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Blesl A, Wurm P, Waschina S, Gröchenig HP, Novacek G, Primas C, Reinisch W, Kutschera M, Illiasch C, Hennlich B, Steiner P, Koch R, Tillinger W, Haas T, Reicht G, Mayer A, Ludwiczek O, Miehsler W, Steidl K, Binder L, Reider S, Watschinger C, Fürst S, Kump P, Moschen A, Aden K, Gorkiewicz G, Högenauer C. Prediction of Response to Systemic Corticosteroids in Active UC by Microbial Composition-A Prospective Multicenter Study. Inflamm Bowel Dis 2024; 30:9-19. [PMID: 37463118 PMCID: PMC10769779 DOI: 10.1093/ibd/izad126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Corticosteroids are used for induction of remission in patients with moderately to severely active ulcerative colitis. However, up to one-third of patients fail to this therapy. We investigated if fecal microbial composition or its metabolic capacity are associated with response to systemic corticosteroids. METHODS In this prospective, multicenter study, patients with active ulcerative colitis (Lichtiger score ≥4) receiving systemic corticosteroids were eligible. Data were assessed and fecal samples collected before and after 4 weeks of treatment. Patients were divided into responders (decrease of Lichtiger Score ≥50%) and nonresponders. The fecal microbiome was assessed by the 16S rRNA gene marker and analyzed with QIIME 2. Microbial metabolic pathways were predicted using parsimonious flux balance analysis. RESULTS Among 93 included patients, 69 (74%) patients responded to corticosteroids after 4 weeks. At baseline, responders could not be distinguished from nonresponders by microbial diversity and composition, except for a subgroup of biologic-naïve patients. Within 4 weeks of treatment, responders experienced changes in beta diversity with enrichment of ascribed beneficial taxa, including Blautia, Anaerostipes, and Bifidobacterium, as well as an increase in predicted butyrate synthesis. Nonresponders had only minor longitudinal taxonomic changes with a significant increase of Streptococcus salivarius and a microbial composition shifting away from responders. CONCLUSION Baseline microbial diversity and composition seem to be of limited use to predict response to systemic corticosteroids in active ulcerative colitis. Response is longitudinally associated with restoration of microbial composition and its metabolic capacity.
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Affiliation(s)
- Andreas Blesl
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Philipp Wurm
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Silvio Waschina
- Christian-Albrechts-University Kiel, Institute for Human Nutrition and Food Science, Nutriinformatics, Kiel, Germany
| | | | - Gottfried Novacek
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Christian Primas
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Walter Reinisch
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Maximilian Kutschera
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Robert Koch
- Medical University of Innsbruck, Innsbruck, Austria
| | | | | | | | | | | | | | - Karin Steidl
- Brothers of Saint John of God Hospital, St. Veit an der Glan, Austria
| | - Lukas Binder
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Simon Reider
- Department of Internal Medicine 2 (Gastroenterology and Hepatology), Faculty of Medicine, Kepler University Hospital, Johannes Kepler University, Linz, Austria
- Christian Doppler Laboratory for Mucosal Immunology, Johannes Kepler University Linz, Linz, Austria
| | - Christina Watschinger
- Department of Internal Medicine 2 (Gastroenterology and Hepatology), Faculty of Medicine, Kepler University Hospital, Johannes Kepler University, Linz, Austria
- Christian Doppler Laboratory for Mucosal Immunology, Johannes Kepler University Linz, Linz, Austria
| | - Stefan Fürst
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Patrizia Kump
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Alexander Moschen
- Department of Internal Medicine 2 (Gastroenterology and Hepatology), Faculty of Medicine, Kepler University Hospital, Johannes Kepler University, Linz, Austria
- Christian Doppler Laboratory for Mucosal Immunology, Johannes Kepler University Linz, Linz, Austria
| | - Konrad Aden
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Internal Medicine I, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Christoph Högenauer
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
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Blesl A, Borenich A, Gröchenig HP, Novacek G, Primas C, Reinisch W, Kutschera M, Illiasch C, Hennlich B, Steiner P, Koch R, Tillinger W, Haas T, Reicht G, Mayer A, Ludwiczek O, Miehsler W, Steidl K, Binder L, Baumann-Durchschein F, Fürst S, Reider S, Watschinger C, Wenzl H, Moschen A, Berghold A, Högenauer C. Factors Associated with Response to Systemic Corticosteroids in Active Ulcerative Colitis: Results from a Prospective, Multicenter Trial. J Clin Med 2023; 12:4853. [PMID: 37510968 PMCID: PMC10382050 DOI: 10.3390/jcm12144853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Among patients with ulcerative colitis, 30-50% receive corticosteroids within the first five years after diagnosis. We aimed to reconsider their effectiveness in the context of the biologic era. METHODS In this prospective, multicenter study, patients with active ulcerative colitis (Lichtiger score ≥ 4) were eligible if initiating systemic corticosteroids. The primary endpoint was clinical response (decrease in the Lichtiger score of ≥50%) at week 4. Secondary endpoints included combined response defined as clinical response and any reduction in elevated biomarkers (CRP and/or calprotectin). Steroid dependence was assessed after three months. RESULTS A total of 103 patients were included. Clinical response was achieved by 73% of patients, and combined response by 68%. A total of 15% of patients were steroid-dependent. Activity of colitis did not influence short-term response to treatment but increased the risk for steroid dependence. Biologic-naïve patients responded better than biologic-experienced patients. Past smoking history (OR 5.38 [1.71, 20.1], p = 0.003), hemoglobin levels (OR 0.76 [0.57, 0.99] for higher levels, p = 0.045), and biologic experience (OR 3.30 [1.08, 10.6], p = 0.036) were independently associated with nonresponse. CONCLUSION Disease activity was not associated with short-term response to systemic corticosteroids but was associated with steroid dependence in patients with active ulcerative colitis. Exposure to biologics negatively affects response rates.
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Affiliation(s)
- Andreas Blesl
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, 8036 Graz, Austria
| | - Andrea Borenich
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria
| | | | - Gottfried Novacek
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Christian Primas
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Walter Reinisch
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Maximilian Kutschera
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, 1090 Vienna, Austria
| | | | | | | | - Robert Koch
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | | | | | - Gerhard Reicht
- Brothers of Saint John of God Hospital, 8020 Graz, Austria
| | - Andreas Mayer
- University Hospital St. Pölten, 3100 St. Pölten, Austria
| | | | | | - Karin Steidl
- Brothers of Saint John of God Hospital, 9300 St. Veit an der Glan, Austria
| | - Lukas Binder
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, 8036 Graz, Austria
| | - Franziska Baumann-Durchschein
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, 8036 Graz, Austria
| | - Stefan Fürst
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, 8036 Graz, Austria
| | - Simon Reider
- Department of Internal Medicine II (Gastroenterology and Hepatology), Faculty of Medicine, Kepler University Hospital, Johannes Kepler University, 4021 Linz, Austria
- Christian Doppler Laboratory for Mucosal Immunology, Johannes Kepler University, 4021 Linz, Austria
| | - Christina Watschinger
- Department of Internal Medicine II (Gastroenterology and Hepatology), Faculty of Medicine, Kepler University Hospital, Johannes Kepler University, 4021 Linz, Austria
- Christian Doppler Laboratory for Mucosal Immunology, Johannes Kepler University, 4021 Linz, Austria
| | - Heimo Wenzl
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, 8036 Graz, Austria
| | - Alexander Moschen
- Department of Internal Medicine II (Gastroenterology and Hepatology), Faculty of Medicine, Kepler University Hospital, Johannes Kepler University, 4021 Linz, Austria
- Christian Doppler Laboratory for Mucosal Immunology, Johannes Kepler University, 4021 Linz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria
| | - Christoph Högenauer
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, 8036 Graz, Austria
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Penrose C, Steiner P, Gladden LF, Sederman AJ, York APE, Bentley M, Mantle MD. A simple liquid state 1H NMR measurement to directly determine the surface hydroxyl density of porous silica. Chem Commun (Camb) 2021; 57:12804-12807. [PMID: 34783334 DOI: 10.1039/d1cc03959h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Silica is widely used in industrial applications and its performance is partially decided by its surface hydroxyl density αOH. Here we report a quick, simple liquid 1H NMR method to determine αOH using a benchtop 1H NMR spectrometer. The results show excellent agreement with the literature with an αOH range from 4.16 to 6.56 OH per nm2.
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Affiliation(s)
- C Penrose
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Dr, Cambridge CB3 0AS, UK.
| | - P Steiner
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Dr, Cambridge CB3 0AS, UK. .,Gdanska 335/23, Praha 8, 181 00, Czech Republic
| | - L F Gladden
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Dr, Cambridge CB3 0AS, UK.
| | - A J Sederman
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Dr, Cambridge CB3 0AS, UK.
| | - A P E York
- Johnson Matthey Technology Centre, Blounts Court, Sonning Common, Reading, RG4 9NH, UK
| | - M Bentley
- Johnson Matthey Technology Centre, Blounts Court, Sonning Common, Reading, RG4 9NH, UK
| | - M D Mantle
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Dr, Cambridge CB3 0AS, UK.
