of early-stage eccentric myocardial remodeling after volume overload. Induced expression of some of the respiratory chain enzymes suggests a metabolic shift towards an oxidative phosphorylation that might contribute to the favorable remodeling seen in early VO. Down-regulation of α-1-antitrypsin might contribute to extracellular matrix remodeling and left ventricular dilatation. We also identified PTRF as a potential signaling regulator of volume overload-induced cardiac hypertrophy.
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Affiliation(s)
- Belal A Mohamed
- Department of Cardiology and Pneumology, University Medical Center, Goettingen, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Germany.,Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Abdul R Asif
- Institute of Clinical Chemistry/UMG-Laboratories, University Medical Center, Goettingen, Germany
| | - Moritz Schnelle
- Department of Cardiology and Pneumology, University Medical Center, Goettingen, Germany
| | - Mohamed Qasim
- Institute of Clinical Chemistry/UMG-Laboratories, University Medical Center, Goettingen, Germany.,Department of Microbiology, Kohat University of Science and Technology, Kohat, Pakistan
| | - Sara Khadjeh
- Department of Cardiology and Pneumology, University Medical Center, Goettingen, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Germany
| | - Dawid Lbik
- Department of Cardiology and Pneumology, University Medical Center, Goettingen, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Germany
| | - Peter Schott
- Department of Cardiology and Pneumology, University Medical Center, Goettingen, Germany
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, University Medical Center, Goettingen, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Germany
| | - Karl Toischer
- Department of Cardiology and Pneumology, University Medical Center, Goettingen, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Germany. .,Abteilung Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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15
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Gülker JE, Schott P, Katoh M, Bufe A. Case report: Cerebral stentretreiver thrombectomy of an embolized valve fragment after valve in valve TAVI. Clin Res Cardiol 2015; 105:372-5. [DOI: 10.1007/s00392-015-0935-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/22/2015] [Indexed: 12/20/2022]
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16
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Werner SG, Langer HE, Schott P, Bahner M, Schwenke C, Lind-Albrecht G, Spiecker F, Kurtz B, Burmester GR, Backhaus M. Indocyanine Green-Enhanced Fluorescence Optical Imaging in Patients With Early and Very Early Arthritis: A Comparative Study With Magnetic Resonance Imaging. ACTA ACUST UNITED AC 2013; 65:3036-44. [DOI: 10.1002/art.38175] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 08/22/2013] [Indexed: 01/18/2023]
Affiliation(s)
- Stephanie G. Werner
- Charité University Medicine Berlin; Berlin Germany
- RHIO Center Dusseldorf and RHIO Research Institute; Dusseldorf Germany
| | | | - Peter Schott
- Evangelisches Krankenhaus Dusseldorf; Dusseldorf Germany
| | | | | | | | | | - Bernward Kurtz
- Evangelisches Krankenhaus Dusseldorf; Dusseldorf Germany
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17
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Hein W, Ellringmann U, Vollmann D, Rostock T, Schott P. [Recurrent failed ICD therapy of ventricular tachycardia]. Med Klin Intensivmed Notfmed 2012; 107:641-4. [PMID: 23070331 DOI: 10.1007/s00063-012-0150-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 07/09/2012] [Accepted: 07/16/2012] [Indexed: 11/25/2022]
Abstract
Implantable cardioverter defibrillators (ICD) are used as standard therapy to prevent sudden cardiac death in heart failure patients. Today, physicians in emergency and intensive care medicine are often confronted with problems of ICD therapy in these patients. We report a case of a patient suffering from recurrent ventricular tachycardia (VT) requiring antiarrhythmia treatment with amiodarone. With an increasing drug loading, the VT cycle length was progressively prolonged resulting in a slow VT undetectable for the ICD. Subsequently, the patient was scheduled for VT ablation after which the patient became free of arrhythmia recurrences.
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Affiliation(s)
- W Hein
- Abteilung Kardiologie und internistische Intensivmedizin, Klinikum Werra-Meißner Eschwege, Elsa-Brändström-Straße 1, Eschwege, Germany.
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18
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Werner SG, Langer HE, Ohrndorf S, Bahner M, Schott P, Schwenke C, Schirner M, Bastian H, Lind-Albrecht G, Kurtz B, Burmester GR, Backhaus M. Inflammation assessment in patients with arthritis using a novel in vivo fluorescence optical imaging technology. Ann Rheum Dis 2012; 71:504-10. [PMID: 22388997 PMCID: PMC3298665 DOI: 10.1136/annrheumdis-2010-148288] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Indocyanine green (ICG)-enhanced fluorescence optical imaging (FOI) is an established technology for imaging of inflammation in animal models. In experimental models of arthritis, FOI findings corresponded to histologically proven synovitis. This is the first comparative study of FOI with other imaging modalities in humans with arthritis. METHODS 252 FOI examinations (Xiralite system, mivenion GmbH, Berlin, Germany; ICG bolus of 0.1 mg/kg/body weight, sequence of 360 images, one image per second) were compared with clinical examination (CE), ultrasonography (US) and MRI of patients with arthritis of the hands. RESULTS In an FOI sequence, three phases could be distinguished (P1-P3). With MRI as reference, FOI had a sensitivity of 76% and a specificity of 54%, while the specificity of phase 1 was 94%. FOI had agreement rates up to 88% versus CE, 64% versus greyscale US, 88% versus power Doppler US and 83% versus MRI, depending on the compared phase and parameter. FOI showed a higher rate of positive results compared to CE, US and MRI. In individual patients, FOI correlated significantly (p<0.05) with disease activity (Disease Activity Score 28, r=0.41), US (r=0.40) and RAMRIS (Rheumatoid Arthritis MRI Score) (r=0.56). FOI was normal in 97.8% of joints of controls. CONCLUSION ICG-enhanced FOI is a new technology offering sensitive imaging detection of inflammatory changes in subjects with arthritis. FOI was more sensitive than CE and had good agreement with CE, US in power Doppler mode and MRI, while showing more positive results than these. An adequate interpretation of an FOI sequence requires a separate evaluation of all phases. For the detection of synovitis and tenosynovitis, FOI appears to be as informative as 1.5 T MRI and US.
