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Lofredi R, Auernig CG, Ewert S, Irmen F, Steiner LA, Scheller U, van Wijk BCM, Oxenford S, Kühn AA, Horn A. Interrater reliability of deep brain stimulation electrode localizations. Neuroimage 2022; 262:119552. [PMID: 35981644 DOI: 10.1016/j.neuroimage.2022.119552] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/15/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022] Open
Abstract
Lead-DBS is an open-source, semi-automatized and widely applied software tool facilitating precise localization of deep brain stimulation electrodes both in native as well as in standardized stereotactic space. While automatized preprocessing steps within the toolbox have been tested and validated in previous studies, the interrater reliability in manual refinements of electrode localizations using the tool has not been objectified so far. Here, we investigate the variance introduced in this processing step by different raters when localizing electrodes based on postoperative CT or MRI. Furthermore, we compare the performance of novel trainees that received a structured training and more experienced raters with an expert user. We show that all users yield similar results with an average difference in localizations ranging between 0.52-0.75 mm with 0.07-0.12 mm increases in variability when using postoperative MRI and following normalization to standard space. Our findings may pave the way toward formal training for using Lead-DBS and demonstrate its reliability and ease-of-use for imaging research in the field of deep brain stimulation.
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Affiliation(s)
- Roxanne Lofredi
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany.
| | - Cem-Georg Auernig
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Siobhan Ewert
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Friederike Irmen
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Leon A Steiner
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Ute Scheller
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Bernadette C M van Wijk
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Simon Oxenford
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Bernstein Center for Computational Neuroscience, Humboldt-Universität, Berlin, Germany; NeuroCure, Exzellenzcluster, Charité-Universitätsmedizin Berlin, Berlin, Germany; DZNE, German center for neurodegenerative diseases, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin
| | - Andreas Horn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School; MGH Neurosurgery & Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology, Massachusetts General Hospital, Harvard Medical School
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2
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Krause P, Völzmann S, Ewert S, Kupsch A, Schneider GH, Kühn AA. Correction to: Long-term effects of bilateral pallidal deep brain stimulation in dystonia: a follow-up between 8 and 16 years. J Neurol 2021; 269:540. [PMID: 34779890 PMCID: PMC8739304 DOI: 10.1007/s00415-021-10863-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- P Krause
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - S Völzmann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - S Ewert
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - A Kupsch
- Department of Neurology and Stereotactic Neurosurgery, University Medicine of Magdeburg, Magdeburg, Germany
| | - G H Schneider
- Department of Neurosurgery, Charité, University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - Andrea A Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
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3
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Al-Fatly B, Ewert S, Kübler D, Kroneberg D, Horn A, Kühn AA. Connectivity profile of thalamic deep brain stimulation to effectively treat essential tremor. Brain 2020; 142:3086-3098. [PMID: 31377766 DOI: 10.1093/brain/awz236] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 01/19/2023] Open
Abstract
Essential tremor is the most prevalent movement disorder and is often refractory to medical treatment. Deep brain stimulation offers a therapeutic approach that can efficiently control tremor symptoms. Several deep brain stimulation targets (ventral intermediate nucleus, zona incerta, posterior subthalamic area) have been discussed for tremor treatment. Effective deep brain stimulation therapy for tremor critically involves optimal targeting to modulate the tremor network. This could potentially become more robust and precise by using state-of-the-art brain connectivity measurements. In the current study, we used two normative brain connectomes (structural and functional) to show the pattern of effective deep brain stimulation electrode connectivity in 36 patients with essential tremor. Our structural and functional connectivity models were significantly predictive of postoperative tremor improvement in out-of-sample data (P < 0.001 for both structural and functional leave-one-out cross-validation). Additionally, we segregated the somatotopic brain network based on head and hand tremor scores. These resulted in segregations that mapped onto the well-known somatotopic maps of both motor cortex and cerebellum. Crucially, this shows that slightly distinct networks need to be modulated to ameliorate head versus hand tremor and that those networks could be identified based on somatotopic zones in motor cortex and cerebellum. Finally, we propose a multi-modal connectomic deep brain stimulation sweet spot that may serve as a reference to enhance clinical care, in the future. This spot resided in the posterior subthalamic area, encroaching on the inferior borders of ventral intermediate nucleus and sensory thalamus. Our results underscore the importance of integrating brain connectivity in optimizing deep brain stimulation targeting for essential tremor.