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Scharrer S, Primas C, Eichinger S, Tonko S, Kutschera M, Koch R, Blesl A, Reinisch W, Mayer A, Haas T, Feichtenschlager T, Fuchssteiner H, Steiner P, Ludwiczek O, Platzer R, Miehsler W, Tillinger W, Apostol S, Schmid A, Schweiger K, Vogelsang H, Dejaco C, Herkner H, Novacek G. Inflammatory Bowel Disease and Risk of Major Bleeding During Anticoagulation for Venous Thromboembolism. Inflamm Bowel Dis 2021; 27:1773-1783. [PMID: 33386735 DOI: 10.1093/ibd/izaa337] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Little is known about the bleeding risk in patients with inflammatory bowel disease (IBD) and venous thromboembolism (VTE) treated with anticoagulation. Our aim was to elucidate the rate of major bleeding (MB) events in a well-defined cohort of patients with IBD during anticoagulation after VTE. METHODS This study is a retrospective follow-up analysis of a multicenter cohort study investigating the incidence and recurrence rate of VTE in IBD. Data on MB and IBD- and VTE-related parameters were collected via telephone interview and chart review. The objective of the study was to evaluate the impact of anticoagulation for VTE on the risk of MB by comparing time periods with anticoagulation vs those without anticoagulation. A random-effects Poisson regression model was used. RESULTS We included 107 patients (52 women, 40 with ulcerative colitis, 64 with Crohn disease, and 3 with unclassified IBD) in the study. The overall observation time was 388 patient-years with and 1445 patient-years without anticoagulation. In total, 23 MB events were registered in 21 patients, among whom 13 MB events occurred without anticoagulation and 10 occurred with anticoagulation. No fatal bleeding during anticoagulation was registered. The incidence rate for MB events was 2.6/100 patient-years during periods exposed to anticoagulation and 0.9/100 patient-years during the unexposed time. Exposure to anticoagulation (adjusted incidence rate ratio, 3.7; 95% confidence interval, 1.5-9.0; P = 0.003) and ulcerative colitis (adjusted incidence rate ratio, 3.5; 95% confidence interval, 1.5-8.1; P = 0.003) were independent risk factors for MB events. CONCLUSION The risk of major but not fatal bleeding is increased in patients with IBD during anticoagulation. Our findings indicate that this risk may be outweighed by the high VTE recurrence rate in patients with IBD.
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Affiliation(s)
- Susanna Scharrer
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Christian Primas
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Sabine Eichinger
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Sebastian Tonko
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.,Praxis am rhy AG, Kriessern, Switzerland
| | - Maximilian Kutschera
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Robert Koch
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Blesl
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Walter Reinisch
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Andreas Mayer
- Department of Internal Medicine II, Universitätsklinikum St. Pölten, St. Pölten, Austria
| | | | | | - Harry Fuchssteiner
- Department of Internal Medicine IV, Hospital Elisabethinen Linz, Linz, Austria
| | - Pius Steiner
- Department of Internal Medicine I, Hospital Wels-Grieskirchen, Wels, Austria
| | | | - Reingard Platzer
- Department of Internal Medicine I, Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - Wolfgang Miehsler
- Department of Internal Medicine, Hospital Brothers of St. John of God Salzburg, Salzburg, Austria
| | | | - Sigrid Apostol
- Department of Internal Medicine, Hietzing Clinic, Vienna, Austria
| | - Alfons Schmid
- Department of Internal Medicine 2, Danube Hospital, Vienna, Austria
| | - Karin Schweiger
- Department of Internal Medicine 4, Ottakring Clinic, Vienna, Austria
| | - Harald Vogelsang
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Clemens Dejaco
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Gottfried Novacek
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
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Malzner A, Steiner P, Windpessl M. A young man with abdominal pain and intestinal distension. Eur J Intern Med 2021; 90:98-99. [PMID: 34193374 DOI: 10.1016/j.ejim.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/13/2021] [Accepted: 06/06/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Andrea Malzner
- First Department of Medicine, Gastroenterology and Hepatology, Klinikum Wels-Grieskirchen, Austria
| | - Pius Steiner
- First Department of Medicine, Gastroenterology and Hepatology, Klinikum Wels-Grieskirchen, Austria
| | - Martin Windpessl
- Fourth Department of Medicine, Section of Nephrology, Klinikum Wels-Grieskirchen, Austria.
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6
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Kutschera M, Waldhör T, Gröchenig HP, Haas T, Wenzl H, Steiner P, Koch R, Feichtenschlager T, Eckhardt G, Mayer A, Kirchgatterer A, Ludwiczek O, Platzer R, Papay P, Gartner J, Fuchssteiner H, Peters PG, Reicht G, Moser G, Dejaco C, Vogelsang H, Primas C, Novacek G, Miehsler W. Use of complementary and alternative medicine and low quality of life associate with the need for psychological and psychotherapeutic interventions in inflammatory bowel disease. United European Gastroenterol J 2021; 9:72-81. [PMID: 32723070 PMCID: PMC8259281 DOI: 10.1177/2050640620946874] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/04/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Patients with inflammatory bowel disease (IBD) suffer from various symptoms, impairing their quality of life and often affecting psychosocial issues. This may lead to the need for additional psychological care. This study investigated patients' subjective need for integrated psychosomatic support and psychotherapy and indicators for it. Materials and methods This is a cross‐sectional multicentre study in Austrian IBD patients who were in routine care at 18 IBD outpatient clinics. Patients filled in an anonymous, validated questionnaire (Assessment of the Demand for Additional Psychological Treatment Questionnaire [ADAPT]) assessing the need for psychological care. The ADAPT gives two separate scores: the need for integrated psychosomatic support and for psychotherapy. In addition, health‐related quality of life and the use of complementary and alternative medicine as well as clinical and socio‐demographic variables were queried. Multivariable regression analysis was performed to estimate the effect of the previously mentioned variables on the need for additional psychological care. Results Of 1286 patients, 29.7% expressed a need for additional psychological care, 19.6% expressed a need for integrated psychosomatic support and 20.2% expressed a need for psychotherapy. In the multivariable analysis, the two strongest indicators for the need for both types of psychological care were the use of complementary and alternative medicine (for integrated psychosomatic support: odds ratio = 1.64, 95% confidence interval 1.13–2.39, p = 0.010; for psychotherapy: odds ratio = 1.74, 95% confidence interval 1.20–2.53, p = 0.004), and a low health‐related quality of life score (for integrated psychosomatic support: odds ratio = 0.95, 95% confidence interval 0.94–0.96, p < 0.001; for psychotherapy: odds ratio = 0.96, 95% confidence interval 0.94–0.97, p < 0.001). Discussion About 30% of the Austrian IBD patients expressed a need for integrated psychosomatic support and/or psychotherapy. The most important indicators for this need were the use of complementary and alternative medicine and low quality of life.
What is already known?
Despite ongoing improvement of treatment options, patients may not respond to treatment or may develop side effects. Due to this burden of disease, patients may also suffer from psychological symptoms, such as depression In our previous study in 2008, we found that 31% of patients with inflammatory bowel disease (IBD) expressed a subjective need for psychological interventions
What are the significant and/or new findings of the study?
Despite improvements in therapy, around 30% of patients with IBD express a subjective need for psychological interventions This subjective need for psychological interventions is associated with complementary and alternative medicine use and low quality of life
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Affiliation(s)
- Maximilian Kutschera
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Waldhör
- Department of Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Hans Peter Gröchenig
- Department of Internal Medicine, Brothers of St. John of God Hospital St. Veit an der Glan, St. Veit an der Glan, Austria
| | | | - Heimo Wenzl
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Pius Steiner
- Department of Internal Medicine I, Wels-Grieskirchen Hospital, Wels, Austria
| | - Robert Koch
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Gerald Eckhardt
- Department of Internal Medicine, Oberpullendorf Hospital, Oberpullendorf, Austria
| | - Andreas Mayer
- Department of Internal Medicine II, Universitätsklinikum St. Pölten, St. Pölten, Austria
| | - Andreas Kirchgatterer
- Department of Internal Medicine V, Wels-Grieskirchen Hospital, Grieskirchen, Austria
| | - Othmar Ludwiczek
- Department of Internal Medicine, Hall in Tirol Hospital, Hall in Tirol, Austria
| | - Reingard Platzer
- Department of Internal Medicine I, Wiener Neustadt Hospital, Wiener Neustadt, Austria
| | - Pavol Papay
- Department of Internal Medicine, Franziskus Hospital, Vienna, Austria
| | - Johanna Gartner
- Department of Internal Medicine, Hanusch Hospital, Vienna, Austria
| | - Harry Fuchssteiner
- Department of Internal Medicine IV, Congregation Hospital Sisters of Charity, Linz, Austria
| | | | - Gerhard Reicht
- Department of Internal Medicine II, Brothers of St. John of God Hospital Graz, Graz, Austria
| | - Gabriele Moser
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Clemens Dejaco
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Harald Vogelsang
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christian Primas
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Gottfried Novacek
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Miehsler
- Department of Internal Medicine, Brothers of St. John of God Hospital Salzburg, Salzburg, Austria
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7
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Novacek G, Gröchenig HP, Haas T, Wenzl H, Steiner P, Koch R, Feichtenschlager T, Eckhardt G, Mayer A, Kirchgatterer A, Ludwiczek O, Platzer R, Papay P, Gartner J, Fuchssteiner H, Miehsler W, Peters PG, Reicht G, Vogelsang H, Dejaco C, Waldhör T. Diagnostic delay in patients with inflammatory bowel disease in Austria. Wien Klin Wochenschr 2019; 131:104-112. [PMID: 30715607 DOI: 10.1007/s00508-019-1451-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Delayed diagnosis seems to be common in inflammatory bowel diseases (IBD). The study was carried out to investigate the diagnostic delay and associated risk factors in Austrian IBD patients. METHODS In a multicenter cross-sectional study adult patients with IBD attending 18 Austrian outpatient clinics completed a multi-item questionnaire that recorded medical and socioeconomic characteristics. The study outcome was diagnostic delay defined as the period from symptom onset to diagnosis of IBD. RESULTS A total of 1286 patients (Crohn's disease 830, ulcerative colitis 435, inflammatory bowel disease unclassified 21; females 651) with a median age of 40 years (interquartile range 31-52 years) and a median disease duration of 10 years (4-18 years) were analyzed. The median diagnostic delay was 6 months (2-23 months) in Crohn's disease and 3 months (1-10 months) in ulcerative colitis (p < 0.001). In the multivariable regression analysis Crohn's disease, greater age at diagnosis and a high educational level (compared to middle degree level) were independently associated with longer diagnostic delay. CONCLUSION The diagnostic delay was longer in Crohn's disease than in ulcerative colitis patients and was associated with greater age at diagnosis and a higher educational level.