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19
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Bender P, Neuhaus H, Schott P. Akutes Abdomen bei einer 32-jährige Frau. Dtsch Med Wochenschr 2011; 136:1531-2. [DOI: 10.1055/s-0031-1272575] [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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20
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21
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Schott P, Jacobshagen C, Köhler J, Seidler T, Asif AR, Dihazi H, Hasenfuss G, Maier LS. Proteome changes in CaMKIIδC-overexpressing cardiac myocytes. Cardiovasc Pathol 2010; 19:e241-50. [PMID: 20093047 DOI: 10.1016/j.carpath.2009.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 10/19/2009] [Accepted: 11/25/2009] [Indexed: 11/29/2022] Open
Abstract
Recent studies have demonstrated that the expression as well as the activity of Ca/calmodulin-dependent protein kinase IIδ(C) (CaMKIIδ(C)) is increased in heart failure. Transgenic overexpression of CaMKIIδ(C) in mouse hearts results in severe dilated cardiomyopathy. So far, little is known about CaMKIIδ(C)-induced changes in gene expression and proteome alteration. We hypothesize that proteome changes similar to those found in advanced heart failure can be assessed even after short term overexpression of CaMKIIδ(C) in an in vitro culture model. Thus, we designed a study using a proteomic approach combined with adenovirus-mediated gene transfer of CaMKIIδ(C) to identify early CaMKIIδ(C)-induced changes in cardiac myocyte phenotype on proteome level. CaMKIIδ(C) was overexpressed by adenovirus-mediated gene transfer in isolated cardiac myocytes of adult rabbits for 48 h. Proteome changes were analyzed by two-dimensional gel electrophoresis and mass spectrometry (MS). Overexpression of CaMKIIδ(C) resulted in a decreased expression of 21 proteins (at least twofold change of expression, P<.05, n=10). Using in-gel digest and MS, we identified 13 out of these 21 proteins. CaMKIIδ(C) overexpression leads to a reduced abundance of NADH dehydrogenase, lactate dehydrogenase, pyruvate kinase, dihydrolipoamide succinyltransferase, creatine kinase M, heat shock protein 70, elongation factor Tu, and superoxide dismutase. The profile of the proteome changes induced by CaMKIIδ(C) overexpression after 48 h displayed striking alterations of metabolic proteins, cell-protecting proteins including antioxidants, and proteins involved in protein synthesis. Interestingly, the observed proteome changes are in common with the phenotype of failing cardiac myocytes on the protein level. These altered proteins may act individually as contributors to heart failure, which is observed after overexpression of CaMKIIδ(C) in genetically altered mice.
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Affiliation(s)
- Peter Schott
- Department of Cardiology and Pneumology, Heart Center, Georg-August-University, Göttingen, Germany
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22
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Grebe O, Schott P, Magnusson K, Schlueter S, Kurtz B, Vester E. Clinical benefit of cardiac magnetic resonance imaging in relation to the indication. J Cardiovasc Magn Reson 2010. [DOI: 10.1186/1532-429x-12-s1-p308] [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: 11/10/2022] Open
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23
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Lüthje L, Renner B, Kessels R, Vollmann D, Raupach T, Gerritse B, Tasci S, Schwab JO, Zabel M, Zenker D, Schott P, Hasenfuss G, Unterberg-Buchwald C, Andreas S. Cardiac resynchronization therapy and atrial overdrive pacing for the treatment of central sleep apnoea. Eur J Heart Fail 2009; 11:273-80. [PMID: 19147446 PMCID: PMC2645047 DOI: 10.1093/eurjhf/hfn042] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 11/09/2008] [Accepted: 11/20/2008] [Indexed: 01/08/2023] Open
Abstract
AIMS The combined therapeutic impact of atrial overdrive pacing (AOP) and cardiac resynchronization therapy (CRT) on central sleep apnoea (CSA) in chronic heart failure (CHF) so far has not been investigated. We aimed to evaluate the effect of CRT alone and CRT + AOP on CSA in CHF patients and to compare the influence of CRT on CHF between CSA positive and CSA negative patients. METHODS AND RESULTS Thirty patients with CRT indication underwent full night polysomnography, echocardiography, exercise testing, and neurohumoral evaluation before and 3 months after CRT implantation. In CSA positive patients (60%), two additional sleep studies were conducted after 3 months of CRT, with CRT alone or CRT + AOP, in random order. Cardiac resynchronization therapy resulted in significant improvements of NYHA class, left ventricular ejection fraction, N-terminal pro-brain natriuretic peptide, VO(2)max, and quality of life irrespective of the presence of CSA. Cardiac resynchronization therapy also reduced the central apnoea-hypopnoea index (AHI) (33.6 +/- 14.3 vs. 23.8 +/- 16.9 h(-1); P < 0.01) and central apnoea index (17.3 +/- 14.1 vs. 10.9 +/- 13.9 h(-1); P < 0.01) without altering sleep stages. Cardiac resynchronization therapy with atrial overdrive pacing resulted in a small but significant additional decrease of the central AHI (23.8 +/- 16.9 vs. 21.5 +/- 16.9 h(-1); P < 0.01). CONCLUSION In this study, CRT significantly improved CSA without altering sleep stages. Cardiac resynchronization therapy with atrial overdrive pacing resulted in a significant but minor additional improvement of CSA. Positive effects of CRT were irrespective of the presence of CSA.
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Affiliation(s)
- Lars Lüthje
- Kardiologie und Pneumologie, Georg-August-Universität, Göttingen, Germany.