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Affiliation(s)
- Bassam Al-Fatly
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Siobhan Ewert
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dorothee Kübler
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Kroneberg
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Horn
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Exzellenzcluster NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany
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4
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Reich MM, Horn A, Lange F, Roothans J, Paschen S, Runge J, Wodarg F, Pozzi NG, Witt K, Nickl RC, Soussand L, Ewert S, Maltese V, Wittstock M, Schneider GH, Coenen V, Mahlknecht P, Poewe W, Eisner W, Helmers AK, Matthies C, Sturm V, Isaias IU, Krauss JK, Kühn AA, Deuschl G, Volkmann J. Probabilistic mapping of the antidystonic effect of pallidal neurostimulation: a multicentre imaging study. Brain 2020; 142:1386-1398. [PMID: 30851091 DOI: 10.1093/brain/awz046] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/12/2018] [Accepted: 01/08/2019] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation of the internal globus pallidus is a highly effective and established therapy for primary generalized and cervical dystonia, but therapeutic success is compromised by a non-responder rate of up to 25%, even in carefully-selected groups. Variability in electrode placement and inappropriate stimulation settings may account for a large proportion of this outcome variability. Here, we present probabilistic mapping data on a large cohort of patients collected from several European centres to resolve the optimal stimulation volume within the pallidal region. A total of 105 dystonia patients with pallidal deep brain stimulation were enrolled and 87 datasets (43 with cervical dystonia and 44 with generalized dystonia) were included into the subsequent 'normative brain' analysis. The average improvement of dystonia motor score was 50.5 ± 30.9% in cervical and 58.2 ± 48.8% in generalized dystonia, while 19.5% of patients did not respond to treatment (<25% benefit). We defined probabilistic maps of anti-dystonic effects by aggregating individual electrode locations and volumes of tissue activated (VTA) in normative atlas space and ranking voxel-wise for outcome distribution. We found a significant relation between motor outcome and the stimulation volume, but not the electrode location per se. The highest probability of stimulation induced motor benefit was found in a small volume covering the ventroposterior globus pallidus internus and adjacent subpallidal white matter. We then used the aggregated VTA-based outcome maps to rate patient individual VTAs and trained a linear regression model to predict individual outcomes. The prediction model showed robustness between the predicted and observed clinical improvement, with an r2 of 0.294 (P < 0.0001). The predictions deviated on average by 16.9 ± 11.6 % from observed dystonia improvements. For example, if a patient improved by 65%, the model would predict an improvement between 49% and 81%. Results were validated in an independent cohort of 10 dystonia patients, where prediction and observed benefit had a correlation of r2 = 0.52 (P = 0.02) and a mean prediction error of 10.3% (±8.9). These results emphasize the potential of probabilistic outcome brain mapping in refining the optimal therapeutic volume for pallidal neurostimulation and advancing computer-assisted planning and programming of deep brain stimulation.
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Affiliation(s)
- Martin M Reich
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany.,Beth Israel Deaconess Medical Center, Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Andreas Horn
- Charite-Universitätsmedizin Berlin, Movement Disorders and Neuromodulation Unit, Department of Neurology, Germany
| | - Florian Lange
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
| | - Jonas Roothans
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
| | | | | | - Fritz Wodarg
- University Kiel, Department of Radiology, Germany
| | - Nicolo G Pozzi
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
| | - Karsten Witt
- University Kiel, Department of Neurology, Germany.,University Oldenburg, Department of Neurology, Germany
| | - Robert C Nickl
- Julius-Maximilians-University, Department of Neurosurgery, Germany
| | - Louis Soussand
- Beth Israel Deaconess Medical Center, Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Siobhan Ewert
- Charite-Universitätsmedizin Berlin, Movement Disorders and Neuromodulation Unit, Department of Neurology, Germany
| | - Virgina Maltese
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
| | | | - Gerd-Helge Schneider
- Charite-Universitätsmedizin Berlin, Movement Disorders and Neuromodulation Unit, Department of Neurology, Germany
| | - Volker Coenen
- Freiburg University Medical Center, Department of Stereotactic and Functional Neurosurgery, Germany
| | | | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Austria
| | - Wilhelm Eisner
- Department of Neurosurgery, Innsbruck Medical University, Austria
| | | | - Cordula Matthies
- Julius-Maximilians-University, Department of Neurosurgery, Germany
| | - Volker Sturm
- Julius-Maximilians-University, Department of Neurosurgery, Germany
| | - Ioannis U Isaias
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
| | | | - Andrea A Kühn
- Charite-Universitätsmedizin Berlin, Movement Disorders and Neuromodulation Unit, Department of Neurology, Germany
| | | | - Jens Volkmann
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
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5
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Krause P, Völzmann S, Ewert S, Kupsch A, Schneider GH, Kühn AA. Long-term effects of bilateral pallidal deep brain stimulation in dystonia: a follow-up between 8 and 16 years. J Neurol 2020; 267:1622-1631. [PMID: 32055996 PMCID: PMC8592956 DOI: 10.1007/s00415-020-09745-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 11/29/2022]
Abstract
Objective Observational study to evaluate the long-term motor and non-motor effects of deep brain stimulation (DBS) of the globus pallidus internus (GPi) on medically refractory dystonia. Background Dystonia is a chronic disease affecting mainly young patients with a regular life expectancy and lifelong need for therapy. Pallidal DBS is an established treatment for severe isolated dystonia but long-term data are sparse. Methods We considered 36 consecutive patients with isolated generalized (n = 14) and cervical/segmental (n = 22) dystonia operated at Charité-University Hospital between 2000 and 2007 in a retrospective analysis for long-term outcome of pallidal DBS. In 19 of these patients, we could analyze dystonic symptoms and disability rated by the Burke–Fahn–Marsden Dystonia Rating scale (BFMDRS) at baseline, short-term (ST-FU, range 3–36 months) and long-term follow-up (LT-FU, range 93–197 months). Quality of life and mood were evaluated using the SF36 and Beck Depression Index (BDI) questionnaires. Results Patients reached an improvement in motor symptoms of 63.8 ± 5.7% (mean ± SE) at ST-FU and 67.9 ± 6.1% at LT-FU. Moreover, a significant and stable reduction in disability was shown following DBS (54.2 ± 9.4% at ST-FU and 53.8 ± 9.2% at LT-FU). BDI and SF36 had improved by 40% and 23%, respectively, at LT-FU (n = 14). Stimulation-induced adverse events included swallowing difficulties, dysarthria, and bradykinesia. Pulse generator (n = 3) and electrodes (n = 5) were revised in seven patients due to infection. Conclusions Pallidal DBS is a safe and efficacious long-term treatment for dystonia with sustained effects on motor impairment and disability, accompanied by a robust improvement in mood and quality of life. Electronic supplementary material The online version of this article (10.1007/s00415-020-09745-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- P Krause