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Affiliation(s)
- Gottfried Novacek
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Hans Peter Gröchenig
- Department of Internal Medicine, Brothers of St. John of God Hospital, St. Veit an der Glan, Spitalgasse 26, 9300, St. Veit an der Glan, Austria
| | - Thomas Haas
- Darmpraxis Salzburg, Bayernstraße 17, 5020, Salzburg, Austria
| | - Heimo Wenzl
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Pius Steiner
- Department of Internal Medicine I, Wels-Grieskirchen Hospital, Grieskirchnerstraße 42, 4600, Wels, Austria
| | - Robert Koch
- Department of Internal Medicine I, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, 6020, Innsbruck, Austria
| | - Thomas Feichtenschlager
- Department of Internal Medicine IV, Rudolfstiftung Hospital, Juchgasse 25, 1030, Vienna, Austria
| | - Gerald Eckhardt
- Department of Internal Medicine, Oberpullendorf Hospital, Spitalstraße 32, 7350, Oberpullendorf, Austria
| | - Andreas Mayer
- Department of Internal Medicine II, Universitätsklinikum St. Pölten, Dunant-Platz 1, 3100, St. Pölten, Austria
| | - Andreas Kirchgatterer
- Department of Internal Medicine V, Wels-Grieskirchen Hospital, Wagnleithnerstraße 27, 4710, Grieskirchen, Austria
| | - Othmar Ludwiczek
- Department of Internal Medicine, Hall in Tirol Hospital, Milserstraße 10, 6060, Hall in Tirol, Austria
| | - Reingard Platzer
- Department of Internal Medicine I, Wiener Neustadt Hospital, Corvinusring 3-5, 2700, Wiener Neustadt, Austria
| | - Pavol Papay
- Department of Internal Medicine, Franziskus Hospital, Nikolsdorfergasse 32, 1050, Vienna, Austria
| | - Johanna Gartner
- Department of Internal Medicine, Hanusch Hospital, Heinrich-Collin-Straße 30, 1140, Vienna, Austria
| | - Harry Fuchssteiner
- Department of Internal Medicine IV, Elisabethinen Hospital, Fadingerstraße 1, 4020, Linz, Austria
| | - Wolfgang Miehsler
- Department of Internal Medicine, Brothers of St. John of God Hospital, Kajetanerplatz 1, 5010, Salzburg, Austria
| | - Paul-Gerhard Peters
- Department of Internal Medicine, Feldkirch Hospital, Carinagasse 47, 6800, Feldkirch, Austria
| | - Gerhard Reicht
- Department of Internal Medicine II, Brothers of St. John of God Hospital, Marschallgasse 12, 8020, Graz, Austria
| | - Harald Vogelsang
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Clemens Dejaco
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Thomas Waldhör
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
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Abstract
With regard to complex structure of tissues, laser capture microdissection represents an important step in analytical workflow streaming to proper molecular characterization of different cell types in examined samples. Therefore the simple method for simultaneous processing of higher numbers of microdissected tissues leading not only to rapid and efficient DNA isolation but allowing also the repeated sampling and easy storage may be useful in the practice of histopathological laboratories. We elaborated such a methodology applicable downstream after the microdissection from formalin-fixed paraffin embedded tissues.The tissues for examination are microdissected directly into the circular areas having the diameter 2 mm and marked on the microscopic slide. In this way, one slide is able to accommodate multiple samples. The DNA extraction is performed in low volume of buffer with Proteinase K in a droplet covered by mineral oil just on the slide. Mineral oil in the quality for molecular biology not only avoids evaporation during DNA extraction, but it helps to position the microdisssected tissue, to control the level of cell lysis microscopically and to protect the DNA sample during subsequent manipulations. We provided the evidence that DNA isolated by our methodology remains in the positions on microscopic slide for months without any changes in the lengths of available fragments and that it may be removed from each position repetitively for different kinds of analysis. The new methodological approach presented by us can be practically applied in broad spectrum of laboratories performing routinely genetic analysis on microdissected tissues.
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Korabecna M, Geryk J, Hora M, Steiner P, Seda O, Tesar V. Genome-wide methylation analysis of tubulocystic and papillary renal cell carcinomas. Neoplasma 2019; 63:402-10. [PMID: 26925785 DOI: 10.4149/309_151102n559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tubulocystic renal cell carcinoma (TRCC) represents a rare tumor with incidence lower than 1 % of all renal carcinomas. This study was undertaken to contribute to characterization of molecular signatures associated with TRCC and to compare them with the features of papillary renal cell carcinoma (PRCC) at the level of genome wide methylation analysis.We performed methylated DNA immunoprecipitation (MeDIP) coupled with microarray analysis (Roche NimbleGen). Using the CHARM package, we compared the levels of gene methylation between paired samples of tumors and control renal tissues of each examined individual. We found significant global demethylation in all tumor samples in comparison with adjacent kidney tissues of normal histological appearance but no significant differences in gene methylation between the both compared tumor entities. Therefore we focused on characterization of differentially methylated regions between both tumors and control tissues. We found 42 differentially methylated genes.Hypermethylated genes for protocadherins (PCDHG) and genes coding for products associated with functions of plasma membrane were evaluated as significantly overrepresented among hypermethylated genes detected in both types of renal cell carcinomas.In our pilot study, we provide the first evidence that identical features in the process of carcinogenesis leading to TRCC and/or to PRCC may be found at the gene methylation level.
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Sohn M, Iesalnieks I, Agha A, Steiner P, Hochrein A, Pratschke J, Ritschl P, Aigner F. Perforated Diverticulitis with Generalized Peritonitis: Low Stoma Rate Using a "Damage Control Strategy". World J Surg 2018. [PMID: 29541823 DOI: 10.1007/s00268-018-4585-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Optimal surgical management of perforated diverticulitis of the sigmoid colon has yet to be clearly defined. The purpose of this study was to evaluate efficacy of a "Damage Control Strategy" (DCS). MATERIALS AND METHODS Patients with perforated diverticulitis of the sigmoid colon complicated by generalized peritonitis (Hinchey III and IV) surgically treated according to a damage control strategy between May 2011 and February 2017 were enrolled in the present multicenter retrospective cohort study. Data were collected at three surgical centers. DCS comprises a two-stage concept: [1] limited resection of the perforated colon segment with oral and aboral blind closure during the emergency procedure and [2] definitive reconstruction at scheduled second laparotomy (anastomosis ∓ loop ileostomy or a Hartmann's procedure) after 24-48 h. RESULTS Fifty-eight patients were included into the analysis [W:M 28:30, median age 70.1 years (30-92)]. Eleven patients (19%) initially presented with fecal peritonitis (Hinchey IV) and 47 patients with purulent peritonitis (Hinchey III). An anastomosis could be created during the second procedure in 48 patients (83%), 14 of those received an additional loop ileostomy. In the remaining ten patients (n = 17%), an end colostomy was created at second laparotomy. A fecal diversion was performed in five patients to treat anastomotic complications. Thus, altogether, 29 patients (50%) had stoma at the end of the hospital stay. The postoperative mortality was 9% (n = 5), and median postoperative hospital stay was 18.5 days (3-66). At the end of the follow-up, 44 of 53 surviving patients were stoma free (83%). CONCLUSION The use of the Damage Control strategy leads to a comparatively low stoma rate in patients suffering from perforated diverticulitis with generalized peritonitis.
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Affiliation(s)
- Maximilian Sohn
- Klinik für Allgemein-, Viszeral-, Endokrine- und minimalinvasive Chirurgie, Klinikum Bogenhausen, Städtisches Klinikum München GmbH, Englschalkinger Strasse 77, 81925, Munich, Germany.
| | - I Iesalnieks
- Klinik für Allgemein-, Viszeral-, Endokrine- und minimalinvasive Chirurgie, Klinikum Bogenhausen, Städtisches Klinikum München GmbH, Englschalkinger Strasse 77, 81925, Munich, Germany
| | - A Agha
- Klinik für Allgemein-, Viszeral-, Endokrine- und minimalinvasive Chirurgie, Klinikum Bogenhausen, Städtisches Klinikum München GmbH, Englschalkinger Strasse 77, 81925, Munich, Germany
| | - P Steiner
- Klinik für Allgemein, Viszeral- und Gefäßchirurgie-, Klinikum Harlaching, Städtisches Klinikum München GmbH, Munich, Germany
| | | | - J Pratschke
- Chirurgische Klinik, Charité - Universitätsmedizin Berlin, Campus Charité Mitte|Campus Virchow-Klinikum, Berlin, Germany
| | - P Ritschl
- Chirurgische Klinik, Charité - Universitätsmedizin Berlin, Campus Charité Mitte|Campus Virchow-Klinikum, Berlin, Germany
| | - F Aigner
- Chirurgische Klinik, Charité - Universitätsmedizin Berlin, Campus Charité Mitte|Campus Virchow-Klinikum, Berlin, Germany
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Kohli K, Corns R, Vinnakota K, Steiner P, Elith C, Schellenberg D, Kwan W, Karvat A. A bioimpedance analysis of head-and-neck cancer patients undergoing radiotherapy. ACTA ACUST UNITED AC 2018; 25:e193-e199. [PMID: 29962845 DOI: 10.3747/co.25.3920] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Malnutrition is a frequent manifestation in patients with head-and-neck cancer undergoing radiation therapy and a major contributor to morbidity and mortality. Thus, body composition is an important component of an overall evaluation of nutrition in cancer patients. Malnutrition is characterized by weight loss, loss of muscle mass, changes in cell membrane integrity, and alterations in fluid balance. Bioelectrical impedance analysis is a method to analyze body composition and includes parameters such as intracellular water content, extracellular water content, and cell membrane integrity in the form of a phase angle (Φ). Bioelectrical impedance analysis has consistently been shown to have prognostic value with respect to mortality and morbidity in patients undergoing chemotherapy. The goal of the present study was to evaluate the relationship between Φ, time, intracellular water content, and weight for head-and-neck cancer patients undergoing radiotherapy. The results demonstrate that Φ decreases with time and increases with intracellular water content and weight.
