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Stücker M, Protz K, Eder S, Läuchli S, Traber J, Dissemond J. [Diagnosis of leg edema]. Dermatologie (Heidelb) 2023; 74:182-189. [PMID: 36484790 PMCID: PMC9981498 DOI: 10.1007/s00105-022-05082-6] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 12/13/2022]
Abstract
Edema of the lower extremities is always associated with a pathological condition that should be treated, especially in patients with chronic wounds. Because the underlying causes of edema can vary greatly and sometimes be complex, clinical and, if necessary, various diagnostic tests should also be performed. Often, a suspected clinical diagnosis can already be made after clinical inspection with testing of Stemmer's and Godet's signs. Sonographic examination should then be performed as the next diagnostic test. Although measurement techniques such as water plethysmography are currently considered gold standard for volume measurements, they are very complex and prone to error, so that they are rarely used in clinical routine today. In summary, it is recommended to perform a clinical examination, if possible in combination with sonography, for edema diagnosis. Especially at the beginning of the decongestion phase, regular circumferential measurements should be performed and documented. This documentation is of high relevance for evaluation of therapeutic success.
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Affiliation(s)
- Markus Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken, Kliniken der Ruhr-Universität Bochum, Im St. Maria-Hilf-Krankenhaus, Bochum, Deutschland
| | - Kerstin Protz
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Stefan Eder
- Schwarzwald-Baar Klinikum, Klinik für Gefäßchirurgie und Gefäßmedizin, Villingen-Schwenningen, Deutschland
| | | | - Jürg Traber
- Venenklinik Bellevue Kreuzlingen (VBK), Kreuzlingen, Schweiz
| | - Joachim Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
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Eder S, Thommes M. Aspects of gas storage: Effect of confinement on supercritical isotherms. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255418] [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: 11/11/2022]
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Hodzic A, Birarda G, Juraic K, Sket P, Eder S, Kriechbaum M, D'Amico F, DeGiacomo O, Roblegg E. Revealing hidden molecular nanostructure details in the pellet formulation of ibuprofen by combining Synchrotron and laboratory sources. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103114] [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: 10/19/2022]
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4
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Ito Y, Yamamoto T, Miyai K, Take J, Scherthan H, Rommel A, Eder S, Steinestel K, Rump A, Port M, Shinomiya N, Kinoshita M. Ascorbic acid-2 glucoside mitigates intestinal damage during pelvic radiotherapy in a rat bladder tumor model. Int J Radiat Biol 2021; 98:942-957. [PMID: 34871138 DOI: 10.1080/09553002.2021.2009145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Ascorbic acid is a strong antioxidant and has potent radioprotective effects on radiation injuries. Ascorbic acid 2-glucoside (AA2G) is a stabilized derivative of ascorbic acid and rapidly hydrolyzed into ascorbic acid and glucose. Since there is the possibility that AA2G treatment interferes with the antitumor activity of radiotherapy, we investigated the effect of AA2G treatment during radiotherapy on acute radiation enteritis and antitumor activity of radiotherapy in rats. MATERIALS AND METHODS AY-27 rat bladder tumor cells were used to induce bladder tumors in rats. Two weeks after inoculation rats received fractionated pelvic radiotherapy in eight fractions for 4 weeks totaling 40 Gy. During radiotherapy, one group of rats received per os AA2G (ascorbic acid: 250 mg/kg/day) and its bolus engulfment (ascorbic acid: 250 mg/kg) 8 h before each X-irradiation fraction. Seven days after the last X-irradiation, we studied histology, DNA double strand break (DSB) damage (by 53BP1 foci staining), and the M1/M2 macrophage response by immunohistochemistry of paraffin-fixed bladder and intestinal tissues. RESULTS AA2G treatment reduced the intestinal damage (shortening of villi) but did not reduce antitumor effectiveness of radiotherapy against bladder tumors. Like the controls, AA2G-treated rats showed no residual tumor lesions in the bladder after X-irradiation. Both AA2G-treated and control groups showed similar persistent DSB damage (53BP1 foci) both in bladders and ilea seven days after radiotherapy. Radiotherapy tended to reduce CD163+ M2 macrophages, which are considered as an anti-inflammatory subtype favoring tissue repair, in the bladders. X-irradiation also reduced the occurrence of M2 macrophages in the ilea. AA2G treatment significantly increased CD163+/CD68+ macrophage ratio in the ilea of rats after pelvic irradiation in comparison to the sham irradiated control rats. AA2G treatment increased, albeit not significantly, the CD163+/CD68+ macrophage ratio in the irradiated bladders relative to the control irradiated rats. On the other hand, bladders and ilea of the irradiated rats with and without AA2G treatment showed similar frequencies of CD68+ macrophages. CONCLUSIONS AA2G treatment mitigated radiation-induced intestinal damage without reducing antitumor activity after fractionated pelvic radiotherapy against bladder tumors in rats. The beneficial effect of AA2G treatment seems to promote a restoration of the M2 answer as well as tissue remodeling and wound healing. Similar residual DNA damage in bladders and ilea seven days post-irradiation is consistent with tumor control in both groups.
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Affiliation(s)
- Yasutoshi Ito
- Military Medicine Research Unit, Test and Evaluation Command, Ground Self-Defense Force, Setagaya, Japan
| | - Tetsuo Yamamoto
- Military Medicine Research Unit, Test and Evaluation Command, Ground Self-Defense Force, Setagaya, Japan.,NBC Counter Medical Unit, Ground Self-Defense Force, Setagaya, Japan
| | - Kosuke Miyai
- Military Medicine Research Unit, Test and Evaluation Command, Ground Self-Defense Force, Setagaya, Japan.,Department of Pathology, Self-Defense Forces Central Hospital, Setagaya, Japan
| | - Junya Take
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Japan
| | | | - Anna Rommel
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Stefan Eder
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | | | - Alexis Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | | | - Manabu Kinoshita
- Department of Immunology and Microbiology, National Defense Medical College, Tokorozawa, Japan
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5
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Rump A, Eder S, Hermann C, Lamkowski A, Kinoshita M, Yamamoto T, Take J, Abend M, Shinomiya N, Port M. Modeling principles of protective thyroid blocking. Int J Radiat Biol 2021; 98:831-842. [PMID: 34762000 DOI: 10.1080/09553002.2021.1987570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE In the case of a nuclear incident, the release of radioiodine must be expected. Radioiodine accumulates in the thyroid and by irradiation enhances the risk of cancer. Large doses of stable (non-radioactive) iodine may inhibit radioiodine accumulation and protect the thyroid ('thyroid blocking'). Protection is based on a competition at the active carrier site in the cellular membrane and an additional temporary inhibition of the organification of iodide (Wolff-Chaikoff effect). Alternatively, other agents like e.g. perchlorate that compete with iodide for the uptake into the thyrocytes may also confer thyroidal protection against radioiodine exposure.Biokinetic models for radioiodine mostly describe exchanges between compartments by first order kinetics. This leads to correct predictions only for low (radio)iodide concentrations. These models are not suited to describe the kinetics of iodine if administered at the dosages recommended for thyroid blocking and moreover does not permit to simulate either the protective competition mechanism at the membrane or the Wolff-Chaikoff effect. Models adapted for this purpose must be used. Such models may use a mathematical relation between the serum iodide concentration and a relative uptake suppression or a dependent rate constant determining total thyroidal radioiodine accumulation. Alternatively, the thyroidal uptake rate constant may be modeled as a function of the total iodine content of the gland relative to a saturation amount. Newer models integrate a carrier-mechanism described by Michalis-Menten kinetics in the membrane and in analogy to enzyme kinetics apply the rate law for monomolecular irreversible enzyme reactions with competing substrates to model the competition mechanism. An additional total iodide uptake block, independent on competition but limited in time, is used to simulate the Wolff-Chaikoff effect. CONCLUSION The selection of the best model depends on the issue to be studied. Most models cannot quantify the relative contributions of the competition mechanism at the membrane and the Wolff-Chaikoff effect. This makes it impossible or exceedingly difficult to simulate prolonged radioiodine exposure and the effect of repetitive administrations of stable iodine. The newer thyroid blocking models with a separate modeling of competition and Wolff-Chaikoff effect allow better quantitative mechanistic insights and offer the possibility to simulate complex radioiodine exposure scenarios and various protective dosage schemes of stable iodine relatively easily. Moreover, they permit to study the protective effects of other competitors at the membrane carrier site, like e.g. perchlorate, and to draw conclusions on their protective efficacy in comparison to stable iodine.