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24
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Lüthje L, Vollmann D, Drescher T, Schott P, Zenker D, Hasenfuβ G, Unterberg C. Intrathoracic impedance monitoring to detect chronic heart failure deterioration: Relationship to changes in NT-proBNP. Eur J Heart Fail 2007; 9:716-22. [DOI: 10.1016/j.ejheart.2007.03.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 01/19/2007] [Accepted: 03/12/2007] [Indexed: 10/23/2022] Open
Affiliation(s)
- Lars Lüthje
- Herzzentrum Göttingen, Abteilung Kardiologie und Pneumologie; Georg-August-Universität Göttingen; Robert-Koch-Str. 40, 37075 Göttingen Germany
| | - Dirk Vollmann
- Herzzentrum Göttingen, Abteilung Kardiologie und Pneumologie; Georg-August-Universität Göttingen; Robert-Koch-Str. 40, 37075 Göttingen Germany
| | - Till Drescher
- Herzzentrum Göttingen, Abteilung Kardiologie und Pneumologie; Georg-August-Universität Göttingen; Robert-Koch-Str. 40, 37075 Göttingen Germany
| | - Peter Schott
- Herzzentrum Göttingen, Abteilung Kardiologie und Pneumologie; Georg-August-Universität Göttingen; Robert-Koch-Str. 40, 37075 Göttingen Germany
| | - Dieter Zenker
- Abteilung Thorax-Herz-Gefäβchirurgie; Georg-August-Universität; Göttingen Germany
| | - Gerd Hasenfuβ
- Herzzentrum Göttingen, Abteilung Kardiologie und Pneumologie; Georg-August-Universität Göttingen; Robert-Koch-Str. 40, 37075 Göttingen Germany
| | - Christina Unterberg
- Herzzentrum Göttingen, Abteilung Kardiologie und Pneumologie; Georg-August-Universität Göttingen; Robert-Koch-Str. 40, 37075 Göttingen Germany
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25
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Kögler H, Schott P, Toischer K, Milting H, Van PN, Kohlhaas M, Grebe C, Kassner A, Domeier E, Teucher N, Seidler T, Knöll R, Maier LS, El-Banayosy A, Körfer R, Hasenfuss G. Relevance of brain natriuretic peptide in preload-dependent regulation of cardiac sarcoplasmic reticulum Ca2+ ATPase expression. Circulation 2006; 113:2724-32. [PMID: 16754798 DOI: 10.1161/circulationaha.105.608828] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In heart failure (HF), ventricular myocardium expresses brain natriuretic peptide (BNP). Despite the association of elevated serum levels with poor prognosis, BNP release is considered beneficial because of its antihypertrophic, vasodilating, and diuretic properties. However, there is evidence that BNP-mediated signaling may adversely influence cardiac remodeling, with further impairment of calcium homeostasis. METHODS AND RESULTS We studied the effects of BNP on preload-dependent myocardial sarcoplasmic reticulum Ca2+ ATPase (SERCA2a) expression. In rabbit isolated muscle strips stretched to high preload and shortening isotonically over 6 hours, the SERCA/glyceraldehyde phosphate dehydrogenase mRNA ratio was enhanced by 168% (n=8) compared with unloaded preparations (n=8; P<0.001). Recombinant human BNP at a concentration typically found in end-stage HF patients (350 pg/mL) abolished SERCA upregulation by stretch (n=9; P<0.0001 versus BNP free). Inhibition of cyclic guanosine 3',5' monophosphate (cGMP)-phosphodiesterase-5 mimicked this effect, whereas inhibition of cGMP-dependent protein kinase restored preload-dependent SERCA upregulation in the presence of recombinant human BNP. Furthermore, in myocardium from human end-stage HF patients undergoing cardiac transplantation (n=15), BNP expression was inversely correlated with SERCA levels. Moreover, among 23 patients treated with left ventricular assist devices, significant SERCA2a recovery occurred in those downregulating BNP. CONCLUSIONS Our data indicate that preload stimulates SERCA expression. BNP antagonizes this mechanism via guanylyl cyclase-A, cGMP, and cGMP-dependent protein kinase. This novel action of BNP to uncouple preload-dependent SERCA expression may adversely affect contractility in patients with HF.
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Affiliation(s)
- Harald Kögler
- Abteilung für Kardiologie, Georg August Universität, Göttingen, Germany.
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26
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Schott P, Scholz KH. Thrombolytic therapy for prosthetic pulmonary valve thrombosis. Clin Res Cardiol 2006; 95:413-7. [PMID: 16741629 DOI: 10.1007/s00392-006-0394-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Accepted: 04/24/2006] [Indexed: 11/28/2022]
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27
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Vollmann D, Lüthje L, Drescher T, Busse S, Zenker D, Schott P, Unterberg-Buchwald C. P6-88. Heart Rhythm 2006. [DOI: 10.1016/j.hrthm.2006.02.989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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28
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Schott P, Bürger E, Hasenfuss G. Partial compression of the right atrium caused by a haematoma after coronary artery bypass angioplasty. Clin Res Cardiol 2006; 95:319-20. [PMID: 16598391 DOI: 10.1007/s00392-006-0379-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Accepted: 02/22/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Peter Schott
- University of Göttingen, Dept. of Cardiology, Robert-Kochstr. 40, 37075, Göttingen, Germany,
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29
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Vollmann D, Lüthje L, Schott P, Hasenfuss G, Unterberg-Buchwald C. Biventricular Pacing Improves the Blunted Force–Frequency Relation Present During Univentricular Pacing in Patients With Heart Failure and Conduction Delay. Circulation 2006; 113:953-9. [PMID: 16476849 DOI: 10.1161/circulationaha.105.579987] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
In patients with chronic heart failure (CHF) and conduction delay, biventricular (BiV) and left ventricular (LV) pacing similarly improve systolic function at resting heart rates. We hypothesized that BiV and univentricular pacing differentially affect contractile function at increasing heart rates.