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Affiliation(s)
- K Kohli
- BC Cancer-Fraser Valley Centre, Surrey, BC
| | - R Corns
- Brody School of Medicine, East Carolina University, Greenville, North Carolina, U.S.A
| | - K Vinnakota
- University College Dublin, School of Medicine and Medical Science, Dublin, Ireland
| | - P Steiner
- BC Cancer-Fraser Valley Centre, Surrey, BC
| | - C Elith
- BC Cancer-Fraser Valley Centre, Surrey, BC
| | | | - W Kwan
- BC Cancer-Fraser Valley Centre, Surrey, BC
| | - A Karvat
- BC Cancer-Fraser Valley Centre, Surrey, BC
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Miehsler W, Dejaco C, Gröchenig HP, Fuchssteiner H, Högenauer C, Kazemi-Shirazi L, Maier H, Mayer A, Moschen A, Reinisch W, Petritsch W, Platzer R, Steiner P, Tilg H, Vogelsang H, Wenzl H, Novacek G. [Second Austrian consensus on the safe use of anti-TNFα-antibodies in patients with inflammatory bowel diseases]. Z Gastroenterol 2018. [PMID: 29529682 DOI: 10.1055/s-0044-100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Anti-TNFα-antibodies have revolutionized the therapy of inflammatory bowel diseases and other immune-mediated inflammatory diseases. Due to the increasing application of these substances, the Working Group of Inflammatory Bowel Diseases of the Austrian Association of Gastroenterology and Hepatology intended to update their consensus report on the safe use of Infliximab (published in 2010) and to enlarge its scope to cover all anti-TNFα-antibodies. The present consensus report summarizes the current evidence on the safe use of anti-TNFα-antibodies and covers the following topics: general risk of infection, bacterial infections (i. e., Clostridium difficile, Tuberculosis, food hygiene), Pneumocystis jiroveci, viral infections (i. e., Hepatitis B, Hepatitis C, HIV, CMV, VZV), vaccination in general and recommendation for vaccines, gastrointestinal aspects (i. e., perianal fistula, abdominal fistula, intestinal strictures, stenosis and bowel obstruction), dermatologic aspects (skin malignancies, eczema-like drug-related skin eruption), infusion reactions and immunogenicity, demyelinating diseases, hepatotoxicity, haematotoxicity, congestive heart failure, risk and history of malignancies, and pregnancy and breast feeding. For practical reasons, the relevant aspects are summarized in a checklist which is divided into two parts: issues to be addressed before therapy and issues to be addressed during therapy.
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Affiliation(s)
- Wolfgang Miehsler
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg
| | - Clemens Dejaco
- Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien
| | - Hans-Peter Gröchenig
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder St.Veit, St.Veit a. d. Glan
| | | | - Christoph Högenauer
- Universitätsklinik für Innere Medizin, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz, Graz
| | - Lili Kazemi-Shirazi
- Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien
| | - Harald Maier
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien
| | - Andreas Mayer
- Klinische Abteilung für Innere Medizin 2, Universitätsklinikum St. Pölten, St. Pölten
| | - Alexander Moschen
- Universitätsklinik für Innere Medizin 1, Medizinische Universität Innsbruck, Innsbruck
| | - Walter Reinisch
- Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien
| | - Wolfgang Petritsch
- Universitätsklinik für Innere Medizin, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz, Graz
| | - Reingard Platzer
- Abteilung für Innere Medizin 1, Landesklinikum Wiener Neustadt, Wiener Neustadt
| | - Pius Steiner
- Abteilung für Innere Medizin 1, Klinikum Wels-Grieskirchen, Wels
| | - Herbert Tilg
- Universitätsklinik für Innere Medizin 1, Medizinische Universität Innsbruck, Innsbruck
| | - Harald Vogelsang
- Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien
| | - Heimo Wenzl
- Universitätsklinik für Innere Medizin, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz, Graz
| | - Gottfried Novacek
- Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien
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Pecnik P, Ranftl V, Steiner P. Image of the month: Rolling stones. Clin Med (Lond) 2017; 17:475-476. [PMID: 28974604 PMCID: PMC6301933 DOI: 10.7861/clinmedicine.17-5-475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Bilgilier C, Stadlmann A, Makristathis A, Thannesberger J, Kastner MT, Knoflach P, Steiner P, Schöniger-Hekele M, Högenauer C, Blesl A, Datz C, Huber-Schönauer U, Schöfl R, Wewalka F, Püspök A, Mitrovits N, Leiner J, Tilg H, Effenberger M, Moser M, Siebert F, Hinterberger I, Wurzer H, Stupnicki T, Watzinger N, Gombotz G, Hubmann R, Klimpel S, Biowski-Frotz S, Schrutka-Kölbl C, Graziadei I, Ludwiczek O, Kundi M, Hirschl AM, Steininger C. Prospective multicentre clinical study on inter- and intrapatient genetic variability for antimicrobial resistance of Helicobacter pylori. Clin Microbiol Infect 2017; 24:267-272. [PMID: 28669844 DOI: 10.1016/j.cmi.2017.06.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We report on a large prospective, multicentre clinical investigation on inter- and intrapatient genetic variability for antimicrobial resistance of Helicobacter pylori. METHODS Therapy-naive patients (n = 2004) who had undergone routine diagnostic gastroscopy were prospectively included from all geographic regions of Austria. Gastric biopsy samples were collected separately from antrum and corpus. Samples were analysed by histopathology and real-time PCR for genotypic resistance to clarithromycin and quinolones. Clinical and demographic information was analysed in relation to resistance patterns. RESULTS H. pylori infection was detected in 514 (26%) of 2004 patients by histopathology and confirmed in 465 (90%) of 514 patients by real-time PCR. PCR results were discordant for antrum and corpus in 27 (5%) of 514 patients, indicating inhomogeneous infections. Clarithromycin resistance rates were 17% (77/448) and 19% (84/455), and quinolone resistance rates were 12% (37/310) and 10% (32/334) in antrum and corpus samples, respectively. Combination of test results per patient yielded resistance rates of 21% (98/465) and 13% (50/383) for clarithromycin and quinolones, respectively. Overall, infection with both sensitive and resistant H. pylori was detected in 65 (14%) of 465 patients. CONCLUSIONS Anatomically inhomogeneous infection with different, multiple H. pylori strains is common. Prospective clinical study design, collection of samples from multiple sites and microbiologic methods that allow the detection of coinfections are mandatory for collection of reliable data on antimicrobial resistance patterns in representative patient populations. (ClinicalTrials.gov identifier: NCT02925091).
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Affiliation(s)
- C Bilgilier
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Austria
| | - A Stadlmann
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Austria
| | - A Makristathis
- Department of Laboratory Medicine, Division of Clinical Microbiology, Austria
| | - J Thannesberger
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Austria
| | - M-T Kastner
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Austria
| | - P Knoflach
- Department of Internal Medicine I, Klinikum Wels-Grieskirchen, Wels, Austria
| | - P Steiner
- Department of Internal Medicine I, Klinikum Wels-Grieskirchen, Wels, Austria
| | - M Schöniger-Hekele
- Department of Medicine III, Division of Gastroenterology and Hepatology, Austria
| | - C Högenauer
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Austria
| | - A Blesl
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Austria
| | - C Datz
- Department of Internal Medicine, Hospital Oberndorf, Teaching Hospital of the Paracelsus Private Medical University Salzburg, Oberndorf bei Salzburg, Austria
| | - U Huber-Schönauer
- Department of Internal Medicine, Hospital Oberndorf, Teaching Hospital of the Paracelsus Private Medical University Salzburg, Oberndorf bei Salzburg, Austria
| | - R Schöfl
- Department of Internal Medicine IV, Division of Gastroenterology and Hepatology, Ordensklinikum Linz, Elisabethinen, Austria
| | - F Wewalka
- Department of Internal Medicine IV, Division of Gastroenterology and Hepatology, Ordensklinikum Linz, Elisabethinen, Austria
| | - A Püspök
- Department of Internal Medicine II, Hospital of the Brothers of Saint John of God Eisenstadt, Eisenstadt, Austria
| | - N Mitrovits
- Department of Internal Medicine II, Hospital of the Brothers of Saint John of God Eisenstadt, Eisenstadt, Austria
| | - J Leiner
- Department of Internal Medicine, Ladislaus Batthyány-Strattmann Hospital Kittsee, Kittsee, Austria
| | - H Tilg
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - M Effenberger
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - M Moser
- Ordination Dr Moser, Hall/Tyrol, Austria
| | - F Siebert
- Department of Internal Medicine, Hospital of the Brothers of Saint John of God St Veit/Glan, St Veit, Austria
| | - I Hinterberger
- Department of Internal Medicine, Hospital of the Brothers of Saint John of God St Veit/Glan, St Veit, Austria
| | - H Wurzer
- Department of Internal Medicine, LKH Graz South-West, Graz, Austria
| | - T Stupnicki
- Department of Internal Medicine, LKH Graz South-West, Graz, Austria
| | - N Watzinger
- Department of Internal Medicine, Hospital Group Feldbach-Fürstenfeld, Feldbach, Austria
| | - G Gombotz
- Department of Internal Medicine, Hospital Group Feldbach-Fürstenfeld, Feldbach, Austria
| | - R Hubmann
- Ordination Dr Rainer Hubmann, Linz, Austria
| | - S Klimpel
- Ordination Dr Siegfried Klimpel, Traun, Austria
| | | | | | - I Graziadei
- Department of Internal Medicine, Academic Teaching Hospital, Hall/Tyrol, Austria
| | - O Ludwiczek
- Department of Internal Medicine, Academic Teaching Hospital, Hall/Tyrol, Austria
| | - M Kundi
- Department of Environmental Health, Center for Public Health, Medical University of Vienna, Austria
| | - A M Hirschl
- Department of Laboratory Medicine, Division of Clinical Microbiology, Austria
| | - C Steininger
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Austria.