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Affiliation(s)
- Alexis Rump
- Institut für Radiobiologie der Bundeswehr, München, Germany
| | - Stefan Eder
- Institut für Radiobiologie der Bundeswehr, München, Germany
| | | | | | - Manabu Kinoshita
- Department of Immunology and Microbiology, National Defense Medical College, Tokorozawa, Japan
| | - Tetsuo Yamamoto
- NBC Countermeasure Medical Unit, Japan Ground Self Defense Force, Tokyo Japan
| | - Junya Take
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Japan
| | - Michael Abend
- Institut für Radiobiologie der Bundeswehr, München, Germany
| | | | - Matthias Port
- Institut für Radiobiologie der Bundeswehr, München, Germany
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Rump A, Eder S, Hermann C, Lamkowski A, Kinoshita M, Yamamoto T, Abend M, Shinomiya N, Port M. A comparison of thyroidal protection by iodine and perchlorate against radioiodine exposure in Caucasians and Japanese. Arch Toxicol 2021; 95:2335-2350. [PMID: 34003340 PMCID: PMC8241675 DOI: 10.1007/s00204-021-03065-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022]
Abstract
Radioactive iodine released in nuclear accidents may accumulate in the thyroid and by irradiation enhances the risk of cancer. Radioiodine uptake into the gland can be inhibited by large doses of stable iodine or perchlorate. Nutritional iodine daily intake may impact thyroid physiology, so that radiological doses absorbed by the thyroid as well as thyroid blocking efficacy may differ in Japanese with a very rich iodine diet compared to Caucasians. Based on established biokinetic-dosimetric models for the thyroid, we derived the parameters for Caucasians and Japanese to quantitatively compare the effects of radioiodine exposure and the protective efficacy of thyroid blocking by stable iodine at the officially recommended dosages (100 mg in Germany, 76 mg in Japan) or perchlorate. The maximum transport capacity for iodine uptake into the thyroid is lower in Japanese compared to Caucasians. For the same radioiodine exposure pattern, the radiological equivalent thyroid dose is substantially lower in Japanese in the absence of thyroid blocking treatments. In the case of acute radioiodine exposure, stable iodine is less potent in Japanese (ED50 = 41.6 mg) than in Caucasians (ED50 = 2.7 mg) and confers less thyroid protection at the recommended dosages because of a delayed responsiveness to iodine saturation of the gland (Wolff-Chaikoff effect). Perchlorate (ED50 = 10 mg in Caucasians) at a dose of 1000 mg has roughly the same thyroid blocking effect as 100 mg iodine in Caucasians, whereas it confers a much better protection than 76 mg iodine in Japanese. For prolonged exposures, a single dose of iodine offer substantially lower protection than after acute radioiodine exposure in both groups. Repetitive daily iodine administrations improve efficacy without reaching levels after acute radioiodine exposure and achieve only slightly better protection in Japanese than in Caucasians. However, in the case of continuous radioiodine exposure, daily doses of 1000 mg perchlorate achieve a high protective efficacy in Caucasians as well as Japanese (> 0.98). In Caucasians, iodine (100 mg) and perchlorate (1000 mg) at the recommended dosages seem alternatives in case of acute radioiodine exposure, whereas perchlorate has a higher protective efficacy in the case of longer lasting radioiodine exposures. In Japanese, considering protective efficacy, preference should be given to perchlorate in acute as well as prolonged radioiodine exposure scenarios.
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Affiliation(s)
- A Rump
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany.
| | - S Eder
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - C Hermann
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - A Lamkowski
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - M Kinoshita
- Japan Self Defense Forces National Defense Medical College Research Institute, Tokorozawa, Japan
| | - T Yamamoto
- Japan Ground Self Defense Force NBC Countermeasure Medical Unit, Tokyo, Japan
| | - M Abend
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - N Shinomiya
- Japan Self Defense Forces National Defense Medical College Research Institute, Tokorozawa, Japan
| | - M Port
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
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Ostheim P, Don Mallawaratchy A, Müller T, Schüle S, Hermann C, Popp T, Eder S, Combs SE, Port M, Abend M. Acute radiation syndrome-related gene expression in irradiated peripheral blood cell populations. Int J Radiat Biol 2021; 97:474-484. [PMID: 33476246 DOI: 10.1080/09553002.2021.1876953] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE In a nuclear or radiological event, an early diagnostic tool is needed to distinguish the worried well from those individuals who may later develop life-threatenFing hematologic acute radiation syndrome. We examined the contribution of the peripheral blood's cell populations on radiation-induced gene expression (GE) changes. MATERIALS AND METHODS EDTA-whole-blood from six healthy donors was X-irradiated with 0 and 4Gy and T-lymphocytes, B-lymphocytes, NK-cells and granulocytes were separated using immunomagnetic methods. GE were examined in cell populations and whole blood. RESULTS The cell populations contributed to the total RNA amount with a ratio of 11.6 for T-lymphocytes, 1.2 for B-cells, 1.2 for NK-cells, 1.0 for granulocytes. To estimate the contribution of GE per cell population, the baseline (0Gy) and the radiation-induced fold-change in GE relative to unexposed was considered for each gene. The T-lymphocytes (74.8%/80.5%) contributed predominantly to the radiation-induced up-regulation observed for FDXR/DDB2 and the B-lymphocytes (97.1%/83.8%) for down-regulated POU2AF1/WNT3 with a similar effect on whole blood gene expression measurements reflecting a corresponding order of magnitude. CONCLUSIONS T- and B-lymphocytes contributed predominantly to the radiation-induced up-regulation of FDXR/DDB2 and down-regulation of POU2AF1/WNT3. This study underlines the use of FDXR/DDB2 for biodosimetry purposes and POU2AF1/WNT3 for effect prediction of acute health effects.