Methods and Results—
Twenty-two patients (aged 66±2 years, QRS 179±8 ms, LV ejection fraction 23±1%) underwent cardiac catheterization before device implantation to measure LV hemodynamics at baseline (rate 68±2 bpm; sinus rhythm n=18; atrial fibrillation n=4) and during BiV, LV, and right ventricular (RV) stimulation at 80, 100, 120, and 140 bpm. BiV and LV pacing at 80 bpm equally augmented dP/dt
max
as compared with baseline and RV pacing (
P
<0.001). Stimulation rate significantly interacted with the effect of BiV, LV, and RV pacing on LV end-diastolic pressure (LVEDP), systolic pressure (LVSP), and dP/dt
max
. Increasing the rate from 80 to 140 bpm enhanced dP/dt
max
from 913±28 to 1119±50 mm Hg/s during BiV stimulation (
P
<0.001) but had no significant effect on contractility during single-site LV (951±47 versus 1002±54 mm Hg/s) or RV (800±46 versus 881±49 mm Hg/s) pacing. At 140 bpm, LVEDP was lower and LVSP higher during BiV pacing than during RV and LV pacing (LVEDP 12±1 versus 17±1 and 16±1 mm Hg,
P
<0.001; LVSP 112±5 versus 106±5 and 108±6 mm Hg,
P
<0.01 and
P
=0.09; BiV versus RV and LV pacing, respectively).
Conclusions—
Different modes of ventricular stimulation alter the in vivo force–frequency relation of CHF patients. In contrast to single-site LV and RV pacing, contractile function improves with increasing heart rates during BiV stimulation. This effect may contribute to the enhanced exercise capacity during BiV pacing and could provide a functional benefit over LV-only pacing in patients for whom resynchronization therapy is indicated.
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Affiliation(s)
- Dirk Vollmann
- Department of Cardiology and Pneumology, Georg-August-University, Göttingen, Germany.
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30
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Affiliation(s)
- Alois Haas
- Anorganisch‐Chemischen Institut der Universität Göttingen
| | - Peter Schott
- Anorganisch‐Chemischen Institut der Universität Göttingen
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Schott P, Singer SS, Kögler H, Neddermeier D, Leineweber K, Brodde OE, Regitz-Zagrosek V, Schmidt B, Dihazi H, Hasenfuss G. Pressure overload and neurohumoral activation differentially affect the myocardial proteome. Proteomics 2005; 5:1372-81. [DOI: 10.1002/pmic.200401005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Teucher N, Prestle J, Seidler T, Currie S, Elliott EB, Reynolds DF, Schott P, Wagner S, Kogler H, Inesi G, Bers DM, Hasenfuss G, Smith GL. Excessive sarcoplasmic/endoplasmic reticulum Ca2+-ATPase expression causes increased sarcoplasmic reticulum Ca2+ uptake but decreases myocyte shortening. Circulation 2004; 110:3553-9. [PMID: 15505097 DOI: 10.1161/01.cir.0000145161.48545.b3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Increasing sarcoplasmic/endoplasmic reticulum (SR) Ca2+-ATPase (SERCA) uptake activity is a promising therapeutic approach for heart failure. We investigated the effects of different levels of SERCA1a expression on contractility and Ca2+ cycling. We tested whether increased SERCA1a expression levels enhance myocyte contractility in a gene-dose-dependent manner. METHODS AND RESULTS Rabbit isolated cardiomyocytes were transfected at different multiplicities of infection (MOIs) with adenoviruses encoding SERCA1a (or beta-galactosidase as control). Myocyte relaxation half-time was decreased by 10% (P=0.052) at SERCA1a MOI 10 and by 28% at MOI 50 (P<0.05). Myocyte fractional shortening was increased by 12% at MOI 10 (P<0.05) but surprisingly decreased at MOI 50 (-22%, P<0.05) versus control. SR Ca2+ uptake (in permeabilized myocytes) demonstrated a gene-dose-dependent decrease in K(m) by 29% and 46% and an increase in Vmax by 37% and 72% at MOI 10 and MOI 50, respectively (all P<0.05 versus control). Ca2+ transient amplitude was increased in Ad-SERCA1a-infected myocytes at MOI 10 (by 121%, P<0.05), but at MOI 50, the Ca2+ transient amplitude was not significantly changed. Caffeine-induced Ca2+ transients indicated significantly increased SR Ca2+ content in Ad-SERCA1a-infected cells, by 72% at MOI 10 and by 87% at MOI 50. Mathematical simulations demonstrate that the functional increase in SR Ca2+-ATPase uptake activity at MOI 50 (and increased cytosolic Ca2+ buffering) is sufficient to curtail the Ca2+ transient amplitude and explain the reduced contraction. CONCLUSIONS Moderate SERCA1a gene transfer and expression improve contractility and Ca(2+) cycling. However, higher SERCA1a expression levels can impair myocyte shortening because of higher SERCA activity and Ca2+ buffering.