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - S Völzmann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - S Ewert
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - A Kupsch
- Department of Neurology and Stereotactic Neurosurgery, University Medicine of Magdeburg, Magdeburg, Germany
| | - G H Schneider
- Department of Neurosurgery, Charité, University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - Andrea A Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
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6
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Kroneberg D, Ewert S, Meyer AC, Kühn AA. Shorter pulse width reduces gait disturbances following deep brain stimulation for essential tremor. J Neurol Neurosurg Psychiatry 2019; 90:1046-1050. [PMID: 30765417 PMCID: PMC6820151 DOI: 10.1136/jnnp-2018-319427] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/12/2018] [Accepted: 01/04/2019] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Gait disturbances are frequent side effects occurring during chronic thalamic deep brain stimulation (DBS) in patients with essential tremor (ET). Adapting stimulation settings to shorter pulse widths has been shown to reduce side effects of subthalamic DBS. Here, we assess how a reduction of pulse width changes gait performance of affected patients. METHODS Sensor-based gait assessment was performed to record spatiotemporal gait parameters in 10 healthy subjects (HS) and 7 patients with ET with gait disturbances following thalamic DBS. Patients were tested during standard DBS, after 72 hours of stimulation withdrawal and at least 30 days after adjusting DBS settings to a shorter pulse width of 40 µs (DBS40PW). RESULTS Patients with ET on standard DBS showed significantly higher variability of several spatiotemporal gait parameters compared with HS. Variability of stride length and range of motion of the shanks significantly decreased OFF DBS as compared with standard DBS. This improvement was maintained over 30 days with DBS40PW while providing effective tremor suppression in six out of seven patients. CONCLUSION Shorter pulse widths may reduce gait disturbances in patients with ET that are induced by DBS while preserving a level of tremor suppression equal to standard stimulation settings.
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Affiliation(s)
- Daniel Kroneberg
- Charité - Universitätsmedizin Berlin, Department of Neurology, Movement Disorder and Neuromodulation Unit, Berlin, Germany
| | - Siobhan Ewert
- Charité - Universitätsmedizin Berlin, Department of Neurology, Movement Disorder and Neuromodulation Unit, Berlin, Germany
| | - Anne-Christiane Meyer
- Charité - Universitätsmedizin Berlin, Department of Neurology, Movement Disorder and Neuromodulation Unit, Berlin, Germany
| | - Andrea A Kühn
- Charité - Universitätsmedizin Berlin, Department of Neurology, Movement Disorder and Neuromodulation Unit, Berlin, Germany .,Charité - Universitätsmedizin Berlin, NeuroCure Cluster of Excellence, Berlin, Germany
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7
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Horn A, Li N, Dembek TA, Kappel A, Boulay C, Ewert S, Tietze A, Husch A, Perera T, Neumann WJ, Reisert M, Si H, Oostenveld R, Rorden C, Yeh FC, Fang Q, Herrington TM, Vorwerk J, Kühn AA. Lead-DBS v2: Towards a comprehensive pipeline for deep brain stimulation imaging. Neuroimage 2019; 184:293-316. [PMID: 30179717 PMCID: PMC6286150 DOI: 10.1016/j.neuroimage.2018.08.068] [Citation(s) in RCA: 418] [Impact Index Per Article: 83.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/13/2018] [Accepted: 08/28/2018] [Indexed: 01/09/2023] Open
Abstract
Deep brain stimulation (DBS) is a highly efficacious treatment option for movement disorders and a growing number of other indications are investigated in clinical trials. To ensure optimal treatment outcome, exact electrode placement is required. Moreover, to analyze the relationship between electrode location and clinical results, a precise reconstruction of electrode placement is required, posing specific challenges to the field of neuroimaging. Since 2014 the open source toolbox Lead-DBS is available, which aims at facilitating this process. The tool has since become a popular platform for DBS imaging. With support of a broad community of researchers worldwide, methods have been continuously updated and complemented by new tools for tasks such as multispectral nonlinear registration, structural/functional connectivity analyses, brain shift correction, reconstruction of microelectrode recordings and orientation detection of segmented DBS leads. The rapid development and emergence of these methods in DBS data analysis require us to revisit and revise the pipelines introduced in the original methods publication. Here we demonstrate the updated DBS and connectome pipelines of Lead-DBS using a single patient example with state-of-the-art high-field imaging as well as a retrospective cohort of patients scanned in a typical clinical setting at 1.5T. Imaging data of the 3T example patient is co-registered using five algorithms and nonlinearly warped into template space using ten approaches for comparative purposes. After reconstruction of DBS electrodes (which is possible using three methods and a specific refinement tool), the volume of tissue activated is calculated for two DBS settings using four distinct models and various parameters. Finally, four whole-brain tractography algorithms are applied to the patient's preoperative diffusion MRI data and structural as well as functional connectivity between the stimulation volume and other brain areas are estimated using a total of eight approaches and datasets. In addition, we demonstrate impact of selected preprocessing strategies on the retrospective sample of 51 PD patients. We compare the amount of variance in clinical improvement that can be explained by the computer model depending on the preprocessing method of choice. This work represents a multi-institutional collaborative effort to develop a comprehensive, open source pipeline for DBS imaging and connectomics, which has already empowered several studies, and may facilitate a variety of future studies in the field.