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Affiliation(s)
- Patrick Ostheim
- Bundeswehr Institute of Radiobiology affiliated to the University Ulm, Munich, Germany
| | | | - Thomas Müller
- Bundeswehr Institute of Radiobiology affiliated to the University Ulm, Munich, Germany
| | - Simone Schüle
- Bundeswehr Institute of Radiobiology affiliated to the University Ulm, Munich, Germany
| | - Cornelius Hermann
- Bundeswehr Institute of Radiobiology affiliated to the University Ulm, Munich, Germany
| | - Tanja Popp
- Bundeswehr Institute of Radiobiology affiliated to the University Ulm, Munich, Germany
| | - Stefan Eder
- Bundeswehr Institute of Radiobiology affiliated to the University Ulm, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany.,Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Oberschleißheim, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology affiliated to the University Ulm, Munich, Germany
| | - Michael Abend
- Bundeswehr Institute of Radiobiology affiliated to the University Ulm, Munich, Germany
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Hermann C, Lang S, Popp T, Hafner S, Steinritz D, Rump A, Port M, Eder S. Bardoxolone-Methyl (CDDO-Me) Impairs Tumor Growth and Induces Radiosensitization of Oral Squamous Cell Carcinoma Cells. Front Pharmacol 2021; 11:607580. [PMID: 33584286 PMCID: PMC7878525 DOI: 10.3389/fphar.2020.607580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022] Open
Abstract
Radiotherapy represents a common treatment strategy for patients suffering from oral squamous cell carcinoma (OSCC). However, application of radiotherapy is immanently limited by radio-sensitivity of normal tissue surrounding the tumor sites. In this study, we used normal human epithelial keratinocytes (NHEK) and OSCC cells (Cal-27) as models to investigate radio-modulating and anti-tumor effects of the synthetic triterpenoid 2-cyano-3,12-dioxooleana-1,9,-dien-28-oic acid methyl ester (CDDO-Me). Nanomolar CDDO-Me significantly reduced OSCC tumor xenograft-growth in-ovo applying the chick chorioallantoic membrane (CAM) assay. In the presence of CDDO-Me reactive oxygen species (ROS) were found to be reduced in NHEK when applying radiation doses of 8 Gy, whereas ROS levels in OSCC cells rose significantly even without radiation. In parallel, CDDO-Me was shown to enhance metabolic activity in malignant cells only as indicated by significant accumulation of reducing equivalents NADPH/NADH. Furthermore, antioxidative heme oxygenase-1 (HO-1) levels were only enhanced in NHEK and not in the OSCC cell line, as shown by immunoblotting. Clonogenic survival was left unchanged by CDDO-Me treatment in NHEK but revealed to be abolished almost completely in OSCC cells. Our results indicate anti-cancer and radio-sensitizing effects of CDDO-Me treatment in OSCC cells, whereas nanomolar CDDO-Me failed to provoke clear detrimental consequences in non-malignant keratinocytes. We conclude, that the observed differential aftermath of CDDO-Me treatment in malignant OSCC and non-malignant skin cells may be utilized to broaden the therapeutic range of clinical radiotherapy.
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Affiliation(s)
| | - Simon Lang
- Bundeswehr Institute of Pharmacology and Toxicology, Munich, Germany
| | - Tanja Popp
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Susanne Hafner
- Institute of Pharmacology of Natural Products and Clinical Pharmacology, University of Ulm, Ulm, Germany
| | - Dirk Steinritz
- Bundeswehr Institute of Pharmacology and Toxicology, Munich, Germany
| | - Alexis Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Stefan Eder
- Bundeswehr Institute of Radiobiology, Munich, Germany.,Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich (LMU), Munich, Germany
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Rump A, Ostheim P, Eder S, Hermann C, Abend M, Port M. Preparing for a "dirty bomb" attack: the optimum mix of medical countermeasure resources. Mil Med Res 2021; 8:3. [PMID: 33455578 PMCID: PMC7812656 DOI: 10.1186/s40779-020-00291-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/25/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In radiological emergencies with radionuclide incorporation, decorporation treatment is particularly effective if started early. Treating all people potentially contaminated ("urgent treatment") may require large antidote stockpiles. An efficacious way to reduce antidote requirements is by using radioactivity screening equipment. We analyzed the suitability of such equipment for triage purposes and determined the most efficient mix of screening units and antidote daily doses. METHODS The committed effective doses corresponding to activities within the detection limits of monitoring portals and mobile whole-body counters were used to assess their usefulness as triage tools. To determine the optimal resource mix, we departed from a large-scale scenario (60,000 victims) and based on purchase prices of antidotes and screening equipment in Germany, we calculated efficiencies of different combinations of medical countermeasure resources by data envelopment analysis. Cost-effectiveness was expressed as the costs per life year saved and compared to risk reduction opportunities in other sectors of society as well as the values of a statistical life. RESULTS Monitoring portals are adequate instruments for a sensitive triage after cesium-137 exposure with a high screening throughput. For the detection of americium-241 whole-body counters with a lower daily screening capacity per unit are needed. Assuming that 1% of the potentially contaminated patients actually need decorporation treatment, an efficient resource mix includes 6 monitoring portals and 25 mobile whole-body counters. The optimum mix depends on price discounts and in particular the fraction of victims actually needing treatment. The cost-effectiveness of preparedness for a "dirty bomb" attack is less than for common health care, but costs for a life year saved are less than for many risk-reduction interventions in the environmental sector. CONCLUSION To achieve economic efficiency a high daily screening capacity is of major importance to substantially decrease the required amount of antidote doses. Among the determinants of the number of equipment units needed, the fraction of the potentially contaminated victims that actually needs treatment is the most difficult to assess. Judging cost-effectiveness of the preparedness for "dirty bomb" attacks is an issue of principle that must be dealt with by political leaders.
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Affiliation(s)
- Alexis Rump
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany.
| | - Patrick Ostheim
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Stefan Eder
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Cornelius Hermann
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Michael Abend
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
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Abstract
In many medical expert recommendations and guidelines, the use of compression therapy for acute erysipelas is designated as a contraindication. Due to the sometimes massive oedema, compression therapy is nevertheless used in some clinics. This led to the question whether compression therapy for erysipelas of the lower leg actually leads to complications due to the acute infection and thus represents a contraindication. For the period 01 January 2018 to 30 June 2019, the records of 56 inpatients with acute erysipelas of the lower leg who received compression therapy in addition to systemic antibiotic therapy were retrospectively evaluated. The duration of inpatient treatment, the infection parameters determined as part of the ward routine and any complications that occurred were evaluated. While treated as inpatients the blood parameters for infection clearly dropped. Compression therapy was started on admission day in 92.9% of patients and continued until discharge. None of the patients showed an increase in fever or clinical signs of sepsis during the hospital stay. In this retrospective analysis it could be shown for the first time that compression therapy does not cause a clinical worsening or trigger a septic clinical picture in patients with acute erysipelas. Therefore, the authors consider the declaration of acute erysipelas as contraindication for compression therapy as not justified.