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Affiliation(s)
- Nils Teucher
- Department of Cardiology and Pneumology, University of Goettingen, Goettingen, Germany
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Mehdaoui H, Pascal-mousselard H, Schott P, Dubois B, Valentino R, Joachim-arnaud D. Crit Care 2004; 8:P208. [DOI: 10.1186/cc2675] [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: 11/10/2022] Open
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Kögler H, Hartmann O, Leineweber K, Nguyen van P, Schott P, Brodde OE, Hasenfuss G. Mechanical load-dependent regulation of gene expression in monocrotaline-induced right ventricular hypertrophy in the rat. Circ Res 2003; 93:230-7. [PMID: 12842921 DOI: 10.1161/01.res.0000085042.89656.c7] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rats treated with monocrotaline (MCT) develop pulmonary hypertension. Their right ventricles (RVs) exhibit severe pressure overload-induced hypertrophy, whereas the left ventricles (LVs) are normally loaded. In contrast, enhanced neuroendocrine stimulation during the transition to heart failure affects both ventricles. We assessed gene expression levels of Ca2+-regulating proteins in RVs and LVs of control and MCT rats in transition to heart failure to identify biomechanical load-regulated genes. In MCT RVs, both mRNA and protein levels of the Ca2+-ATPase of the sarcoplasmic/endoplasmic reticulum (SERCA2a) were reduced by 36% (P=0.001) and 17% (P=0.016), respectively, compared with control RVs. Phospholamban and ryanodine receptor mRNA levels likewise were reduced (by 27% [P=0.05] and 21% [P=0.011], respectively) in MCT RVs, whereas sarcolemmal Na+-Ca2+ exchanger expression was not altered. MCT LVs exhibited no significant expression changes compared with control LVs. Isometrically contracting MCT intact RV trabeculae showed enhanced baseline force development. Although control RV preparations exhibited a positive force-frequency relationship, MCT RVs showed a negative force-frequency relationship and blunted postrest potentiation. Contractile function of MCT LV trabeculae was normal. Maximum Ca2+-activated tension was enhanced by 64% in permeabilized RV MCT preparations (P=0.013). beta-Myosin heavy chain protein was upregulated in MCT RVs (P<0.001) but unaltered in MCT LVs. Degradation of troponin T was prominent in MCT RVs, a phenomenon not observed in the LV. Enhanced biomechanical load is necessary to induce the gene expression changes associated with the hypertrophic phenotype of the pressure-overloaded RV. Neuroendocrine factors, which equally affect both chambers, are not sufficient to alter the expression of Ca2+-cycling proteins.
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Affiliation(s)
- Harald Kögler
- Georg-August-Universität Göttingen, Abteilung Kardiologie und Pneumologie, Robert-Koch-Str. 40, D-37075 Göttingen, Germany.
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Abstract
AIM: To evaluate the potential of laparoscopy in the diagnosis of cirrhosis and outcome of interferon treatment in HCV-infected patients.
METHODS: In this retrospective study, diagnostic laparoscopy with laparoscopic liver biopsy was performed in 72 consecutive patients with chronic HCV infection. The presence or absence of cirrhosis was analyzed macroscopically by laparoscopy and microscopically by liver biopsy specimens. Clinical and laboratory data and outcome of interferon-alfa treatment were compared between cirrhotic and noncirrhotic patients.
RESULTS: Laparoscopically, cirrhosis was seen in 29.2% (21/72) and non-cirrhosis in 70.8% (51/72) of patients. Cirrhotic patients were significantly older with a significant longer duration of HCV infection than noncirrhotic patients. Laboratory parameters (AST, y-GT, y-globulin fraction) were measured significantly higher as well as significantly lower (prothrombin index, platelet count) in cirrhotic patients than in non-cirrhotic patients. Histologically, cirrhosis was confirmed in 11.1% (8/72) and non cirrhosis in 88.9% (64/72). Patients with macroscopically confirmed cirrhosis (n = 21) showed histologically cirrhosis in 38.1% (8/21) and histologically non-cirrhosis in 61.9% (13/21). In contrast, patients with macroscopically non-cirrhosis (n = 51) showed histologically non cirrhosis in all cases (51/51). Thirty-nine of 72 patients were treated with interferon-alfa, resulting in 35.9% (14/39) patients with sustained response and 64.1% (25/39) with non response. Non-responders showed significantly more macroscopically cirrhosis than sustained responders. In contrast, there were no significant histological differences between non-responders and sustained responders.
CONCLUSION: Diagnostic laparoscopy is more accurate than liver biopsy in recognizing cirrhosis in patients with chronic HCV infection. Liver biopsy is the best way to assess inflammatory grade and fibrotic stage. The invasive marker for staging, prognosis and management, and treatment outcome of chronic HCV-infected patients need further research and clinical trials. Laparoscopy should be performed for recognition of cirrhosis if this parameter is found to be of prognostic and therapeutic relevance in patients with chronic HCV infection.
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Affiliation(s)
- Perdita Wietzke-Braun
- Medizinische Universitatsklinik, Abteilung Gastroenterologie, Robert-Koch-Strabetae 40, 37075 Goettingen, Germany
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Schott P, Hartmann H, Ramadori G. Hepatitis C virus-associated mixed cryoglobulinemia. Clinical manifestations, histopathological changes, mechanisms of cryoprecipitation and options of treatment. Histol Histopathol 2001; 16:1275-85. [PMID: 11642746 DOI: 10.14670/hh-16.1275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chronic hepatitis C virus (HCV) infection is frequently associated with a variety of autoimmune phenomenons. Mixed cryoglobulinemia (MC) appears in up to 50% of chronic HCV-infected patients. Cryoglobulins consist of immunoglobulin complexes precipitating in vitro when cooled below body temperature. In most cases IgM with rheumatoid factor activity is found in cryoprecipitates which could lead to vasculitis induced by the deposition of immnuocomplexes in small vessels. This vasculitis is thought to cause clinical symptoms called Meltzer's triad. This triad is represented by purpura, arthralgia and weakness. One third of patients suffering from HCV-associated mixed cryoglobulinemia are developing typical symptoms during their course of disease. The striking association between HCV infection and MC has conduced to the hypothesis that HCV is of major importance in the production of MC with followed vasculitis. Both hepatrophism and lymphotrophism have been reported for the hepatitis C virus. Infection of B-cells by HCV could probably lead to a bcl-2 translocation and immunoglobulin gene rearrangement which results in clonal lymphoproliferation and in synthesis of monoclonal IgM with rheumatoid factor activity. These IgM form immunocomplexes with IgG in the cold, which are finally responsible for the described vasculitis. Histopathological changes of the liver are dominated by chronic HCV infection. The majority of times mild activity of hepatitis or mild fibrosis could be found. Nevertheless, cirrhosis is more often found in HCV-infected patients suffering from MC compared to patients without MC. Conventional treatment of MC is aimed to reduce circulating immune complexes by immunosupression and plasmapheresis. With the emerging concept of a viral pathogenesis the therapeutic approach has changed during the last decade. Interferon treatment of MC, particularly of HCV-associated MC is well established nowadays.