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Affiliation(s)
- Andreas Horn
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany.
| | - Ningfei Li
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany
| | - Till A Dembek
- Department of Neurology, University Hospital of Cologne, Germany
| | - Ari Kappel
- Wayne State University, Department of Neurosurgery, Detroit, Michigan, USA
| | | | - Siobhan Ewert
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany
| | - Anna Tietze
- Institute of Neuroradiology, Charité - University Medicine Berlin, Germany
| | - Andreas Husch
- University of Luxembourg, Luxembourg Centre for Systems Biomedicine, Interventional Neuroscience Group, Belvaux, Luxembourg
| | - Thushara Perera
- Bionics Institute, East Melbourne, Victoria, Australia; Department of Medical Bionics, University of Melbourne, Parkville, Victoria, Australia
| | - Wolf-Julian Neumann
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany; Institute of Neuroradiology, Charité - University Medicine Berlin, Germany
| | - Marco Reisert
- Medical Physics, Department of Radiology, Faculty of Medicine, University Freiburg, Germany
| | - Hang Si
- Numerical Mathematics and Scientific Computing, Weierstrass Institute for Applied Analysis and Stochastics (WIAS), Germany
| | - Robert Oostenveld
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, NL, Netherlands; NatMEG, Karolinska Institutet, Stockholm, SE, Sweden
| | - Christopher Rorden
- McCausland Center for Brain Imaging, University of South Carolina, Columbia, SC, USA
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh PA, USA
| | - Qianqian Fang
- Department of Bioengineering, Northeastern University, Boston, USA
| | - Todd M Herrington
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Johannes Vorwerk
- Scientific Computing & Imaging (SCI) Institute, University of Utah, Salt Lake City, USA
| | - Andrea A Kühn
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany
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8
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Ewert S, Horn A, Finkel F, Li N, Kühn AA, Herrington TM. Optimization and comparative evaluation of nonlinear deformation algorithms for atlas-based segmentation of DBS target nuclei. Neuroimage 2018; 184:586-598. [PMID: 30267856 DOI: 10.1016/j.neuroimage.2018.09.061] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/16/2018] [Accepted: 09/21/2018] [Indexed: 12/23/2022] Open
Abstract
Nonlinear registration of individual brain MRI scans to standard brain templates is common practice in neuroimaging and multiple registration algorithms have been developed and refined over the last 20 years. However, little has been done to quantitatively compare the available algorithms and much of that work has exclusively focused on cortical structures given their importance in the fMRI literature. In contrast, for clinical applications such as functional neurosurgery and deep brain stimulation (DBS), proper alignment of subcortical structures between template and individual space is important. This allows for atlas-based segmentations of anatomical DBS targets such as the subthalamic nucleus (STN) and internal pallidum (GPi). Here, we systematically evaluated the performance of six modern and established algorithms on subcortical normalization and segmentation results by calculating over 11,000 nonlinear warps in over 100 subjects. For each algorithm, we evaluated its performance using T1-or T2-weighted acquisitions alone or a combination of T1-, T2-and PD-weighted acquisitions in parallel. Furthermore, we present optimized parameters for the best performing algorithms. We tested each algorithm on two datasets, a state-of-the-art MRI cohort of young subjects and a cohort of subjects age- and MR-quality-matched to a typical DBS Parkinson's Disease cohort. Our final pipeline is able to segment DBS targets with precision comparable to manual expert segmentations in both cohorts. Although the present study focuses on the two prominent DBS targets, STN and GPi, these methods may extend to other small subcortical structures like thalamic nuclei or the nucleus accumbens.
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Affiliation(s)
- Siobhan Ewert
- Charité - University Medicine Berlin, Department of Neurology, Movement Disorders and Neuromodulation Unit, Berlin, Germany; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andreas Horn
- Charité - University Medicine Berlin, Department of Neurology, Movement Disorders and Neuromodulation Unit, Berlin, Germany
| | - Francisca Finkel
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Program in Behavioral Neuroscience, Northeastern University, Boston, MA, USA
| | - Ningfei Li
- Charité - University Medicine Berlin, Department of Neurology, Movement Disorders and Neuromodulation Unit, Berlin, Germany; Institute of Software Engineering and Theoretical Computer Science, Neural Information Processing Group, Technische Universität Berlin, Germany
| | - Andrea A Kühn
- Charité - University Medicine Berlin, Department of Neurology, Movement Disorders and Neuromodulation Unit, Berlin, Germany
| | - Todd M Herrington
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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9
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Neumann WJ, Schroll H, de Almeida Marcelino AL, Horn A, Ewert S, Irmen F, Krause P, Schneider GH, Hamker F, Kühn AA. Functional segregation of basal ganglia pathways in Parkinson’s disease. Brain 2018; 141:2655-2669. [DOI: 10.1093/brain/awy206] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/19/2018] [Indexed: 01/09/2023] Open
Affiliation(s)
- Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Henning Schroll
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Ana Luisa de Almeida Marcelino
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Horn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Siobhan Ewert
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Friederike Irmen
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Biological Psychology and Cognitive Neuroscience, Freie Universität Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universitaet zu Berlin, Germany
| | - Patricia Krause
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité Campus Mitte, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Fred Hamker
- Department of Computer Science, Chemnitz University of Technology, Chemnitz, Germany
| | - Andrea A Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Neurocure, Centre of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany
- DZNE, German Center for Degenerative Diseases, Berlin, Germany
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10
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Neumann W, Horn A, Ewert S, Huebl J, Brücke C, Slentz C, Schneider G, Kühn AA. A localized pallidal physiomarker in cervical dystonia. Ann Neurol 2017; 82:912-924. [DOI: 10.1002/ana.25095] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/06/2017] [Accepted: 11/05/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Wolf‐Julian Neumann