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Affiliation(s)
- S Eder
- Klinik für Gefäßchirurgie und Gefäßmedizin, Schwarzwald-Baar Klinikum, Klinikstr. 11, 78221, Villingen-Schwenningen, Deutschland.
| | - M Stücker
- Universitätsklinik Bochum, Venenzentrum, Hiltroper Landwehr 11-13, 44805, Bochum, Deutschland
| | - S Läuchli
- Dermatologische Klinik, Universitätsspital Zürich, Gloriastr. 31, 8091, Zürich, Schweiz
| | - J Dissemond
- Klinik für Dermatologie, Venerologie, Allergologie, Universitätsklinik Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Kähler J, Hafner S, Popp T, Hermann C, Rump A, Port M, Steinestel K, Eder S. Heterogeneous nuclear ribonucleoprotein K is overexpressed and contributes to radioresistance irrespective of HPV status in head and neck squamous cell carcinoma. Int J Mol Med 2020; 46:1733-1742. [PMID: 32901844 PMCID: PMC7521550 DOI: 10.3892/ijmm.2020.4718] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/17/2020] [Indexed: 12/24/2022] Open
Abstract
Radiotherapy is a major treatment option for head and neck squamous cell carcinoma (HNSCC). However, the success of radiotherapy is limited by tumor cell resistance to ionizing radiation (IR). Clinical studies have demonstrated an overall improved prognosis and higher susceptibility to radiotherapy of high‑risk human papillomavirus (HPV)‑associated HNSCC compared with classic HNSCC, as well as worse overall survival for male HNSCC patients. Overexpression of heterogeneous nuclear ribonucleoprotein (hnRNP) K has been associated with resistance to radiotherapy in melanoma and colorectal carcinoma. The aim of the present study was to analyze the impact of hnRNP K expression on the aggressiveness and radioresistance of HNSCC with respect to patient sex and HPV status. Immunohistochemical staining of HNSCC tissue specimens revealed elevated hnRNP K levels compared with those in the non‑neoplastic epithelium. Cytoplasmic hnRNP K accumulation was associated with advanced tumor stage and male sex. Exposure of HNSCC cells to IR was followed by rapid upregulation of hnRNP K at the protein level, along with re‑localization from the tumor cell nucleus to the cytoplasm. siRNA‑based knockdown of hnRNP K induced apoptosis and abolished tumor formation after xenotransplantation of HNSCC cells onto the chick egg chorioallantoic membrane (CAM). The observed effects were independent of the respective HPV status of the cell lines. These results indicated a tumorigenic and anti‑apoptotic role of hnRNP K in HNSCC, which appeared to be enhanced in male patients and contributed to the radioresistance of these tumors. However, the radioprotective effects of hnRNP K were found to be independent of the tumor's HPV status.
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Affiliation(s)
- Justus Kähler
- Bundeswehr Institute of Radiobiology, D‑80937 Munich, Germany
| | - Susanne Hafner
- Institute of Pharmacology of Natural Products and Clinical Pharmacology, University of Ulm, D‑89081 Ulm, Germany
| | - Tanja Popp
- Bundeswehr Institute of Radiobiology, D‑80937 Munich, Germany
| | | | - Alexis Rump
- Bundeswehr Institute of Radiobiology, D‑80937 Munich, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, D‑80937 Munich, Germany
| | - Konrad Steinestel
- Institute of Pathology and Molecular Pathology, Bundeswehrkrankenhaus Ulm, D‑89081 Ulm, Germany
| | - Stefan Eder
- Bundeswehr Institute of Radiobiology, D‑80937 Munich, Germany
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Böcker L, Bertsch P, Wenner D, Teixeira S, Bergfreund J, Eder S, Fischer P, Mathys A. Stabilizing emulsions with microalgae proteins – Changes in mechanism and efficiency along purification. CHEM-ING-TECH 2020. [DOI: 10.1002/cite.202055458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- L. Böcker
- ETH Zürich Sustainable Food Processing Schmelzbergstr. 9 8092 Zürich Switzerland
| | - P. Bertsch
- ETH Zürich Food Process Engineering Schmelzbergstr. 7 8092 Zürich Switzerland
| | - D. Wenner
- ETH Zürich Sustainable Food Processing Schmelzbergstr. 9 8092 Zürich Switzerland
| | - S. Teixeira
- ETH Zürich Sustainable Food Processing Schmelzbergstr. 9 8092 Zürich Switzerland
| | - J. Bergfreund
- ETH Zürich Food Process Engineering Schmelzbergstr. 7 8092 Zürich Switzerland
| | - S. Eder
- ETH Zürich Food Biochemistry Schmelzbergstr. 9 8092 Zürich Switzerland
| | - P. Fischer
- ETH Zürich Food Process Engineering Schmelzbergstr. 7 8092 Zürich Switzerland
| | - A. Mathys
- ETH Zürich Sustainable Food Processing Schmelzbergstr. 9 8092 Zürich Switzerland
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Eder S, Hermann C, Lamkowski A, Kinoshita M, Yamamoto T, Abend M, Shinomiya N, Port M, Rump A. A comparison of thyroidal protection by stable iodine or perchlorate in the case of acute or prolonged radioiodine exposure. Arch Toxicol 2020; 94:3231-3247. [PMID: 32656655 PMCID: PMC7415763 DOI: 10.1007/s00204-020-02809-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/15/2020] [Indexed: 12/14/2022]
Abstract
In the case of a nuclear power plant accident, repetitive/prolonged radioiodine release may occur. Radioiodine accumulates in the thyroid and by irradiation enhances the risk of cancer. Large doses of non-radioactive iodine may protect the thyroid by inhibiting radioiodine uptake into the gland (iodine blockade). Protection is based on a competition at the active carrier site in the cellular membrane and the Wolff-Chaikoff effect, the latter being, however, only transient (24-48 h). Perchlorate may alternatively provide protection by a carrier competition mechanism only. Perchlorate has, however, a stronger affinity to the carrier than iodide. Based on an established biokinetic-dosimetric model developed to study iodine blockade, and after its extension to describe perchlorate pharmacokinetics and the inhibition of iodine transport through the carrier, we computed the protective efficacies that can be achieved by stable iodine or perchlorate in the case of an acute or prolonged radioiodine exposure. In the case of acute radioiodine exposure, perchlorate is less potent than stable iodine considering its ED50. A dose of 100 mg stable iodine has roughly the same protective efficacy as 1000 mg perchlorate. For prolonged exposures, single doses of protective agents, whether stable iodine or perchlorate, offer substantially lower protection than after acute radioiodine exposure, and thus repetitive administrations seem necessary. In case of prolonged exposure, the higher affinity of perchlorate for the carrier in combination with the fading Wolff-Chaikoff effect of iodine confers perchlorate a higher protective efficacy compared to stable iodine. Taking into account the frequency and seriousness of adverse effects, iodine and perchlorate at equieffective dosages seem to be alternatives in case of short-term acute radioiodine exposure, whereas preference should be given to perchlorate in view of its higher protective efficacy in the case of longer lasting radioiodine exposures.
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Affiliation(s)
- Stefan Eder
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Cornelius Hermann
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Andreas Lamkowski
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Manabu Kinoshita
- Japan Self Defense Forces National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Tetsuo Yamamoto
- Japan Ground Self Defense Forces Military Medicine Research Unit and Ministry of Defense Clinic, Tokyo, Japan
| | - Michael Abend
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Nariyoshi Shinomiya
- Japan Self Defense Forces National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany
| | - Alexis Rump
- Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937, Munich, Germany.