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Affiliation(s)
- P Schott
- Department of Medicine, Georg-August-University, Goettingen, Germany
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Wietzke P, Schott P, Braun F, Mihm S, Ramadori G. Clearance of HCV RNA in a chronic hepatitis C virus-infected patient during acute hepatitis B virus superinfection. Liver 1999; 19:348-53. [PMID: 10459635 DOI: 10.1111/j.1478-3231.1999.tb00060.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The routes of hepatitis B virus and hepatitis C virus transmission are quite similar and coexistence of both viruses in one patient is not a rare phenomenon. Until now, the natural course of liver diseases induced by coinfections has not been well documented and the mechanisms of interaction between the two viruses and the human host have not been fully clarified. We report the case of a patient suffering from chronic hepatitis due to hepatitis C virus who developed an acute hepatitis B virus superinfection. Serum hepatitis C virus ribonucleic acid became undetectable by reverse transcriptase/polymerase chain reaction at diagnosis of acute hepatitis B virus infection. At the same time, there was a striking increase in the serum concentrations of the antibodies against C22 and C33c hepatitis C virus antigens. Four months after clinical resolution of the acute hepatitis, hepatitis B surface antigen was undetectable in serum and three months later antibodies against hepatitis B surface antigen appeared. Two years after acute hepatitis B virus infection, the patient has had no relapse of markers for viral replication of hepatitis B virus. Transaminases are within the reference range and hepatitis C virus ribonucleic acid is undetectable in both serum and liver tissue. We hypothesize that acute hepatitis B virus infection stimulated a specific humoral response against hepatitis C virus as well as triggering non-specific defense mechanisms which finally eliminated both viruses.
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Affiliation(s)
- P Wietzke
- Department of Medicine, Division of Gastroenterology and Endocrinology, Georg-August-Universität, Göttingen, Germany
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Abstract
Two studies were conducted to investigate the influence of attention on the components of the chemosensory event-related potential (CSERP). In the first study the odors linalool and eugenol were delivered to six male subjects, in the second study three male and two female subjects were presented with their own body odor (axillary hair) and the body odor of a same sex donor. In both studies the odors were presented in an oddball paradigm under ignore and attend conditions via a constant-flow olfactometer. In the ignore condition attention was diverted from the odors with a distractor task, while in the attend condition the subjects were asked to respond to the infrequently occurring odor. In both studies the allocation of attention led to a decrease in the latency of the early components (N1, P2, N2) and to an increase in the amplitude of the late positivities. The modulation of the early components suggests that attentional gating in olfaction might already be effective at an early processing level.
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Affiliation(s)
- K Krauel
- Institute of Psychology, Christian-Albrechts-Universität zu Kiel, Germany.
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Schott P, Pott C, Ramadori G, Hartmann H. Hepatitis C virus infection-associated non-cryoglobulinaemic monoclonal IgMkappa gammopathy responsive to interferon-alpha treatment. J Hepatol 1998; 29:310-5. [PMID: 9722214 DOI: 10.1016/s0168-8278(98)80018-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIMS An association of HCV infection with lymphoproliferative disorders, particularly B-cell non-Hodgkin's lymphoma has been described. In the majority of reported patients, mixed cryoglobulinaemia was present as well. Rarely, HCV-associated lymphoproliferative disorders have been observed in the absence of cryoglobulinaemia. In these latter patients, the response to interferon-alpha is largely unknown. CASE REPORT We report a case of an asymptomatic 31-year-old male with chronic HCV infection and non-cryoglobulinaemic monoclonal IgMkappa gammopathy responsive to interferon-alpha therapy. Prior to therapy, elevated plasma transaminase activities known for longer than a year, serum anti-HCV antibodies and HCV RNA detected by reverse transcriptase-polymerase chain reaction were present. Serum IgM concentration was markedly elevated, immunofixation demonstrated monoclonal serum IgM, and urine kappa-light chains were detected. Cryoglobulins were undetectable in several consecutive serum samples. Bone marrow aspirate and biopsy specimens were unremarkable. Further evaluation, e.g. by ultrasonography and radiography, did not reveal evidence for lymphoma. Treatment with interferon-alpha2a for 12 months resulted in a long-term sustained response to HCV infection and in a normalisation of serum IgM concentration. CONCLUSION Therefore, the corresponding effects of interferon-alpha on HCV infection and on a monoclonal B-cell population observed in the present case might suggest a pathogenetic connection, similarly, to what has been described for HCV and mixed cryoglobulinaemia. The molecular events, however, leading to HCV-induced monoclonal B-cell expansion remain unknown.
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Affiliation(s)
- P Schott
- Department of Medicine, Georg-August-Universität, Göttingen, Germany
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Abstract
BACKGROUND/AIMS Mixed cryoglobulinemia is frequently associated with chronic hepatitis C virus infection. We aimed to clarify the mechanism, kinetics and participating proteins in cryoprecipitate formation, which are still being debated. METHODS Eighteen patients with cryoglobulinemia were studied. Isolated serum cryoprecipitates and purified cryoglobulin IgM and IgG fractions were analyzed in vitro by turbidimetry for temperature-dependent complex formation. Immunoglobulin reactivity, i.e. in cryoprecipitates and in cryoglobulin-free sera, was studied using immunoblot and enzyme immunoassays. HCV RNA was detected by reverse transcriptase/polymerase chain reaction. RESULTS By turbidimetry, purified cryo-IgM precipitated (in the absence of HCV RNA) with cryo-IgG as well as with non-cryoglobulin IgG and with IgG Fc or F(ab')2 fragments. In contrast, purified cryo-IgG did not precipitate with non-cryoglobulin IgM. Anti-HCV IgG reactivity was found in cryoglobulin-free sera, in cryoprecipitates and in purified cryoglobulin IgG fractions. The respective titers were similar. Purified cryo-IgM did not react to HCV-encoded proteins. Binding of cryo-IgM to heterologous IgG was inhibited by intact IgG (up to a mean of about 52%) as well as by IgG Fc (33%) and F(ab')2 fragments (17%). Binding of cryo-IgM to IgG was enhanced at low temperature (4 degrees C vs. 37 degrees C), particularly for type III cryoglobulin IgM. CONCLUSIONS In hepatitis C virus-associated cryoglobulinemia the in vitro precipitate formation depended on cryo-IgM, while IgG appeared to act as an unspecific antigenic partner. Hepatitis C viral particles were probably not required. Cryo-IgM binding occurred primarily to intact IgG. Anti-HCV reactivity of either cryo-IgM or cryo-IgG was not necessary for precipitate formation. Regarding the pathogenesis, a direct hepatitis C virus protein-dependent stimulation of B-cells producing cryo-IgM seems to be unlikely.