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Armbruster W, Kubulus D, Schlechtriemen T, Adler J, Höhn M, Schmidt D, Duchêne S, Steiner P, Volk T, Wrobel M. [Improvement of emergency physician education through simulator training. Consideration on the basis of the model project "NASimSaar25"]. Anaesthesist 2015; 63:691-6. [PMID: 25056410 DOI: 10.1007/s00101-014-2353-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prehospital emergency medicine is a challenge for trainee emergency physicians. Rare injuries and diseases as well as patients in extreme age groups can unexpectedly face emergency physicians. In the regulations on medical education the German Medical Association requires participation in 50 emergency missions under the supervision of an experienced emergency physician. This needs to be improved because on-the-job training does not generally represent the whole spectrum of emergency medicine and a good and structured training under on call conditions is nearly impossible. AIM The subject of the model project described was whether practical training for emergency physicians can be achieved by participation in simulation training instead of real emergency situations. MATERIAL AND METHODS After modification of the Saarland regulations on medical education it was possible to replace up to 25 participations in emergency missions by simulation training. The concept of the course NASimSaar25 requires participants to complete 25 simulator cases in 3 days in small training groups. Emergency situations from all medical disciplines need to be treated. A special focus is on the treatment of life-threatening and rare diseases and injuries. Modern simulators and actors are used. The debriefings are conducted by experienced tutors based on approved principles. Medical contents, learning targets from the field of crew resource management (CRM) and soft skills are discussed in these debriefings. RESULTS Education in the field of emergency medicine can be improved by simulator-based learning and training. However, practical work under a tutor in real and clinical experience cannot be completely replaced by simulation. Simulator training can only be successful if theoretical knowledge has already been acquired. CONCLUSION A simulator-based course concept can result in an improvement of emergency medical education. The model project NASimSaar25 was well received by the target audience and mostly very well evaluated in terms of learning and reality. If this project becomes established the demand on simulation-based training will increase. The training should achieve a consistent standard of quality.
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Affiliation(s)
- W Armbruster
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikums des Saarlandes, Gebäude 57, Kirrberger Str., 66421, Homburg/Saar, Deutschland,
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Sohn M, Schmid R, Schepp W, Steiner P. [Left-sided infradiaphragmatic lesion : rare differential diagnosis in adulthood]. Chirurg 2014; 86:493-5. [PMID: 24994587 DOI: 10.1007/s00104-014-2782-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M Sohn
- Klinik für Viszeral,-Gefäß- und Thoraxchirurgie, Klinikum Bogenhausen, Städtisches Klinikum München GmbH, Engelschalkinger Str. 77, 81925, München, Deutschland,
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Reinert F, Steiner P, Engel T, Hüfner S. Low energy excitations in KMnO4 with 1 eV<=ΔE<=10 eV from electron-energy loss spectroscopy. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s002570050031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Angelberger S, Campregher C, Fuchssteiner H, Gasche C, Gröchenig HP, Haas T, Kazemi-Shirazi L, Mayer A, Miehsler W, Platzer R, Reinisch W, Steiner P, Tilg H, Tillinger W, Vogelsang H, Novacek G. [Colorectal cancer: screening and surveillance in inflammatory bowel diseases - consensus of the working group for inflammatory bowel diseases of the Austrian Society of Gastroenterology and Hepatology]. Z Gastroenterol 2013; 51:450-7. [PMID: 23681899 DOI: 10.1055/s-0033-1335252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Patients with ulcerative colitis and Crohn's colitis are at increased risk of colorectal cancer (CRC). This risk is dependent on the duration and extent of disease, inflammatory activity and possible additional risk factors. Thus, the aim is to reduce this risk and to detect dysplastic and malignant lesions at an early stage. The working group for Inflammatory Bowel Diseases (IBD) of the Austrian Society of Gastroenterology and Hepatology (ÖGGH) has developed consensus statements on the following topics: risk of colorectal cancer, screening and surveillance, procedure of surveillance colonoscopy, dysplasia and its management, and chemoprevention. This consensus is intended to increase awareness of the increased risk of CRC in IBD and to support a standardised approach in cancer prevention.
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Affiliation(s)
- S Angelberger
- Medizinische Universität Wien, Innere Medizin III, Abt. für Gastroenterologie und Hepatologie, Wien, Österreich
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Xiao Z, Rothstein R, Carrasco R, Wetzel L, Kinneer K, Chen H, Tice D, Hollingsworth R, Steiner P. Abstract P4-07-05: MEDI3379, an antibody against HER3, is active in HER2-driven human breast tumor models. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p4-07-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
HER3 (ERBB3) is a member of the EGFR/HER family of receptor tyrosine kinases (RTK), consisting of EGFR, HER2, HER3 and HER4. Unlike the other HER family members, HER3 lacks intrinsic tyrosine kinase activity and therefore needs to form heterodimers with EGFR, HER2 or other kinase-proficient RTKs to be functionally active. Dimerization is induced by overexpression of EGFR or HER2 in a ligand-independent (LI) manner. In this process HER3 acts as a driver in divergent cancer types including HER2-positive breast cancer (BC) via induction of the PI3K-AKT pathway. Alternatively, heregulin (NRG1/HRG), the major HER3 ligand, induces a conformational shift in HER3 which leads to dimer formation with a partner RTK in a ligand-dependent (LD) manner.
We have developed an antagonistic human monoclonal antibody against HER3, termed MEDI3379, and tested it in multiple breast cancer cell lines. We observed effective suppression of constitutive pHER3 and pAKT with MEDI3379, leading to anti-proliferation effects in cell culture models. Preclinical evaluation of MEDI3379 demonstrated antitumor activity in several orthotopic BC xenografts in nude mice which did not express HRG. For example, the BC xenograft model BT474 with amplified HER2 responded to MEDI3379 (65% dTGI). In conclusion, our findings with targeting of HER3 in mouse models support continued development of MEDI3379 for cancer.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-07-05.
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Affiliation(s)
- Z Xiao
- MedImmune, LLC, Gaithersburg, MD
| | | | | | - L Wetzel
- MedImmune, LLC, Gaithersburg, MD
| | | | - H Chen
- MedImmune, LLC, Gaithersburg, MD
| | - D Tice
- MedImmune, LLC, Gaithersburg, MD
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Steiner P, Kinneer K, Schifferli K, Rothstein R, Carrasco R, Tammali R, Hollingsworth R, Tice D, Xiao Z. 331 MEDI3379, an Antibody Against HER3, is Active in Heregulin or HER2-driven Human Tumor Models. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)72129-9] [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: 11/29/2022]
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Cao F, Ramaseshan R, Corns R, Harrop S, Nuraney N, Steiner P, Aldridge S, Liu M, Carolan H, Agranovich A, Karva A. Poster - Thur Eve - 57: Craniospinal irradiation with jagged-junction IMRT approach without beam edge matching for field junctions. Med Phys 2012; 39:4635. [PMID: 28516683 DOI: 10.1118/1.4740165] [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: 11/07/2022] Open
Abstract
PURPOSE Craniospinal irradiation were traditionally treated the central nervous system using two or three adjacent field sets. A intensity-modulated radiotherapy (IMRT) plan (Jagged-Junction IMRT) which overcomes problems associated with field junctions and beam edge matching, improves planning and treatment setup efficiencies with homogenous target dose distribution was developed. METHODS AND MATERIALS Jagged-Junction IMRT was retrospectively planned on three patients with prescription of 36 Gy in 20 fractions and compared to conventional treatment plans. Planning target volume (PTV) included the whole brain and spinal canal to the S3 vertebral level. The plan employed three field sets, each with a unique isocentre. One field set with seven fields treated the cranium. Two field sets treated the spine, each set using three fields. Fields from adjacent sets were overlapped and the optimization process smoothly integrated the dose inside the overlapped junction. RESULTS For the Jagged-Junction IMRT plans vs conventional technique, average homogeneity index equaled 0.08±0.01 vs 0.12±0.02, and conformity number equaled 0.79±0.01 vs 0.47±0.12. The 95% isodose surface covered (99.5±0.3)% of the PTV vs (98.1±2.0)%. Both Jagged-Junction IMRT plans and the conventional plans had good sparing of the organs at risk. CONCLUSIONS Jagged-Junction IMRT planning provided good dose homogeneity and conformity to the target while maintaining a low dose to the organs at risk. Jagged-Junction IMRT optimization smoothly distributed dose in the junction between field sets. Since there was no beam matching, this treatment technique is less likely to produce hot or cold spots at the junction in contrast to conventional techniques.
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Affiliation(s)
- F Cao
- Fraser Valley Centre, Department of Medical Physics, BC Cancer Agency, Surrey, BC, Canada
| | - R Ramaseshan
- Fraser Valley Centre, Department of Medical Physics, BC Cancer Agency, Surrey, BC, Canada
| | - R Corns
- Fraser Valley Centre, Department of Medical Physics, BC Cancer Agency, Surrey, BC, Canada
| | - S Harrop
- Fraser Valley Centre, Department of Medical Physics, BC Cancer Agency, Surrey, BC, Canada
| | - N Nuraney
- Department of Radiation Oncology, BC Cancer Agency, Surrey, BC, Canada
| | - P Steiner
- Department of Radiation Oncology, BC Cancer Agency, Surrey, BC, Canada
| | - S Aldridge
- Department of Radiation Oncology, BC Cancer Agency, Surrey, BC, Canada
| | - M Liu
- Vancouver Centre, Department of Radiation Oncology, BC Cancer Agency, Vancouver, BC, Canada
| | - H Carolan
- Vancouver Centre, Department of Radiation Oncology, BC Cancer Agency, Vancouver, BC, Canada
| | - A Agranovich
- Department of Radiation Oncology, BC Cancer Agency, Surrey, BC, Canada
| | - A Karva
- Department of Radiation Oncology, BC Cancer Agency, Surrey, BC, Canada
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Abstract
ABSTRACTIndium, tin, antimony and aluminum are deposited by an electrochemical process into the pores of n-type porous silicon which is anodized with ultraviolet light applied during formation. The presence of these metal atoms in the porous layer is checked by electron microprobe measurement. As reported previously, UV-light etched material shows red photoluminescence (630 nm) and blue electroluminescence (470 nm) without the metal treatment. After metal deposition the photoluminescence intensity decreases slightly (factor 0.5 - 0.8), whereas the spectral position remains constant. The electroluminescence efficiency is significantly enhanced by indium, aluminum and tin in the pores (factor 5 - 90). The tin and antimony treatment causes a red shift to 580 nm and 740 nm, respectively. The conductivity is slightly increased by all kinds of metals by a factor 2-5.