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Beinke C, Scherthan H, Port M, Popp T, Hermann C, Eder S. Triterpenoid CDDO-Me induces ROS generation and up-regulates cellular levels of antioxidative enzymes without induction of DSBs in human peripheral blood mononuclear cells. Radiat Environ Biophys 2020; 59:461-472. [PMID: 32409897 PMCID: PMC7369132 DOI: 10.1007/s00411-020-00847-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 04/30/2020] [Indexed: 05/11/2023]
Abstract
Ionizing radiation produces reactive oxygen species (ROS) leading to cellular DNA damage. Therefore, patients undergoing radiation therapy or first responders in radiological accident scenarios could both benefit from the identification of specifically acting pharmacological radiomitigators. The synthetic triterpenoid bardoxolone-methyl (CDDO-Me) has previously been shown to exert antioxidant, anti-inflammatory and anticancer activities in several cell lines, in part by enhancing the DNA damage response. In our study, we examined the effect of nanomolar concentrations of CDDO-Me in human peripheral blood mononuclear cells (PBMC). We observed increased cellular levels of the antioxidative enzymes heme oxygenase-1 (HO-1), NAD(P)H dehydrogenase (quinone1) and mitochondrial superoxide dismutase 2 by immunoblotting. Surprisingly, we found increased intracellular ROS-levels using imaging flow-cytometry. However, the radiation-induced DNA double-strand break (DSB) formation using the γ-H2AX + 53BP1 DSB focus assay and the cytokinesis-block micronucleus assay both revealed, that nanomolar CDDO-Me pre-treatment of PBMC for 2 h or 6 h ahead of X irradiation with 2 Gy did neither significantly affect γ-H2AX + 53BP1 DSB foci formation nor the frequency of micronuclei. CDDO-Me treatment also failed to alter the nuclear division index and the frequency of IR-induced PBMC apoptosis as investigated by Annexin V-labeled live-cell imaging. Our results indicate that pharmacologically increased cellular concentrations of antioxidative enzymes might not necessarily exert radiomitigating short-term effects in IR-exposed PBMC. However, the increase of antioxidative enzymes could also be a result of a defensive cellular mechanism towards elevated ROS levels.
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Affiliation(s)
- Christina Beinke
- Bundeswehr Institute of Radiobiology Affiliated to the University Ulm, Neuherbergstr. 11, 80937, Munich, Germany.
| | - Harry Scherthan
- Bundeswehr Institute of Radiobiology Affiliated to the University Ulm, Neuherbergstr. 11, 80937, Munich, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology Affiliated to the University Ulm, Neuherbergstr. 11, 80937, Munich, Germany
| | - Tanja Popp
- Bundeswehr Institute of Radiobiology Affiliated to the University Ulm, Neuherbergstr. 11, 80937, Munich, Germany
| | - Cornelius Hermann
- Bundeswehr Institute of Radiobiology Affiliated to the University Ulm, Neuherbergstr. 11, 80937, Munich, Germany
| | - Stefan Eder
- Bundeswehr Institute of Radiobiology Affiliated to the University Ulm, Neuherbergstr. 11, 80937, Munich, Germany
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich (LMU), Munich, Germany
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Beinke C, Wanke C, Eder S, Port M. Cytogenetic Analysis After Temporary Residence in the Area of the Uncontrolled Ruthenium-106 Release in Russia in September 2017. Health Phys 2019; 117:598-605. [PMID: 31124834 DOI: 10.1097/hp.0000000000001097] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In September and October 2017, elevated atmospheric ruthenium contamination was measured in several European countries. The most probable origin of this release of radionuclides was reconstructed to be the Southern Ural region. During that time, five workers from a German company stayed up to 2 wk about 120 km from the Chelyabinsk region in Ekaterinburg, Russia. No clinical symptoms were reported during or after the suspected radiation exposure, and no internal contamination was found in whole-body measurements. However, to investigate radiation protection issues and to clarify the workers' situation in order to reassure them, as they planned to continue working in Ekaterinburg, our laboratory was urgently requested by the company's occupational physician to perform biodosimetry using dicentric analysis to determine if the workers have been exposed to radiation by incorporation of radionuclides. The workers' dicentric yields have been compared to reference data of background frequencies in unexposed individuals, but, as it is not reasonable to quantify individual absorbed radiation doses from internalized beta emitters due to various confounding factors, individual dose estimation has not been performed. Dicentric frequencies for two workers differed significantly from the mean laboratory background level, which could have been induced by an exposure to incorporated radionuclides due to beta emissions by Ru or to gamma irradiation by the decay nuclide of Ru. However, the maximum absorbed radiation doses calculated for a resident in the Ru-contaminated area during that time does not correspond to the observed dicentric frequencies. It cannot be excluded that their dicentric frequencies were already elevated before September 2017, potentially induced by an earlier radiation exposure to diagnostic x rays or even by chance.
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Affiliation(s)
- C Beinke
- Bundeswehr Institute of Radiobiology affiliated with the University Ulm, Munich, Germany
| | - C Wanke
- Medizinische Hochschule Hannover, Stabsstelle Strahlenschutz und Abteilung Medizinische Physik
| | - S Eder
- Bundeswehr Institute of Radiobiology affiliated with the University Ulm, Munich, Germany
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Inner City Clinic, University Hospital of Munich (LMU), Munich, Germany
| | - M Port
- Bundeswehr Institute of Radiobiology affiliated with the University Ulm, Munich, Germany
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Rump A, Eder S, Lamkowski A, Kinoshita M, Yamamoto T, Abend M, Shinomiya N, Port M. Development of New Biokinetic-Dosimetric Models for the Simulation of Iodine Blockade in the Case of Radioiodine Exposure in Man. Drug Res (Stuttg) 2019; 69:583-597. [PMID: 31390663 DOI: 10.1055/a-0960-5590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the case of nuclear incidents, radioiodine may be liberated. After incorporation it accumulates in the thyroid and by internal irradiation enhances the risk of cancer occurrence. By administering a large dose of non-radioactive iodine the uptake of radioiodine into the gland can be inhibited ("iodine blockade"). Biokinetic models using first order kinetics are not suited to simulate iodine blockade, as the uptake into the gland is mediated by a saturable active transport. Therefore, we integrated an uptake mechanism described by a Michaelis-Menten kinetic into a simple ICRP biokinetic model. We moreover added a total uptake blocking mechanism representing the Wolff-Chaikoff effect becoming active when the gland is saturated with iodine. The validity of the model was ascertained by comparison with IMBA software. The competition of radioiodine and stable iodine at the membrane carrier site was modeled according to the rate law for monomolecular reactions for competing substrates. Our simulations show that competition for the uptake at the membrane carrier site accounts for about 60% and the saturation of the gland with iodine for over 35% of the total protective efficacy that exceeds 95%. Following acute radioiodine exposure, it is preferable to administer a single large dose of stable iodine. In the case of continuous radioiodine exposure, a single dose of stable iodine is less effective than after an acute exposure and splitting the total available dose and shortening the dosage intervals enhance efficacy. Model-based simulations may be a useful tool to develop antidote dosage schemes for uncommon emergencies.