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charite MittéCharité–Universitätsmedizin Berlin
| | - Andreas Horn
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charite MittéCharité–Universitätsmedizin Berlin
| | - Siobhan Ewert
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charite MittéCharité–Universitätsmedizin Berlin
| | - Julius Huebl
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charite MittéCharité–Universitätsmedizin Berlin
| | - Christof Brücke
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charite MittéCharité–Universitätsmedizin Berlin
| | - Colleen Slentz
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charite MittéCharité–Universitätsmedizin Berlin
| | - Gerd‐Helge Schneider
- Department of Neurosurgery, Campus Charite MittéCharité–Universitätsmedizin Berlin
| | - Andrea A. Kühn
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charite MittéCharité–Universitätsmedizin Berlin
- Berlin School of Mind and BrainCharité–Universitätsmedizin Berlin
- NeuroCureCharité–Universitätsmedizin BerlinBerlin Germany
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11
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van Wijk BCM, Pogosyan A, Hariz MI, Akram H, Foltynie T, Limousin P, Horn A, Ewert S, Brown P, Litvak V. Localization of beta and high-frequency oscillations within the subthalamic nucleus region. Neuroimage Clin 2017; 16:175-183. [PMID: 28794978 PMCID: PMC5540829 DOI: 10.1016/j.nicl.2017.07.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/05/2017] [Accepted: 07/22/2017] [Indexed: 12/01/2022]
Abstract
Parkinsonian bradykinesia and rigidity are typically associated with excessive beta band oscillations in the subthalamic nucleus. Recently another spectral peak has been identified that might be implicated in the pathophysiology of the disease: high-frequency oscillations (HFO) within the 150–400 Hz range. Beta-HFO phase-amplitude coupling (PAC) has been found to correlate with severity of motor impairment. However, the neuronal origin of HFO and its usefulness as a potential target for deep brain stimulation remain to be established. For example, it is unclear whether HFO arise from the same neural populations as beta oscillations. We intraoperatively recorded local field potentials from the subthalamic nucleus while advancing DBS electrodes in 2 mm steps from 4 mm above the surgical target point until 2 mm below, resulting in 4 recording sites. Data from 26 nuclei from 14 patients were analysed. For each trajectory, we identified the recording site with the largest spectral peak in the beta range (13–30 Hz), and the largest peak in the HFO range separately. In addition, we identified the recording site with the largest beta-HFO PAC. Recording sites with largest beta power and largest HFO power coincided in 50% of cases. In the other 50%, HFO was more likely to be detected at a more superior recording site in the target area. PAC followed more closely the site with largest HFO (45%) than beta power (27%). HFO are likely to arise from spatially close, but slightly more superior neural populations than beta oscillations. Further work is necessary to determine whether the different activities can help fine-tune deep brain stimulation targeting. LFPs were recorded from multiple sites within and around the subthalamic nucleus. Sites with largest beta and high-frequency oscillations (HFO) were identified. HFO were located slightly more superior than beta oscillations. Phase-amplitude coupling more closely followed the site with largest HFO. This work hints at different neural generators for beta and HFO.
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Affiliation(s)
- B C M van Wijk
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, United Kingdom
| | - A Pogosyan
- Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - M I Hariz
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom.,Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - H Akram
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom.,Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - T Foltynie
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - P Limousin
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - A Horn
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Berenson-Allen Center for Non-Invasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S Ewert
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - P Brown
- Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.,Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom
| | - V Litvak
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, United Kingdom
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12
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Urech DM, Feige U, Ewert S, Schlosser V, Ottiger M, Polzer K, Schett G, Lichtlen P. Anti-inflammatory and cartilage-protecting effects of an intra-articularly injected anti-TNF{alpha} single-chain Fv antibody (ESBA105) designed for local therapeutic use. Ann Rheum Dis 2009; 69:443-9. [PMID: 19293161 DOI: 10.1136/ard.2008.105775] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES (1) To show that a single-chain Fv antibody (scFv) against tumour necrosis factor alpha (TNFalpha) (ESBA105) has efficacy comparable to a full length anti-TNFalpha IgG (infliximab); (2) to evaluate whether ESBA105 has all the properties required for the local treatment of arthritis; and (3) to investigate its discriminative tissue penetration properties. METHODS In vivo efficacy was measured in arthritis of the knee joint induced by the intra-articular injection of recombinant human TNFalpha (rhTNFalpha) in Lewis rats. Cartilage penetration of scFv (ESBA105) and full length IgG (infliximab) were studied in bovine cartilage specimens ex vivo. Tissue penetration, biodistribution and pharmacokinetics of ESBA105 were followed and compared after intra-articular and intravenous administration. RESULTS In cell culture, ESBA105 showed similar TNFalpha inhibitory potency to infliximab. In vivo, ESBA105 inhibited rhTNFalpha-induced synovial inflammation in rats with efficacy again comparable to infliximab. An 11-fold molar excess of ESBA105 over rhTNFalpha resulted in 90% inhibition of knee joint swelling, inflammatory infiltrates and proteoglycan loss from cartilage. In ex vivo studies of bovine cartilage, ESBA105 penetrated well into the cartilage whereas infliximab remained on the surface. In vivo, rapid penetration into the synovial tissue, cartilage and surrounding tissues was observed following intra-articular injection of [(125)I]-ESBA105 into the knee joint of rabbits. CONCLUSIONS ESBA105 potently inhibits inflammation and prevents cartilage damage triggered by TNFalpha. In contrast to a full length IgG, ESBA105 also penetrates into cartilage and can be expected to reverse the TNFalpha-induced catabolic state of articular cartilage in arthritides.