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Kozlowski F, Wagenseil W, Steiner P, Lang W. Stabilization of electroluminescence and photoluminescence of porous n-silicon by chemical oxidation in H2O2. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-358-677] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTWe have oxidized porous (n-)silicon samples in solutions of H202 and have found that PL can be stabilized at a high level. The PL intensity of as prepared samples (PL quantum efficiencies in the range of 5 %) degrades to about 1/3 of the initial value in some ten minutes (the exact value depends on the experimental conditions). After having treated the samples for about 30 - 45 minutes in hydrogen peroxide it can be observed that bright PL remains stable for hours. These results confirm similar experiments performed with porous silicon made from p-substrates1. While red electroluminescing samples have shown long time stability for about 100 hours2, samples with blue-green electroluminescence have a lifetime of about 20 - 40 minutes. Oxidizing electroluminescent samples as described above results in a stabilization of electroluminescence for more than 7 hours.
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Steiner P, Wetzel L, Camara M, Schifferli K, Baffa R, LaVallee T, Coats S, Jallal B, Trail P, Chang Y. 57 Glioblastoma multiforme is characterized by high incidence of PDGFRalpha expression and susceptibility to the PDGFRalphaspecific antibody MEDI-575 in mouse tumor models. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)71762-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Steiner P, Wetzel L, Schifferli K, Camara M, Baffa R, LaVallee T, Jallal B, Coats S, Trail P, Chang Y. 100 Inhibition of PDGFRalpha in tumor stroma with MEDI-575 enhances activity of carboplatin/paclitaxel and delays tumor regrowth in a NSCLC xenograft model. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)71805-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cao F, Ramaseshan R, Nuraney N, Steiner P, Liu M, Carolan H. 146 A NOVEL APPROACH FOR WHOLE SPINE IRRADIATION (WSI) USING A TWO-ISOCENTRE IMRT PLAN WITH FIELD JUNCTIONS. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72533-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Steiner P. Exstirpation des Ganglion stellatum bei Asthma bronchiale. Respiration 2009. [DOI: 10.1159/000191366] [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: 11/19/2022] Open
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Huang Z, McGregor J, Steiner P, Gladden L, Rugmini S, Jackson S. NMR Studies of coke laydown on supported V/Al2O3 catalysts. Magn Reson Imaging 2007. [DOI: 10.1016/j.mri.2007.01.050] [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: 11/15/2022]
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Wykypiel H, Kamolz T, Steiner P, Klingler A, Granderath FA, Pointner R, Wetscher GJ. Austrian experiences with redo antireflux surgery. Surg Endosc 2005; 19:1315-9. [PMID: 16206012 DOI: 10.1007/s00464-004-2208-1] [Citation(s) in RCA: 35] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Accepted: 05/10/2005] [Indexed: 12/18/2022]
Abstract
BACKGROUND From 1996, the entire number of fundoplications performed in Austria increased dramatically, favoring the laparoscopic technique. Despite good results, some patients experience failure of antireflux surgery and therefore require redo surgery if medical therapy fails to control symptoms. The aim of the study was to describe the refundoplication policy in Austria with evaluation of the postoperative results. METHODS A questionnaire was sent to all Austrian surgical departments at the beginning of 2003 with questions about redo fundoplications (number, techniques, intraoperative complications, history, migration of patients, preoperative workup, mortality, and postoperative long-term complaints). It also included questions about primary fundoplications (number, technique, postoperative symptoms). RESULTS Out of 4,504 primary fundoplications performed in Austria since 1990, 3,952 have been carried out laparoscopically. In a median of 31 months after the primary operation, 225 refundoplications have been performed, laparoscopically in the majority of patients. The Nissen and the partial posterior fundoplication were the preferred techniques. The conversion rate in these was 10.8%, mainly because of adhesions and lacerations of the spleen, the stomach, and the esophagus. The mortality rate after primary fundoplications was 0.04%, whereas the rate after refundoplications was 0.4%, all resulting from an open approach. CONCLUSION Laparoscopic refundoplications are widely accepted as a treatment option after failed primary antireflux surgery in Austria. However, the conversion rate is 6 times higher and the mortality rate is 10 times higher than for primary antireflux surgery. Therefore, redo fundoplications should be performed only in departments with large experience.
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Affiliation(s)
- H Wykypiel
- Department of General and Transplant Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Kirchgatterer A, Steiner P, Hubner D, Fritz E, Aschl G, Preisinger J, Hinterreiter M, Stadler B, Knoflach P. Colorectal cancer in geriatric patients: Endoscopic diagnosis and surgical treatment. World J Gastroenterol 2005; 11:315-8. [PMID: 15637734 PMCID: PMC4205327 DOI: 10.3748/wjg.v11.i3.315] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the prevalence of colorectal cancer in geriatric patients undergoing endoscopy and to analyze their outcome.
METHODS: All consecutive patients older than 80 years who underwent lower gastrointestinal endoscopy between January 1995 and December 2002 at our institution were included. Patients with endoscopic diagnosis of colorectal cancer were evaluated with respect to indication, localization and stage of cancer, therapeutic consequences, and survival.
RESULTS: Colorectal cancer was diagnosed in 88 patients (6% of all endoscopies, 55 women and 33 men, mean age 85.2 years). Frequent indications were lower gastrointestinal bleeding (25%), anemia (24%) or sonographic suspicion of tumor (10%). Localization of cancer was predominantly the sigmoid colon (27%), the rectum (26%), and the ascending colon (20%). Stage Dukes A was rare (1%), but Dukes D was diagnosed in 22% of cases. Curative surgery was performed in 54 patients (61.4%), in the remaining 34 patients (38.6%) surgical treatment was not feasible due to malnutrition and asthenia or cardiopulmonary comorbidity (15 patients), distant metastases (11 patients) or refusal of operation (8 patients). Patients undergoing surgery had a very low in-hospital mortality rate (2%). Operated patients had a one-year and three-year survival rate of 88% and 49%, and the survival rates for non-operated patients amounted to 46% and 13% respectively.
CONCLUSION: Nearly two-thirds of 88 geriatric patients with endoscopic diagnosis of colorectal cancer underwent successful surgery at a very low perioperative mortality rate, resulting in significantly higher survival rates. Hence, the clinical relevance of lower gastrointestinal endoscopy and oncologic surgery in geriatric patients is demonstrated.
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Affiliation(s)
- Andreas Kirchgatterer
- First Department of Medicine/Gastroenterology, General Hospital Wels, A-4600 Wels/Austria, Grieskirchnerstrasse 42, Austria.
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Zhu M, Burman WJ, Starke JR, Stambaugh JJ, Steiner P, Bulpitt AE, Ashkin D, Auclair B, Berning SE, Jelliffe RW, Jaresko GS, Peloquin CA. Pharmacokinetics of ethambutol in children and adults with tuberculosis. Int J Tuberc Lung Dis 2004; 8:1360-7. [PMID: 15581206] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
SETTING Five hospitals in the United States. OBJECTIVE To describe ethambutol pharmacokinetics in children and adults with active tuberculosis (TB). DESIGN Prospective, open-labeled study in 56 adults and 14 children with active tuberculosis who received ethambutol as part of their multidrug TB regimens. RESULTS Most serum samples were collected up to 10 h post dose and assayed using a validated gas chromatography assay with mass selective detection (GC/MS). Concentration data were analyzed using non-compartmental and population pharmacokinetic methods. Drug exposure increased with dose, but less than proportionally at doses >3000 mg. Lower than expected maximum serum concentrations (Cmax <2 microg/ml) were common in adults. Very low Cmax (<1 microg/ml) were common in children, as was delayed absorption (time to Cmax >3 h). Many Cmax were at or below typical TB minimal inhibitory concentrations. Cmax values for HIV-positive patients were 20% lower than HIV-negative patients with daily doses, but were similar with larger twice-weekly doses. CONCLUSIONS Adult TB patients often had lower than expected ethambutol serum concentrations, and most pediatric TB patients had very low ethambutol serum concentrations. Higher doses and therapeutic drug monitoring may be indicated for many of these patients.
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Affiliation(s)
- M Zhu
- Department of Medicine, National Jewish Medical and Research Center, Denver, Colorado 80206, USA
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Meijering E, Jacob M, Sarria JCF, Steiner P, Hirling H, Unser M. Design and validation of a tool for neurite tracing and analysis in fluorescence microscopy images. Cytometry A 2004; 58:167-76. [PMID: 15057970 DOI: 10.1002/cyto.a.20022] [Citation(s) in RCA: 1042] [Impact Index Per Article: 52.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
Abstract
BACKGROUND For the investigation of the molecular mechanisms involved in neurite outgrowth and differentiation, accurate and reproducible segmentation and quantification of neuronal processes are a prerequisite. To facilitate this task, we developed a semiautomatic neurite tracing technique. This article describes the design and validation of the technique. METHODS The technique was compared to fully manual delineation. Four observers repeatedly traced selected neurites in 20 fluorescence microscopy images of cells in culture, using both methods. Accuracy and reproducibility were determined by comparing the tracings to high-resolution reference tracings, using two error measures. Labor intensiveness was measured in numbers of mouse clicks required. The significance of the results was determined by a Student t-test and by analysis of variance. RESULTS Both methods slightly underestimated the true neurite length, but the differences were not unanimously significant. The average deviation from the true neurite centerline was a factor 2.6 smaller with the developed technique compared to fully manual tracing. Intraobserver variability in the respective measures was reduced by a factor 6.0 and 23.2. Interobserver variability was reduced by a factor 2.4 and 8.8, respectively, and labor intensiveness by a factor 3.3. CONCLUSIONS Providing similar accuracy in measuring neurite length, significantly improved accuracy in neurite centerline extraction, and significantly improved reproducibility and reduced labor intensiveness, the developed technique may replace fully manual tracing methods.