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Affiliation(s)
- Alexis Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Stefan Eder
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | | | - Manabu Kinoshita
- Japan Self Defense Forces, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Tetsuo Yamamoto
- Japan Ground Self Defense Forces, Military Medicine Research Unit and Ministry of Defense Clinic, Tokyo, Japan
| | - Michael Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Nariyoshi Shinomiya
- Japan Self Defense Forces, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
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Rump A, Eder S, Lamkowski A, Hermann C, Abend M, Port M. A quantitative comparison of the chemo- and radiotoxicity of uranium at different enrichment grades. Toxicol Lett 2019; 313:159-168. [PMID: 31276769 DOI: 10.1016/j.toxlet.2019.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 04/16/2019] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The radiotoxic effects of uranium are often in the focus of the public fears but the chemical toxic effects of uranium are reported to surpass radiation effects. As there is no uranium isotope that is not radioactive, it is not possible to study chemical effects fully independently from radiation effects. In order to quantitate and compare radio- and chemotoxicity, we determined the median lethal doses of uranium due to its chemical toxicity and calculated the absorbed radiological doses resulting from the ingestion or inhalation of corresponding amounts depending on the isotopic enrichment grade. Committed effective doses over 50 years are related to the stochastic health effects like cancer occurrence and can be converted to a loss of statistical life time (mean loss 0.4 day / mSv). The equivalent doses absorbed within a short time frame permits conclusion on the induction of deterministic effects (e.g. acute radiation sickness). METHOD Simulations were based on the biokinetic models of the International Commission for Radioprotection and performed using Integrated Modules for Bioassay Analysis software. Results were compared with the doses given by the calculator of the WISE uranium project. The fractions of the total doses absorbed within different time periods were derived from the respective areas under the activity-time curves in the whole body. RESULTS The distribution of the total dose on the organs and tissues depends on the invasion pathway and the solubility of the compound. In the case of inhalation, the absorption of the total dose is more protracted than after ingestion. The incorporation of depleted or natural uranium in lethal amounts due to nephrotoxicity does not lead to deterministic radiation effects and is associated with committed effective doses reaching at most about 200 mSv (proposed possible threshold for therapeutic interventions after accidental radionuclide incorporation). The inhalation of low enriched uranium leads to higher effective doses up to 690 mSv, but they are still insufficient to cause acute deterministic effects. Even highly enriched uranium seems not to induce radiation nephropathy, but deterministic effects on the hematopoetic system cannot be excluded in particularly sensitive patients. But the equivalent doses to the lungs associated with the inhalation of poorly soluble compounds of highly enriched uranium are in a range that may induce radiation pneumonitis. CONCLUSION Our findings give clear evidence that for depleted and natural uranium chemical toxicity is much more marked than radiotoxicity. However, this conclusion must not be drawn for enriched and in particular highly enriched compounds that besides stochastic effects may even cause deterministic radiation effects.
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Affiliation(s)
- A Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany.
| | - S Eder
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - A Lamkowski
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - C Hermann
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - M Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - M Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
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Koutsamanis I, Eder S, Beretta M, Witschnigg A, Paudel A, Nickisch K, Friedrich M, Eggenreich K, Roblegg E. Formulation and processability screening for the rational design of ethylene-vinyl acetate based intra-vaginal rings. Int J Pharm 2019; 564:90-97. [DOI: 10.1016/j.ijpharm.2019.04.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 10/27/2022]
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Rump A, Ostheim P, Lamkowski A, Eder S, Abend M, Port M. Decorporation therapy. The “Precautionary approach” versus the “Urgent approach”. BIO Web Conf 2019. [DOI: 10.1051/bioconf/20191406009] [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: 11/14/2022] Open
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Daskalaki W, Wardelmann E, Port M, Stock K, Steinestel J, Huss S, Sperveslage J, Steinestel K, Eder S. Expression levels of hnRNP K and p21WAF1/CIP1 are associated with resistance to radiochemotherapy independent of p53 pathway activation in rectal adenocarcinoma. Int J Mol Med 2018; 42:3269-3277. [PMID: 30272263 PMCID: PMC6202084 DOI: 10.3892/ijmm.2018.3898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 08/14/2018] [Indexed: 12/17/2022] Open
Abstract
Ionizing radiation (IR) is frequently applied in the treatment of rectal adenocarcinoma, however, there is marked variance in the response to radiochemotherapy between individual tumors. In our previous investigations, it was shown that the overexpression of heterogeneous nuclear ribonucleoprotein K (hnRNP K) confers radioresistance to malignant melanoma and colorectal carcinoma (CRC) in vitro, however, the underlying mechanism remains to be elucidated. As hnRNP K, a p53 binding partner and cofactor for the transcriptional activation of p53 target genes, is overexpressed in CRC, the present study investigated the possible radioprotective effect of the hnRNP K/p53-induced upregulation of p21 (also known as WAF1/CIP1) in rectal adenocarcinoma. Immunohistochemistry was performed for hnRNP K, p53 and p21 in a series of 68 consecutive cases of rectal adenocarcinoma with full molecular characterization following radiochemo-therapy and 14 corresponding pre-therapeutic biopsies, and the results were correlated with clinicopathological characteristics and the percentage of vital tumor cells following therapy. In addition, pathway analyses, protein immunoprecipitation, western immunoblotting and immunofluorescence microscopy were performed to identify dysregulated kinase signaling and hnRNP K targets upon exposure of CRC cells to IR. Although the fraction of vital tumor cells upon neoadjuvant therapy was significantly higher in hnRNP K/p21-positive tumors (P=0.0047 and P=0.0223, Students’ t-test), no significant association was found between the protein expression levels of hnRNP K, p53 and p21 (P>0.05, χ2 test). Irradiation enhanced apoptotic pathway activation via p53/CHK2 phosphorylation and poly (ADP-ribose) polymerase cleavage, and induced the overexpression and interaction of hnRNP K and p53. However, p53 Ser15-phosphorylation was independent of the presence of hnRNP K, and there was no measurable effect of hnRNP K on the expression of p21 in vitro. Taken together, the results of the present study support a radioprotective role for hnRNP K, which may be mediated through an interaction with p53, however, this effect appears to be independent of the hnRNP K/p53-induced upregulation of p21 in rectal adenocarcinoma.