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Affiliation(s)
- P Schott
- Department of Medicine, Georg-August-University, Göttingen, Germany
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Saile B, Knittel T, Matthes N, Schott P, Ramadori G. CD95/CD95L-mediated apoptosis of the hepatic stellate cell. A mechanism terminating uncontrolled hepatic stellate cell proliferation during hepatic tissue repair. Am J Pathol 1997; 151:1265-72. [PMID: 9358752 PMCID: PMC1858076] [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: 02/05/2023]
Abstract
During liver tissue repair, hepatic stellate cells (HSC), a pericyte-like mesenchymal liver cell population, transform from a "quiescent" status ("resting" HSC) into myofibroblast-like cells ("activated" HSC) with the latter representing the principle matrix synthesizing cell of the liver. Presently, the mechanisms that terminate HSC cell proliferation when tissue repair is concluded are poorly understood. Controlled cell death known as apoptosis could be a mechanism underlying this phenomenon. Therefore, apoptosis and its regulation were studied in HSC using an in vitro and in vivo approach. Spontaneous apoptosis became detectable in parallel with HSC activation because resting cells (2 days after isolation) displayed no sign of apoptosis, whereas apoptosis was present in 8% (+/- 5%) of "transitional" cells (day 4) and in 18% (+/- 8%) of fully activated cells (day 7). Both CD95 (APO-1/Fas) and CD95L (APO-1-/Fas-ligand) became increasingly expressed during the course of activation. Apoptosis could be fully blocked by CD95-blocking antibodies in normal cells and HSC already entering the apoptotic cycle. Using CD95-activating antibodies, transition of more than 95% cells into apoptosis was evident at each activation step. The apoptosis-regulating proteins Bcl-2 and p53 could not be detected in resting cells but were found in increasing amounts at days 4 and 7 of cultivation. Whereas p53 expression was induced by the CD95-activating antibody, no change was inducible in Bcl-2 expression. The Bcl-2-related protein bax could be found at days 2 and 4 in similar expression, was considerably up-regulated at day 7, but was not regulated by CD95-agonistic antibodies. In vivo, acute tissue damage was first accompanied by activation and proliferation of HSC displaying no sign of apoptosis. In the recovery phase, apoptotic HSC were detectable in parallel to a reduction in the total number of HSC present in the liver tissue. The data demonstrate that apoptosis becomes detectable in parallel with HSC activation, which suggests that apoptosis might represent an important mechanism terminating proliferation of activated HSC.
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Affiliation(s)
- B Saile
- University of Göttingen, Department of Internal Medicine, Germany
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Fayyazi A, Schott P, Hartmann H, Mihm S, Middel P, Ramadori G, Radzun HJ. Clinical, biochemical, and histological changes in hepatitis C virus infection-associated cryoglobulinemia. Z Gastroenterol 1997; 35:921-8. [PMID: 9370142] [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: 02/05/2023]
Abstract
The most common extrahepatic manifestation of HCV infection is mixed cryoglobulinemia (MC). 62 unselected patients with chronic HCV infection were prospectively evaluated for the presence of cryoglobulinemia and associated clinical and biochemical parameters. Furthermore, a putative relationship between the HCV genotypes and cryoglobulinemia was tested. Histological features typical for HCV infection were comparatively analyzed in cases with and without cryoglobulinemia. Whether an intrahepatic Th2-response is responsible for the strong antibody production causing cryoglobulinemia was also examined. Cryoglobulins were detected in sera of 30 patients (approximately equal to 48%). Patients with cryoglobulinemia were on the average elder, showed an apparent longer duration of infection, and suffered more frequently from arthralgia, accompanied by a significant increase of total serum IgM concentration and rheumatoid factor activity. The HCV genotype distribution among patients with cryoglobulinemia was not different from that found in patients without cryoglobulinemia. In cases with cryoglobulinemia, an increased activity of chronic hepatitis and a higher grade of liver fibrosis was noted. The prevalence of HCV-typical histological lesions among all patients were: Portal lymphocytic aggregates (40%), bile duct damage (35%), steatosis (47%), and intracellular acidophilic bodies (29%). A significant correlation, however, could not be found between cryoglobulinemia and the presence of HCV-typical histological lesions. An intrahepatic Th2-response causing an increased antibody production could not be observed in cases with cryoglobulinemia.