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13
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Ewert S, Spak E, Olbers T, Johnsson E, Edebo A, Fändriks L. Angiotensin II induced contraction of rat and human small intestinal wall musculature in vitro. Acta Physiol (Oxf) 2006; 188:33-40. [PMID: 16911251 DOI: 10.1111/j.1748-1716.2006.01600.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [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: 11/30/2022]
Abstract
BACKGROUND Angiotensin II (Ang II) is a well-known activator of smooth muscle in the vasculature but has been little explored with regard to intestinal wall muscular activity. This study investigates pharmacological properties of Ang II and expression of its receptors in small-intestinal smooth muscle from rats and humans. METHODS Isometric recordings were performed in vitro on small intestinal longitudinal muscle strips. Protein expressions of Ang II typ 1 (AT1R) and typ 2 (AT2R) receptors were assessed by Western blot. RESULTS Ang II elicited concentration-dependent contractions of rat jejunal and ileal muscle preparations. The concentration-response curve (rat ileum, EC(50): 1.5 +/- 0.9 x 10(-8) M) was shifted to the right by the AT1R receptor antagonist losartan (10(-7) M) but was unaffected by the AT2R antagonist PD123319 (10(-7) M) as well as by the adrenolytic guanethidine (3 x 10(-6) M) and the anticholinergic atropine (10(-6) M). Human duodenal, jejunal and ileal longitudinal muscle preparations all contracted concentration-dependently in response to Ang II. The concentration-response curve (human jejunum, EC(50): 1.5 +/- 0.8 x 10(-8) M) was shifted to the right by losartan (10(-7) M) but was unaffected by PD123319 (10(-7) M). Both AT1R and AT2R were detected in all segments of the rat small intestinal wall musculature, whereas only AT1R was readily detectable in the human samples. CONCLUSION Ang II elicits contractions of small-intestinal longitudinal muscle preparations from the small intestine of rats and man. The pharmacological pattern and protein expression analyses indicate mediation via the AT1R.
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MESH Headings
- Adrenergic Antagonists/pharmacology
- Adult
- Aged
- Angiotensin II/pharmacology
- Angiotensin II Type 1 Receptor Blockers/pharmacology
- Angiotensin II Type 2 Receptor Blockers
- Animals
- Atropine/pharmacology
- Blotting, Western/methods
- Cholinergic Antagonists/pharmacology
- Dose-Response Relationship, Drug
- Female
- Guanethidine/pharmacology
- Humans
- Imidazoles/pharmacology
- In Vitro Techniques
- Intestine, Small/drug effects
- Intestine, Small/physiology
- Losartan/pharmacology
- Male
- Middle Aged
- Muscle Contraction/drug effects
- Muscle, Smooth/chemistry
- Muscle, Smooth/drug effects
- Muscle, Smooth/physiology
- Pyridines/pharmacology
- Rats
- Receptor, Angiotensin, Type 1/analysis
- Receptor, Angiotensin, Type 2/analysis
- Species Specificity
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Affiliation(s)
- S Ewert
- Department of Gastrosurgical Research, Institute of Clinical Sciences, Sahlgrenska Academy, Goteborg University, Gothenburg, Sweden
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14
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Ewert S, Sjoberg T, Johansson B, Duvetorp A, Holm M, Fandriks L. Dynamic expression of the angiotensin II type 2 receptor and duodenal mucosal alkaline secretion in the Sprague-Dawley rat. Exp Physiol 2005; 91:191-9. [PMID: 16263801 DOI: 10.1113/expphysiol.2005.031401] [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: 11/08/2022]
Abstract
Activation of angiotensin II type 2 receptors (AT2R) has been shown to stimulate duodenal mucosal alkaline secretion (DMAS) in Sprague-Dawley rats (S-D). This finding could not be confirmed in another line of S-D, and the present study investigates whether the level of AT2R expression determines the response to the AT2R agonist CGP42112A. DMAS was measured in anaesthetized rats using in situ pH-stat titration. Real-time PCR and Western blot were used to assess AT1R and AT2R RNA and protein expression, respectively. CGP42112A (0.1 microg kg(-1)min(-1) I.V.) elicited a 45% net increase in DMAS in the previous S-D line studied, whereas no change occurred in the new S-D line. Luminal administration of prostaglandin E2 (10(-5) M) increased DMAS similarly in both S-D lines. AT2R protein expression was significantly higher in tissue from the previous line compared to the new line. Individual AT1R to AT2R ratios (RNA and protein) were significantly higher in the new line compared to the previous S-D line. In the new S-D line intravenous infusion of angiotensin II (Ang II; 10 microg kg(-1) h(-1)) over 120 min significantly lowered the duodenal AT1aR to AT2R RNA ratio. Prolonged Ang II infusion over 240 min increased AT2R protein expression and evoked a 42% stimulatory response in DMAS to CGP42112A. The level of local AT2R expression determines the effect of the AT2R agonist CGP42112A on rat duodenal mucosal alkaline secretion. AT2R expression should be confirmed before interpreting the experimental effects of pharmacological interferences with this receptor.
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MESH Headings
- Angiotensin II/pharmacology
- Animals
- Dinoprostone/pharmacology
- Duodenum/drug effects
- Duodenum/metabolism
- Intestinal Mucosa/drug effects
- Intestinal Mucosa/metabolism
- Male
- Oligopeptides/pharmacology
- RNA, Messenger/metabolism
- Rats
- Rats, Sprague-Dawley
- Receptor, Angiotensin, Type 1/drug effects
- Receptor, Angiotensin, Type 1/genetics
- Receptor, Angiotensin, Type 1/metabolism
- Receptor, Angiotensin, Type 2/agonists
- Receptor, Angiotensin, Type 2/genetics
- Receptor, Angiotensin, Type 2/metabolism
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Affiliation(s)
- S Ewert
- Department of Gastrosurgical Research, Institute of Surgical Sciences, Sahlgrenska Academy at Göteborg University, PO Box 750 38, SE 400 36 Gothenburg, Sweden.