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Affiliation(s)
- Wassiliki Daskalaki
- Gerhard‑Domagk‑Institute of Pathology, University Hospital Münster, D‑48149 Münster, Germany
| | - Eva Wardelmann
- Gerhard‑Domagk‑Institute of Pathology, University Hospital Münster, D‑48149 Münster, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology Affiliated to The University of Ulm, D‑80937 Munich, Germany
| | - Katharina Stock
- Gerhard‑Domagk‑Institute of Pathology, University Hospital Münster, D‑48149 Münster, Germany
| | - Julie Steinestel
- Department of Urology, University Hospital Münster, D‑48149 Münster, Germany
| | - Sebastian Huss
- Gerhard‑Domagk‑Institute of Pathology, University Hospital Münster, D‑48149 Münster, Germany
| | - Jan Sperveslage
- Gerhard‑Domagk‑Institute of Pathology, University Hospital Münster, D‑48149 Münster, Germany
| | - Konrad Steinestel
- Gerhard‑Domagk‑Institute of Pathology, University Hospital Münster, D‑48149 Münster, Germany
| | - Stefan Eder
- Bundeswehr Institute of Radiobiology Affiliated to The University of Ulm, D‑80937 Munich, Germany
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Rump A, Becker B, Eder S, Lamkowski A, Abend M, Port M. Medical management of victims contaminated with radionuclides after a "dirty bomb" attack. Mil Med Res 2018; 5:27. [PMID: 30086798 PMCID: PMC6080556 DOI: 10.1186/s40779-018-0174-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 04/06/2018] [Accepted: 07/23/2018] [Indexed: 01/05/2023] Open
Abstract
A wide spectrum of scenarios may lead to radiation incidents and the liberation of radioactive material. In the case of a terrorist attack by a "dirty bomb", there is a risk of mechanical and thermal trauma, external irradiation, superficial contamination and incorporation of radioactive material. The first treatment priority must be given to the care of trauma patients with life-threatening injuries, as the health effects of radiation occur with latency. Radionuclide incorporation will lead to a longer-lasting irradiation from inside the body, associated with a higher risk of stochastic radiation effects (e.g., occurrence of tumors) in the long run. It must be expected that victims with potentially incorporated radionuclides will far outnumber trauma patients. The elimination of radionuclides can be enhanced by the administration of decorporation agents such as (Ca) Diethylenetriaminepentaacetic acid (DTPA) or Prussian blue, reducing the radiological burden of the body. There is still no consensus whether decorporation treatment should be started immediately based only on a suspicion of radionuclide incorporation ("urgent approach") or if the results of internal dosimetry confirming the necessity of a treatment should be awaited, accepting the delay caused by the measurements and computations ("precautionary approach"). As the therapeutic effectiveness may be substantially decreased if treatment initiation is delayed only by several days, depending on the radionuclide, the physicochemical properties of the compounds involved and the route of absorption, we favor an "urgent approach" from a medical point of view. In doubt, it seems justified to treat victims by precaution, as the adverse effects of the medication seem minimal. However, in the case of a high number of victims, an "urgent treatment approach" may require a large number of daily doses of antidotes, and therefore, adequate investments in preparedness and antidote stockpiling are necessary.
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Affiliation(s)
- Alexis Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany.
| | | | - Stefan Eder
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | | | - Michael Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
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Wernly B, Eder S, Navarese EP, Marcus F, Lichtenauer M, Datz C, Frank F, Landmesser U, Hoppe UC, Jung C, Lauten A. P3519Transcatheter aortic valves replacement for pure aortic valve regurgitation constitutes a valid option in high risk patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Wernly
- Paracelsus Private Medical University, Salzburg, Austria
| | - S Eder
- Hospital Oberndorf, Internal Medicine, Oberndorf, Austria
| | - E P Navarese
- Inova Heart and Vascular Institute, Interventional Cardiology and Cardiovascular Medicine Research, Falls Church, United States of America
| | - F Marcus
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - M Lichtenauer
- Paracelsus Private Medical University, Salzburg, Austria
| | - C Datz
- Hospital Oberndorf, Internal Medicine, Oberndorf, Austria
| | - F Frank
- Charité - Universitätsmedizin Berlin, Department of Cardiology, Berlin, Germany
| | - U Landmesser
- Charité - Universitätsmedizin Berlin, Department of Cardiology, Berlin, Germany
| | - U C Hoppe
- Paracelsus Private Medical University, Salzburg, Austria
| | - C Jung
- University Duesseldorf, Division of Cardiology, Pulmonology, and Vascular Medicine, Duesseldorf, Germany
| | - A Lauten
- Charité - Universitätsmedizin Berlin, Department of Cardiology, Berlin, Germany
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Arndt A, Steinestel K, Rump A, Sroya M, Bogdanova T, Kovgan L, Port M, Abend M, Eder S. Anaplastic lymphoma kinase (ALK) gene rearrangements in radiation-related human papillary thyroid carcinoma after the Chernobyl accident. J Pathol Clin Res 2018; 4:175-183. [PMID: 29633575 PMCID: PMC6065115 DOI: 10.1002/cjp2.102] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 01/01/2023]
Abstract
Childhood radiation exposure has been associated with increased papillary thyroid carcinoma (PTC) risk. The role of anaplastic lymphoma kinase (ALK) gene rearrangements in radiation‐related PTC remains unclear, but STRN‐ALK fusions have recently been detected in PTCs from radiation exposed persons after Chernobyl using targeted next‐generation sequencing and RNA‐seq. We investigated ALK and RET gene rearrangements as well as known driver point mutations in PTC tumours from 77 radiation‐exposed patients (mean age at surgery 22.4 years) and PTC tumours from 19 non‐exposed individuals after the Chernobyl accident. ALK rearrangements were detected by fluorescence in situ hybridisation (FISH) and confirmed with immunohistochemistry (IHC); point mutations in the BRAF and RAS genes were detected by DNA pyrosequencing. Among the 77 tumours from exposed persons, we identified 7 ALK rearrangements and none in the unexposed group. When combining ALK and RET rearrangements, we found 24 in the exposed (31.2%) compared to two (10.5%) in the unexposed group. Odds ratios increased significantly in a dose‐dependent manner up to 6.2 (95%CI: 1.1, 34.7; p = 0.039) at Iodine‐131 thyroid doses >500 mGy. In total, 27 cases carried point mutations of BRAF or RAS genes, yet logistic regression analysis failed to identify significant dose association. To our knowledge we are the first to describe ALK rearrangements in post‐Chernobyl PTC samples using routine methods such as FISH and IHC. Our findings further support the hypothesis that gene rearrangements, but not oncogenic driver mutations, are associated with ionising radiation‐related tumour risk. IHC may represent an effective method for ALK‐screening in PTCs with known radiation aetiology, which is of clinical value since oncogenic ALK activation might represent a valuable target for small molecule inhibitors.