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Affiliation(s)
- E Meijering
- Department of Medical Informatics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Solanki SK, Preuss O, Haugan MP, Gandorfer A, Povel HP, Steiner P, Stucki K, Bernasconi PN, Soltau D. Solar constraints on new couplings between electromagnetism and gravity. Int J Clin Exp Med 2004. [DOI: 10.1103/physrevd.69.062001] [Citation(s) in RCA: 32] [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: 11/07/2022]
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35
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Steiner P, Sauer U. Overexpression of the ATP-dependent helicase RecG improves resistance to weak organic acids in Escherichia coli. Appl Microbiol Biotechnol 2003; 63:293-9. [PMID: 12898065 DOI: 10.1007/s00253-003-1405-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2003] [Revised: 06/18/2003] [Accepted: 06/20/2003] [Indexed: 11/25/2022]
Abstract
Increased resistance to several weak organic acids was conferred on Escherichia coli by overexpression of the ATP-dependent helicase RecG and, to a lesser extent, by overexpressing the helicase RuvAB. This property of helicases was identified by reproducible selection of recG-bearing clones from genomic libraries of the acetate-resistant species Acetobacter aceti and Staphylococcus capitis. We show that overexpression of RecG from both species, but also from E. coli, increased the maximum biomass concentration attained by E. coli cultures that were grown in the presence of various weak organic acids and uncouplers. Furthermore, overexpression of RecG from A. aceti significantly improved the maximum growth rates of E. coli under weak organic acid challenge. Based on the known role of RecG in DNA replication/repair, our data provide a first indication that weak organic acids negatively affect DNA replication and/or repair, and that these negative effects may be counteracted by helicase activity.
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Affiliation(s)
- P Steiner
- Institute of Biotechnology, ETH Zürich, 8093, Zürich, Switzerland
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Heim P, Steiner P, Schoder V, Dieckmann C, Kuhlencordt R, Adam G. Detektion von Leberläsionen mit der Gadolinium-verstärkten VIBE-Sequenz im Vergleich zur SPIO-verstärkten MRT. ROFO-FORTSCHR RONTG 2003; 175:1376-83. [PMID: 14556107 DOI: 10.1055/s-2003-42891] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Detection of malignant liver lesions with gadolinium-enhanced volumetric interpolated breath-hold examination (VIBE) in comparison with SPIO-enhanced MRT (four different SPIO-enhanced T2w sequences) and histological and imaging follow-up in non-cirrhotic livers at 1.5 T. PATIENTS AND METHODS Twenty-two patients with suspected focal liver lesions prospectively underwent a gadolinium-enhanced 3D VIBE. Four T2w sequences (HASTE sequence, fast spin-echo-sequence with and without fat-saturation, FLASH 2D gradient echo-sequence) after administration of superparamagnetic iron oxide (SPIO) served as gold standard combined with histological work-up in 17 patients and histological and imaging follow-up in five patients. The image quality was evaluated and the detectability of intrahepatic lesions was rated by the alternative free-response receiver operating characteristic (AFROC) analysis. In addition, the contrast-to-noise ratio was compared. RESULTS Altogether 49 malignant and 35 benign liver lesions were found. Concerning the image quality, VIBE turned out to be of slightly poorer image quality than the SPIO-enhanced examination with HASTE sequence (4.95 vs. 5.0). The fast spin-echo-sequence without fat-saturation demonstrated the highest contrast-to-noise ratio. All sequences showed a comparable certainty in detecting lesion (area under the curve 0.68-0.73) and identifying malignant liver lesions. CONCLUSION Despite the small number of patients, VIBE seems to be a comparable, inexpensive and fast method in diagnosing malignant liver lesions.
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Affiliation(s)
- P Heim
- Radiologisches Zentrum, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Hamburg-Eppendorf.
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Stadlmann S, Moser PL, Pollheimer J, Steiner P, Krugmann J, Dirnhofer S, Mikuz G, Margreiter R, Amberger A. Heparanase-1 gene expression in normal, hyperplastic and neoplastic prostatic tissue. Eur J Cancer 2003; 39:2229-33. [PMID: 14522383 DOI: 10.1016/s0959-8049(03)00457-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Heparanase-1 (Hpa-1) has been implicated in tumour invasion and metastasis. In the present study, we evaluated the clinicopathological significance of Hpa-1 mRNA expression in prostate cancer and non-cancerous prostatic tissue by one-step polymerase chain reaction (PCR) of laser microdissected prostatic gland cells. In addition, cell type-specific expression of Hpa-1 mRNA in prostatic tissue was analysed by in situ hybridisation. Hpa-1 mRNA expression was found in 50% of normal and 40% of hyperplastic prostatic tissue. In situ hybridisation showed that Hpa-1 mRNA was strongly expressed in prostate gland cells. Of the 26 prostate carcinomas tested, 42% were positive for Hpa-1 mRNA. However, in non-cancerous prostatic tissue, Hpa-1 mRNA was significantly more often expressed than in less differentiated or more invasive prostate cancers (P<0.05). In situ hybridisation revealed only focal Hpa-1 mRNA expression in the neoplastic gland cells. Hpa-1 mRNA expression in the tumours significantly correlated with tumour differentiation and tumour stage (P<0.05). Our data indicate that Hpa-1 gene expression may be lost during dedifferentiation of prostatic gland cells.
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Affiliation(s)
- S Stadlmann
- Institute of Pathology, University of Innsbruck, Muellerstrasse 44, 6020 Innsbruck, Austria.
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Yersin A, Hirling H, Steiner P, Magnin S, Regazzi R, Hüni B, Huguenot P, De los Rios P, Dietler G, Catsicas S, Kasas S. Interactions between synaptic vesicle fusion proteins explored by atomic force microscopy. Proc Natl Acad Sci U S A 2003; 100:8736-41. [PMID: 12853568 PMCID: PMC166382 DOI: 10.1073/pnas.1533137100] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [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: 01/22/2003] [Indexed: 11/18/2022] Open
Abstract
Measuring the biophysical properties of macromolecular complexes at work is a major challenge of modern biology. The protein complex composed of vesicle-associated membrane protein 2, synaptosomal-associated protein of 25 kDa, and syntaxin 1 [soluble N-ethyl-maleimide-sensitive factor attachment protein receptor (SNARE) complex] is essential for docking and fusion of neurotransmitter-filled synaptic vesicles with the presynaptic membrane. To better understand the fusion mechanisms, we reconstituted the synaptic SNARE complex in the imaging chamber of an atomic force microscope and measured the interaction forces between its components. Each protein was tested against the two others, taken either individually or as binary complexes. This approach allowed us to determine specific interaction forces and dissociation kinetics of the SNAREs and led us to propose a sequence of interactions. A theoretical model based on our measurements suggests that a minimum of four complexes is probably necessary for fusion to occur. We also showed that the regulatory protein neuronal Sec1 injected into the atomic force microscope chamber prevented the complex formation. Finally, we measured the effect of tetanus toxin protease on the SNARE complex and its activity by on-line registration during tetanus toxin injection. These experiments provide a basis for the functional study of protein microdomains and also suggest opportunities for sensitive screening of drugs that can modulate protein-protein interactions.
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Affiliation(s)
- A Yersin
- Laboratoire de Neurobiologie Cellulaire, Faculté des Sciences de la Vie, Ecole Polytechnique Fédérale de Lausanne, CH-1015 Lausanne, Switzerland.
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Steiner E, Bermoser K, Steiner P. Technique of mobilization and mesh fixation in laparoscopic hernia repair by transabdominal preperitoneal mesh prosthesis. Dig Surg 2003; 19:500-1. [PMID: 12499744 DOI: 10.1159/000067604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
In laparoscopic inguinal hernia repair the preparation technique is very important to avoid recurrences. A standardized dissection, mesh placement and fixation with staplers provides safe closure of every inguinal and femoral hernia.
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Affiliation(s)
- E Steiner
- Department of General Surgery, Bezirkskrankenhaus Hall in Tirol, Milserstrasse 10, A-6060 Hall in Tirol, Austria.
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Stork A, Lund GK, Bansmann M, Kemper J, Weiss F, Steiner P, Meinertz T, Adam G. [Comparison of an edema-sensitive HASTE-TIRM sequence with delayed contrast enhancement in acute myocardial infarcts]. ROFO-FORTSCHR RONTG 2003; 175:194-8. [PMID: 12584618 DOI: 10.1055/s-2003-37225] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
GOAL Comparison between a fluid-sensitive (HASTE-TIRM)-sequence and delayed contrast-enhancement in patients with acute myocardial infarct (AMI) in MRI. MATERIAL AND METHODS 32 patients with AMI were imaged 7 +/- 4 days after the time of infarction with a 1.5 T unit using a T2 HASTE-TIRM and a contrast-enhanced (CE) T1 turbo FLASH sequence. A threshold method (>2 SD in comparison with normal myocardium) was used to quantify the hyperintense zones in both sequences. The transmurality of the hyperintense regions was measured on a segmental basis. RESULTS The hyperintense areas were larger on the HASTE-TIRM sequence with 29.6 +/- 13.2 % of the left ventricular (LV) area as compared to the CE-MRI with 19.2 +/- 10 % of the LV area (p < 0.0001). The measured transmurality was higher with the HASTE-TIRM sequence than with the CE-MRI (p < 0.0001). While the correlation between CE-MRI and peak creatine kinase (CK max) was good (r = 0.59, p < 0.001), no correlation was found between the HASTE-TIRM sequence and CK max (r = 0.29, p = ns). CONCLUSIONS The peri-infarct edema can be depicted with a HASTE-TIRM sequence in addition to the non-viable infarct zone. The HASTE-TIRM sequence shows a higher transmurality of the hyperintense regions than the CE-MRI. The additional area depicted by the HASTE-TIRM sequence could represent functionally impaired but viable myocardium).
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Affiliation(s)
- A Stork
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Eppendorff, Hamburg.