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Laesser M, Oi Y, Ewert S, Fändriks L, Aneman A. The angiotensin II receptor blocker candesartan improves survival and mesenteric perfusion in an acute porcine endotoxin model. Acta Anaesthesiol Scand 2004; 48:198-204. [PMID: 14995942 DOI: 10.1111/j.0001-5172.2004.00283.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [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: 11/28/2022]
Abstract
BACKGROUND Blockade of the angiotensin II type 1 (AT1) receptor has been demonstrated to ameliorate splanchnic hypoperfusion in acute experimental circulatory failure. This study focused on hemodynamic changes and survival in pigs treated with AT1 blockade prior to or during acute endotoxinemia. METHODS Escherichia coli lipopolysaccharide endotoxin was infused in anesthetized and mechanically ventilated pigs. Systemic, renal, mesenteric and jejunal mucosal perfusion as well as systemic oxygen and acid-base balance were monitored. The selective AT1 receptor blocker candesartan was administered prior to as well as during endotoxinemia. Control animals received the saline vehicle. RESULTS Pre-treatment with candesartan resulted in higher survival rate (83%, 10 out of 12 animals) compared with 50% (6 of 12) in control animals and 27% (3 of 11) in animals treated during endotoxinemia. Pre-treatment with candesartan resulted in higher cardiac output, mixed venous oxygen saturation, arterial standard base-excess, portal venous blood flow during endotoxin infusion compared with controls and animals treated during endotoxinemia. No adverse effects were found on neither systemic nor renal circulation. CONCLUSION The favorable results of AT1 receptor blockade prior to endotoxinemia are lost when blockade is established during endotoxinemia demonstrating the importance of the renin-angiotensin system and its dynamic involvement in acute endotoxinemic shock.
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Affiliation(s)
- M Laesser
- Department of Physiology, Göteborg University, Göteborg, Sweden
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16
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Johansson B, Holm M, Ewert S, Casselbrant A, Pettersson A, Fändriks L. Angiotensin II type 2 receptor-mediated duodenal mucosal alkaline secretion in the rat. Am J Physiol Gastrointest Liver Physiol 2001; 280:G1254-60. [PMID: 11352819 DOI: 10.1152/ajpgi.2001.280.6.g1254] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [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: 01/31/2023]
Abstract
The aims of this study were to elucidate the distribution of angiotensin receptors (AT(1) and AT(2)) in the duodenal wall and to investigate whether AT(2) receptors are involved in the regulation of duodenal mucosal alkaline secretion, which is of importance for the mucosal defense against gastric acid. Immunohistochemistry was used to locate AT(1) and AT(2) receptors in chloralose-anesthetized rats. Duodenal mucosal alkaline output was measured by use of in situ pH-stat titration. Immunohistochemistry demonstrated a distinct staining for both AT(1) and AT(2) receptors in the lamina propria of the villi and also for AT(1) receptors in the muscularis interna. When angiotensin II was infused in the presence of the AT(1) receptor antagonist losartan, mucosal alkaline secretion increased by ~50%. This response was inhibited by the AT(2) receptor antagonist PD-123319. The AT(2) receptor agonist CGP-42112A increased mucosal alkaline secretion by ~50%. This increase was absent in the presence of PD-123319 but not in the presence of losartan or the local anesthetic lidocaine. We conclude that angiotensin II stimulates duodenal mucosal alkaline secretion by activation of AT(2) receptors located in the duodenal mucosa/submucosa.
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Affiliation(s)
- B Johansson
- Department of Physiology, Göteborg University, SE 405 30 Göteborg, Sweden
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17
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Laesser M, Fändriks L, Pettersson A, Ewert S, Aneman A. Angiotensin II blockade in existing hypovolemia: effects of candesartan in the porcine splanchnic and renal circulation. Shock 2000; 14:471-7. [PMID: 11049112 DOI: 10.1097/00024382-200014040-00009] [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: 11/25/2022]
Abstract
Angiotensin II (AngII) is an important vasoconstrictor during hypovolemia. This study focused on the effects of the AngII receptor blocker candesartan on intestinal, hepatic, and renal hemodynamics during severe hypovolemia when administered in preexisting moderate hypovolemia. It was hypothesized that specific AngII receptor blockade might enhance splanchnic perfusion during hypovolemia. Fasted, anesthetized, ventilated, juvenile pigs were hemorrhaged by 20% of the blood volume for 30 min. Animals were then randomized to receive candesartan (CAND, n = 11) or the vehicle (CTRL, n = 10) prior to further hemorrhage to 40% of the blood volume for 30 min. The shed blood was then retransfused. Systemic and splanchnic hemodynamics were recorded including intestinal mucosal, superficial and parenchymal hepatic, and cortical and medullary renal microcirculation by laser-Doppler flowmetry. Arterial blood gases were analysed. Candesartan-treated animals maintained mesenteric and jejunal mucosal perfusion during 40% hypovolemia compared to CTRL animals, while no differences were observed in the hepatic and renal circulation. Retransfusion restored mesenteric and renal blood flows despite persistent hypotension and reduced cardiac output in both CAND and CTRL animals. Renal medullary and hepatic parenchymal microcirculation failed to recover during retransfusion in both CAND and CTRL animals. Arterial acidosis, hypercarbia, and a negative base excess were observed in CTRL animals following retransfusion whereas those parameters were normalised in CAND animals. Administration of candesartan in moderate hypovolemia ameliorated the reduction and consequences of mesenteric and intestinal, but not hepatic perfusion during severe hypovolemia. No adverse effects were observed in the renal circulation.