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Affiliation(s)
- A Fayyazi
- Department of Pathology, Georg-August University, Göttingen
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Abstract
BACKGROUND/AIMS Chronic hepatitis C virus infection is frequently associated with mixed cryoglobulinemia. The efficacy of interferon-alpha treatment in the presence of cryoglobulinemia, particularly the rate of sustained responders, has not yet been well defined. METHODS Fifty-nine consecutive patients with chronic HCV infection were studied prospectively with regard to the presence of cryoglobulinemia and their biochemical and virological response to interferon-alpha2a therapy. RESULTS Cryoglobulins were detected in sera of 23 patients. For this latter group of patients, significant differences were found compared to the 36 patients without cryoglobulinemia, i.e. the prevalence of female sex was higher, the duration of liver disease was longer and distinctive laboratory abnormalities, e.g. higher rheumatoid factor activity, were noted as well as a higher prevalence of cirrhosis. The distribution of HCV genotypes and serum HCV RNA titers was similar in the two groups. Interferon-alpha treatment regimens were not different regarding mean cumulative dose and mean duration of therapy. The response to therapy was almost identical, i.e. 35% of patients with cryoglobulinemia showed a sustained response compared to 22% of patients without cryoglobulinemia. The percentages of patients showing a relapse or breakthrough were similar in both groups. Pre-treatment viremia levels were higher in non-responders compared to sustained responders. Non-responders appeared to be more frequent among patients infected with genotypes 1a and 1b, especially among male patients without cryoglobulinemia. CONCLUSIONS The presence of cryoglobulinemia per se in chronic HCV-infected patients does not adversely affect the outcome of interferon-alpha therapy, including the rate of sustained response.
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Affiliation(s)
- F Polzien
- Department of Medicine, Georg-August-Universitat, Göttingen, Germany
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Hartmann H, Schott P, Polzien F, Mihm S, Uy A, Kaboth U, Pardowitz I, Ramadori G. Cryoglobulinemia in chronic hepatitis C virus infection: prevalence, clinical manifestations, response to interferon treatment and analysis of cryoprecipitates. Z Gastroenterol 1995; 33:643-50. [PMID: 8600660] [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: 01/31/2023]
Abstract
Chronic hepatitis C virus infection can be associated with mixed cryoglobulinemia and systemic vasculitis. The pathogenesis remains poorly understood. 55 consecutive patients with chronic HCI infection (anti-HCV- and serum HCV RNA-positive) were studies prospectively. Cryoglobulinemia was detected in 28 patients (51%) with a mean cryocrit level of 2.2%. Clinical symptoms of vasculitis were encountered in six patients. Compared to those HCV-infected patients without cryoglobulinemia the following distinctive features were observed in the presence of cryoglobulinemia: increased age (p<0.02), female preponderance (p<0.002), longer-lasting HCV infection (mean of 10.7 vs. 4.7 yrs), higher prevalence of cirrhosis (42.8 vs. 0%), increased serum concentration of IgM and increased rheumatoid factor activity, decreased concentration of serum C4 (each p<0.05). The response to interferon treatment was similar in patients with and without cryoglobulinemia. When cryoprecipitates were analyzed by immunofixation, type II cryoglobulinemia was present in 1/3 and type III in 2/3 of patients. By SDS-PAGE four different proteins were demonstrable in cryoprecipitates each identified by immunoblotting as IgG and IgM heavy or light chains respectively. Cryoprecipitate IgGs were shown to react with HCV structural as well a non-structural proteins in a recombinant immunoblotting assay (RIBA). In contrast, cryoprecipitate IgMs reacted only to the HCV core protein c22-3. HCV RNA was detected in cryoprecipitates without a significant enrichment when compared to the corresponding serum or supernatant HCV RNA content. Given the monoclonality of some cryoprecipitate IgM and their reactivity to HCV core, a cross-reactivity to IgG was postulated. In fact, when performing a computer-assisted search for sequence homology, a motif within the core protein (EGLGWAGWL, conserved in HCV genotypes) was identified homologous to a sequence of IgG heavy chains. Thus, temperature-dependent affinity changes of IgM anti-HCV core (nonapeptide) and ensuing complex formation with IgG via binding to the homologous IgG sequence could be a mechanism of cryoprecipitate formation.
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Affiliation(s)
- H Hartmann
- Department of Medicine, Georg-August-Universität, Göttingen, Germany
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Brun Y, Chanal M, Durosoir JL, Schott P, Sirot D, Saliou P, Coulet M, Thabaut A, Cluzel R, Fleurette J. [Comparative multicenter study of 2 methods of determining sensitivity to antibiotics. Gel diffusion method and semiautomatic method in fluid ABAC medium]. Pathol Biol (Paris) 1984; 32:29-34. [PMID: 6422428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Susceptibility of 60 bacterial isolates to 15 antibiotics was determined by two methods in three laboratories: 48 Gram negative bacilli and 12 Staphylococci were selected because of "intermediate" susceptibility to at least one antibiotic. Results show a good correlation between the two methods: more than 90% for carbenicillin, cefazolin, cefoxitin, cefamandole, kanamycin, tobramycin, amikacin, erythromycin, pristinamycin and fusidic acid, between 80 and 90% for penicillin G, ampicillin, oxacillin, gentamicin, doxycycline, chloramphenicol, spiramycin and clindamycin, less than 80% for neomycin, tetracycline, minocycline and oleandomycin. Interpretation criteria are different in the two methods for rifampicin, colistin and cotrimoxazole. Between the three laboratories, correlation was 90,3% and 88,6% for disc diffusion method and ABAC system respectively.
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Haas A, Schott P. Zur Chemie der Trifluormethyl-Schwefel-Stickstoff-Verbindungen, III Darstellung und Eigenschaften von (CF3S)3N, CF3SNSNSCF3, CF3SNSF2 und CF3SNSO. ACTA ACUST UNITED AC 1968. [DOI: 10.1002/cber.19681011011] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Haas A, Schott P. Trifluormethylsulfenylimino-schwefeldifluorid CF3SNSF2 und Bis(trifluormethylsulfenylimino)-schwefel CF3SNSNSCF3. Angew Chem Int Ed Engl 1967. [DOI: 10.1002/ange.19670790724] [Citation(s) in RCA: 7] [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: 11/09/2022]
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Haas A, Schott P. Difluoro(trifluoromethylsulfenylimino)sulfur CF3SNSF2 and Bis(trifluoromethylsulfenylimino)sulfur CF3SNSNSCF3. Angew Chem Int Ed Engl 1967. [DOI: 10.1002/anie.196703702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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