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Adam G, Lorenzen J, Krupski G, Schackmann R, Steiner P, Reuter H, Paschen U. [Establishing a quality management system according to DIN EN ISO 9001:2000 in an academic radiological department]. ROFO-FORTSCHR RONTG 2003; 175:176-82. [PMID: 12584615 DOI: 10.1055/s-2003-37235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Establishing a quality management (QM) system according the guidelines of DIN EN ISO 9001:2000 in an academic radiological department. MATERIALS AND METHODS To fulfill the requirements of an academic radiological department a quality management system according the guidelines of DIN EN ISO 9001 : 2000 has been established within one year. All important educational, research and patient care issues have been discussed in plenary sessions of all employees of the department twice a week. All core processes of the department have been documented as process instructions and standard operation procedures. RESULTS Supported by the staff unit "quality assurance" of the university hospital, the QM system has been established during one year. Assisted by all parties of the department, obliging regulations have been established which are well accepted in the daily routine clinical work but also in research and education. The implementation of the QM system caused an additional work load. However, spreading the work load by a consequent responsibility assignment, it could be reduced effectively. CONCLUSION The implementation of a QM system within the daily routine work of an academic radiological department is feasible. It allows the installation of generally accepted rules which regulate the principal tasks of research and education, and patient care.
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Affiliation(s)
- G Adam
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Hamburg-Eppendorf.
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Abstract
The soluble N-ethylmaleimide-sensitive factor-attached protein receptor (SNARE) proteins syntaxin 1 and synaptosomal-associated protein-25 have been implicated in axonal outgrowth. Neuronal Sec1 (nSec1), also called murine unc18a (Munc18a), is a syntaxin 1-binding protein involved in the regulation of SNARE complex formation in synaptic vesicle membrane fusion. Here we analysed whether nSec1/Munc18a is involved in neurite formation. nSec1/Munc18a expressed under the control of an inducible promoter in differentiated PC12 cells as well as in hippocampal neurons appears first in the cell body, and at later times after induction along neurites and in growth cones. It is localised to distinct tubular and punctated structures. In addition, exogenous nSec1/Munc18a inhibited regulated secretion in PC12 cells. Overexpression in PC12 cells of nSec1/Munc18a or its homologue Munc18b, reduced the total length of neurites. This effect was enhanced with nSec1-T574A, a mutant that lacks a cyclin-dependent kinase 5 phosphorylation site and displays an increased binding to syntaxin 1. In contrast, in hippocampal neurons the total length of all primary neurites and branches was increased upon transfection of nSec1/Munc18a. Detailed morphometric analysis revealed that this was a consequence of an increased number of axonal side branches, while the average lengths in primary neurites and of side branches were not affected. From these results we suggest that nSec1/Munc18a is involved in the regulation of SNARE complex-dependent membrane fusion events implicated in the ramification of axonal processes in neurons.
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Affiliation(s)
- P Steiner
- Faculté des Sciences de la Vie, Ecole Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland
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Abstract
As a typical product of microbial metabolism, the weak acid acetate is well known for its cytotoxic effects. In contrast to most other microbes, the so-called acetic acid bacteria can acquire significant resistance to high acetate concentrations when properly adapted to such hostile conditions. To characterize the molecular events that are associated with this adaptation, we analyzed global protein expression levels during adaptation of Acetobacter aceti by two-dimensional gel electrophoresis. Adaptation was achieved by using serial batch and continuous cultivations with increasing acetate supplementation. Computer-aided analysis revealed a complex proteome response with at least 50 proteins that are specifically induced by adaptation to acetate but not by other stress conditions, such as heat or oxidative or osmotic stress. Of these proteins, 19 were significantly induced in serial batch and continuous cultures and were thus noted as acetate adaptation proteins (Aaps). Here we present first microsequence information on such Aaps from A. aceti. Membrane-associated processes appear to be of major importance for adaptation, because some of the Aap bear N-terminal sequence homology to membrane proteins and 11 of about 40 resolved proteins from membrane protein-enriched fractions are significantly induced.
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Affiliation(s)
- P Steiner
- Institute of Biotechnology, ETH Zürich, Switzerland
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Weber C, Steiner P, Baldus S, Pourtehrani PY, Adam G. [MRI first-pass myocardial perfusion in patients undergoing percutaneous myocardial laser revascularization]. ROFO-FORTSCHR RONTG 2001; 173:329-35. [PMID: 11367842 DOI: 10.1055/s-2001-12460] [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] [Indexed: 10/17/2022]
Abstract
PURPOSE Evaluation of MRI first-pass myocardial perfusion pre- and post-percutaneous myocardial laser revascularisation (PMR). PATIENTS AND METHODS MRI was performed in 10 patients with coronary heart disease grade III-IV, 1-4 days prior to PMR, as well as 1-5 days and 6 months after PMR. Contrast enhanced (0.1 ml/kgBw; 4 ml/s) "first-pass" MRI imaging was obtained by breath-hold, ECG-triggered, multislice Turbo-FLASH GRE. For quantitative analysis the absolute and percentual signal-to-noise (S/N)-measurements were calculated. Positron emission tomography (PET) was regarded as the gold standard for myocardial perfusion. RESULTS The mean values of absolute and % S/N increase revealed no statistical difference between pre- and immediately post-PMR imaging. 6 months following PMR both values were significantly elevated (14.1 vs. 24.4 and 127 vs. 176; p = 0.03 and p = 0.01). However, the non-treated myocardial segments revealed a similar S/N pattern. Intraindividual analysis showed a significant S/N increase post PMR in one patient, and in additional 4 patients 6 months later. PET revealed increased myocardial perfusion in only two patients. Following PMR 5/10 patients experienced a significant reduction of chest pain equivalent to two CCS grades. Two of these had significant S/N elevations but no evidence of increased perfusion by PET. CONCLUSION S/N first-pass calculations following PMR do not correlate well with the true situation of myocardial perfusion. They seem to be more closely associated with other histological phenomena and possible explanations for the improved clinical symptomatology.
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Affiliation(s)
- C Weber
- Radiologische Klinik und Poliklinik, Abteilung für Röntgendiagnostik, Universitätsklinikum Hamburg Eppendorf.
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Weiss F, Habermann CR, Welger J, Knaape A, Metternich F, Steiner P, Rozeh B, Schoder V, Bücheler E. MRT in der präoperativen Diagnostik der chronischen Sinusitis im Vergleich mit der CT. ROFO-FORTSCHR RONTG 2001; 173:319-24. [PMID: 11367840 DOI: 10.1055/s-2001-12458] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE To determine the value of MRI in the preoperative evaluation of chronic paranasal sinusitis and to compare the results with CT and intraoperative findings. METHOD/MATERIALS 42 patients with clinical signs of chronic paranasal sinusitis underwent MRI after CT evaluation on one day, with subsequent functional endoscopic sinus surgery on the next day. Coronary CT was obtained with 5-mm slices and table-feed in the prone position, while MRI was performed in the supine position with coronary T2-TSE + pd and coronary and transverse HASTE, each with 5-mm slice thickness. Aquisition time in MRI was less than 8 minutes. Two radiologists reviewed the CT and MRI scans for signs of sinusitis and detection of anatomical landmarks. The results were correlated with the intraoperative findings. RESULTS MRI offered no artifacts of dental work and showed more often high quality pictures than CT. CT and MRI demonstrated a good correlation in the detection of mucosal pathologies (kappa = 0.46-0.87) and anatomic variants (kappa = 0.55-0.86). All important anatomical structures could be evaluated sufficiently with MRI for preoperative management. Both diagnostic tools showed an unsatisfactory correlation with intraoperative findings in the ethmoidal complex and maxillary sinus (tau = -0.08-0.3). CONCLUSIONS MRI is a fast and reliable alternative to preoperative CT in examining paranasal sinuses and offers a good visualization of mucosal changes. CT and MRI both give an unreliable representation of the ethmoidal complex.
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Affiliation(s)
- F Weiss
- Klinik und Poliklinik für Radiologie, Universitätsklinikum Hamburg-Eppendorf.
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Botnar RM, Steiner P, Dubno B, Erhart P, von Schulthess GK, Debatin JF. Temperature quantification using the proton frequency shift technique: In vitro and in vivo validation in an open 0.5 tesla interventional MR scanner during RF ablation. J Magn Reson Imaging 2001; 13:437-44. [PMID: 11241819 DOI: 10.1002/jmri.1063] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Open magnetic resonance (MR) scanners allow MR-guided targeting of tumors, as well as temperature monitoring of radio frequency (RF) ablation. The proton frequency shift (PFS) technique, an accurate and fast imaging method for temperature quantification, was used to synthesize thermal maps after RF ablation in an open 0.5 T MR system under ex vivo and in vivo conditions. Calibration experiments with 1.5% agarose gel yielded a chemical shift factor of 0.011 +/- 0.001 ppm/ degrees C (r2 = 0.96). Three gradient echo (GRE) pulse sequences were tested for thermal mapping by comparison with fiberoptic thermometer (Luxtron Model 760) readings. Temperature uncertainty decreased from high to low bandwidths (BW): +/-5.9 degrees C at BW = 15.6 kHz, +/-1.4 degrees C at BW = 3.9 kHz, and +/-0.8 degrees C at BW = 2.5 kHz. In vitro experiments (N = 9) in the paraspinal muscle yielded a chemical shift factor of 0.008 +/- 0.001 ppm/ degrees C. Temperature uncertainty was determined as +/-2.7 degrees C (BW = 3.9 kHz, TE = 19.3 msec). The same experiments carried out in the paraspinal muscle (N = 9) of a fully anesthetized pig resulted in a temperature uncertainty of +/-4.3 degrees C (BW = 3.9 kHz, TE = 19.3 msec), which is higher than it is in vitro conditions (P < 0.15). Quantitative temperature monitoring of RF ablation is feasible in a 0.5 T open-configured MR scanner under ex vivo and in vivo conditions using the PFS technique.
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Affiliation(s)
- R M Botnar
- Radiology Department, University Hospital Zurich, Zurich, Switzerland
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