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Affiliation(s)
- M Laesser
- Department of Physiology, Göteborg University, Sweden
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18
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Rathke-Hartlieb S, Budde P, Ewert S, Schlomann U, Staege MS, Jockusch H, Bartsch JW, Frey J. Elevated expression of membrane type 1 metalloproteinase (MT1-MMP) in reactive astrocytes following neurodegeneration in mouse central nervous system. FEBS Lett 2000; 481:227-34. [PMID: 11007969 DOI: 10.1016/s0014-5793(00)02011-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [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: 01/16/2023]
Abstract
Reactive astrocytes occurring in response to neurodegeneration are thought to play an important role in neuronal regeneration by upregulating the expression of extracellular matrix (ECM) components as well as the ECM degrading metalloproteinases (MMPs). We examined the mRNA levels and cellular distribution of membrane type matrix metalloproteinase 1 (MT1-MMP) and tissue inhibitors 1-4 of MMPs (TIMPs) in brain stem and spinal cord of wobbler (WR) mutant mice affected by progressive neurodegeneration and astrogliosis. MT1-MMP, TIMP-1 and TIMP-3 mRNA levels were elevated, whereas TIMP-2 and TIMP-4 expression was not affected. MT1-MMP was expressed in reactive astrocytes of WR. In primary astrocyte cultures, MT1-MMP mRNA was upregulated by exogeneous tumor necrosis factor alpha. Increased plasma membrane and secreted MMP activities were found in primary WR astrocytes.
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Affiliation(s)
- S Rathke-Hartlieb
- Developmental Biology and Molecular Pathology, WY, University of Bielefeld, D-33501 Bielefeld, Germany
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19
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Oi Y, Aneman A, Svensson M, Ewert S, Dahlqvist M, Haljamäe H. Hypertonic saline-dextran improves intestinal perfusion and survival in porcine endotoxin shock. Crit Care Med 2000; 28:2843-50. [PMID: 10966260 DOI: 10.1097/00003246-200008000-00027] [Citation(s) in RCA: 44] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the effects of hypertonic (7.5%) saline-6% dextran 70 (HSD) and isotonic (0.9%) saline-6% dextran 70 (ISD) on cardiovascular function and intestinal perfusion in experimental endotoxin shock. DESIGN Experimental, randomized, unblinded, interventional study. SETTING University experimental animal laboratory. SUBJECTS Anesthetized and mechanically ventilated landrace pigs (n = 24). INTERVENTIONS Induction of endotoxin (ET) shock by infusion of Escherichia coil lipopolysaccharide endotoxin (serotype 0111: B4) followed by no fluid treatment (control; C) or small-volume (4 mL/kg) treatment with HSD or ISD. MEASUREMENTS AND MAIN RESULTS Mean arterial pressure, central venous pressure, pulmonary artery pressure, pulmonary artery occlusion pressure, cardiac output, portal vein blood flow, intestinal microcirculation, intramucosal (regional) P(CO2), intestinal-arterial gap of CO2, and intramucosal pH were monitored, and blood gases were analyzed. Infusion of ET resulted in hypokinetic shock, which in untreated animals led to cardiovascular deterioration and a survival rate of only 33% at 300 mins after start of ET infusion. ISD treatment transiently improved hemodynamic variables and mucosal blood flow but did not affect the survival rate vs. C. Significant beneficial, long-lasting effects of HSD infusion on hemodynamics, especially on mucosal blood flow and intramucosal pH, were demonstrable, resulting in a survival rate of 86%. The relative risk of death at 300 mins was 1.20 for ISD vs. C and 0.17 for HSD vs. C. CONCLUSION Small-volume HSD resuscitation is much more effective than ISD resuscitation. Variables that were improved include cardiac output, portal blood flow, and intestinal mucosal blood flow in ET shock, all of which improve survival. Such beneficial effects of HSD on splanchnic perfusion may be of value in treating critically ill septic patients in the intensive care unit.
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Affiliation(s)
- Y Oi
- Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Göteborg, Sweden
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20
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Ewert S, Kessler S, Seidl N. ["I was always with body and soul a dedicated nurse"]. Pflege 2000; 13:99-103. [PMID: 10839112 DOI: 10.1024/1012-5302.13.2.99] [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: 11/19/2022]
Affiliation(s)
- S Ewert
- Fachhochschule Frankfurt am Main
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21
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Oi Y, Åneman A, Dahlqvist M, Svensson M, Ewert S, Haljamäe H. Effect of hypertonic dextran on intestinal mucosal perfusion during porcine endotoxin shock. Crit Care 1999. [PMCID: PMC3301856 DOI: 10.1186/cc528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Seifert E, Ewert S, Werle J. [Exercise and sports therapy for patients with head and neck tumors]. Rehabilitation (Stuttg) 1992; 31:33-7. [PMID: 1585052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Important aspects in the aftercare of patients with cancer of head and neck can be realized by physical training in a sports group. The aftermath of operative therapy, e.g. loss of motion, imbalances of muscular activity or respiratory movements, can be reduced. The main importance of physical training in a group is the patient's reintegration in a social environment. Evaluating the quality of life of the individual patient we found that this method of psychosocial aftercare can improve subjective quality of life. Therefore, this conception of rehabilitation should not be missing in the aftercare of patients with malignant cancer.
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Affiliation(s)
- E Seifert
- Klinik für HNO-Heilkunde des Klinikums Mannheim, Fakultät für Klinische Medizin, Universität Heidelberg
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Pankert J, Marbach G, Comberg A, Lemmens P, Fröning P, Ewert S. Ultrasonic attenuation by the vortex lattice of high-Tc superconductors. Phys Rev Lett 1990; 65:3052-3055. [PMID: 10042767 DOI: 10.1103/physrevlett.65.3052] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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