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Affiliation(s)
- Annette Arndt
- Institute of Pathology and Molecular Pathology, Bundeswehrkrankenhaus Ulm, Ulm, Germany
| | - Konrad Steinestel
- Institute of Pathology and Molecular Pathology, Bundeswehrkrankenhaus Ulm, Ulm, Germany
| | - Alexis Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Manveer Sroya
- Imperial College London, Charing Cross Hospital, London, UK
| | - Tetiana Bogdanova
- State Institution V.P. Kommissarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - Leonila Kovgan
- Division of Dosimetry and Radiation Hygiene, Scientific Research Center for Radiation Medicine, Kiev, Ukraine
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Michael Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Stefan Eder
- Bundeswehr Institute of Radiobiology, Munich, Germany.,Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich (LMU), Munich, Germany
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Lamkowski A, Kreitlow M, Radunz J, Willenbockel M, Sabath F, Schuhn W, Stiemer M, Fichte LO, Dudzinski M, Böhmelt S, Ullmann R, Majewski M, Franchini V, Eder S, Rump A, Port M, Abend M. Gene Expression Analysis in Human Peripheral Blood Cells after 900 MHz RF-EMF Short-Term Exposure. Radiat Res 2018; 189:529-540. [DOI: 10.1667/rr14909.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Andreas Lamkowski
- Bundeswehr Institute of Radiobiology, Munich, Germany
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, AllergieZENTRUM, Klinikum der Universität München, Munich, Germany
| | - Matthias Kreitlow
- NBC-Protection, Bundeswehr Research Institute for Protective Technology, Munster, Germany
| | - Jörg Radunz
- NBC-Protection, Bundeswehr Research Institute for Protective Technology, Munster, Germany
| | - Martin Willenbockel
- NBC-Protection, Bundeswehr Research Institute for Protective Technology, Munster, Germany
| | - Frank Sabath
- NBC-Protection, Bundeswehr Research Institute for Protective Technology, Munster, Germany
| | - Winfried Schuhn
- NBC-Protection, Bundeswehr Research Institute for Protective Technology, Munster, Germany
| | - Marcus Stiemer
- Theory of Electrical Engineering, Helmut Schmidt University of the Federal Armed Forces, Hamburg, Germany
| | - Lars Ole Fichte
- Theory of Electrical Engineering, Helmut Schmidt University of the Federal Armed Forces, Hamburg, Germany
| | - Michael Dudzinski
- Theory of Electrical Engineering, Helmut Schmidt University of the Federal Armed Forces, Hamburg, Germany
| | - Sebastian Böhmelt
- Theory of Electrical Engineering, Helmut Schmidt University of the Federal Armed Forces, Hamburg, Germany
| | | | | | | | - Stefan Eder
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Alexis Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Michael Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
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Rump A, Stricklin D, Lamkowski A, Eder S, Abend M, Port M. Analysis of the antidote requirements and outcomes of different radionuclide decorporation strategies for a scenario of a "dirty bomb" attack. Am J Disaster Med 2018; 12:227-241. [PMID: 29468625 DOI: 10.5055/ajdm.2017.0276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE In radiological emergencies, there is a risk of radionuclide incorporation. The radiological doses absorbed can be reduced by decorporation treatment. Antidote requirements depend on the scenario and treatment strategy ("urgent approach": immediate treatment of all patients with possible incorporation; "precautionary approach": treatment only after confirmation of incorporation). We calculated the number of daily antidote doses for different scenarios and the differences in outcome for both treatment strategies. DESIGN The number of potentially contaminated victims was varied from 1,000 to 60,000 (a maximum that might seem plausible for "dirty bomb" scenarios in Germany), the proportion of patients actually needing decorporation treatment from 0.1 percent to 100 percent, the radioactive screening capacities from 250 to 2,500 people/day and treatment duration from 10 to 90 days. The outcomes were assessed as total statistical lifetime saved assuming an inhalation of 1 mCi cesium-137 and the achievable dose reductions by a Prussian Blue treatment. RESULTS Assuming 1 percent of the potentially contaminated people actually needing treatment, applying an "urgent approach" the requirements for 1,000 victims range from 1,100 to 3,400 and for 60,000 victims from 489,000 to 4,400,000 daily doses, depending on treatment duration and screening capacities. The "urgent approach" is associated with larger stockpile requirements than the "precautionary approach", up to several hundred times in large-scale scenarios if the proportion of people actually needing treatment is low. The impact of the screening capacities is particularly important in large-scale scenarios, a low proportion of people needing treatment and extended treatment duration. The outcome is better for an "urgent approach" particularly in large-scale scenarios and low screening capacities. CONCLUSIONS If only a small fraction of the victims actually needs treatment, their timely identification by enhancing screening capacities may be the most efficacious way to reduce antidote requirements. In large-scale scenarios, it might be necessary to abandon the medically preferable "urgent approach" for an antidote-sparing "precautionary approach".
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Affiliation(s)
- Alexis Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | | | | | - Stefan Eder
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Michael Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
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Rump A, Stricklin D, Lamkowski A, Eder S, Port M. Benefit-Cost Analysis of Radiocesium Decorporation by a Prussian Blue Treatment and Stockpiling. Drug Res (Stuttg) 2017; 68:89-99. [PMID: 29036734 DOI: 10.1055/s-0043-119793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In the case of an attack by a "dirty bomb" with cesium-137 there is a risk of internal contamination. The excretion of cesium-137 can be enhanced by Prussian Blue (PB), and thus the committed effective dose be reduced. We analyzed the benefit and costs of PB decorporation treatment. We simulated the reduction of the radiological dose by PB treatment after cesium-137 incorporation by inhalation. The saving of life time was quantified using the monetary "value of a statistical life" (VSL). Treatment costs were based on the market price of PB in Germany. Moreover we considered the holding costs of stockpiling. The benefit of PB treatment increases with its duration up to about 90 days. If treatment initiation is delayed, the maximum achievable benefit is decreased. For a VSL of 1.646 million €, the net benefit of a 90-days treatment started 1 day after the incorporation remains positive up to a stockpiling duration of 10 years. If starting PB treatment as late as the 180th day after incorporation, the costs will surpass the benefit. We conclude that a prompt decision making and early treatment initiation greatly impacts on the medical but also economic efficiency of a PB treatment.
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Affiliation(s)
- Alexis Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | | | | | - Stefan Eder
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
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Edlinger C, Granitz M, Paar V, Jung C, Pfeil A, Eder S, Wernly B, Kammler J, Hergan K, Hoppe UC, Steinwender C, Lichtenauer M, Kypta A. P437Analysis of artifact characteristics of leadless pacemaker systems in cardiac MRI: results from an ex vivo model. Europace 2017. [DOI: 10.1093/ehjci/eux141.160] [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: 11/14/2022] Open
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Cousino M, Rea K, Zamberlan M, Jordan J, Eder S, Fredericks E, Schumacher K. Psychosocial Screening in Pediatric Heart Transplant Recipients and Their Families. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.997] [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: 10/19/2022] Open
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Dissemond J, Eder S, Läuchli S, Partsch H, Stücker M, Vanscheidt W. [Compression therapy of venous leg ulcers in the decongestion phase]. Med Klin Intensivmed Notfmed 2017; 113:552-559. [PMID: 28078355 DOI: 10.1007/s00063-016-0254-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/23/2016] [Indexed: 11/25/2022]
Abstract
Compression therapy is the basis for successful treatment in most patients with venous leg ulcers. Concerning compression therapy, the initial phase of decongestion and the following phase of maintenance should be differentiated. While in the maintenance phase (ulcer) stocking systems are now frequently recommended, in the decongestion phase compression bandages are mostly still used, which however are often inappropriately applied. In German-speaking countries, compression therapy with short-stretch bandages has a long tradition. However, their correct application requires good training and monitoring, which is often lacking in daily practice. Less error-prone treatment alternatives are multicomponent systems, some of which have an optical marker for the control of the correct subbandage pressure. In another new type of compression system, which is called adaptive or wrap bandages, the compression pressure can be adjusted using a Velcro fastener. Accompanying intermittent pneumatic compression therapy can also be used in the decongestion phase. Thus, there are now several different treatment options that can be used for the decongestion phase in patients with venous leg ulcers. Often bandages with short-stretch materials are very prone to errors and should in most cases be replaced by other compression systems today. The patient's preference, need, and capability should be considered when selecting the appropriate system for the individual patient.
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Affiliation(s)
- J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland.
| | - S Eder
- Klinik für Gefäßchirurgie und Gefäßmedizin, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Deutschland
| | - S Läuchli
- Dermatologische Klinik, UniversitätsSpital Zürich, Zürich, Schweiz
| | - H Partsch
- , Steinhäusl 126, 3033, Altlengbach, Österreich
| | - M Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - W Vanscheidt
- Hautarztpraxis, Paula-Modersohn-Platz 3, 79100, Freiburg, Deutschland
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Rump A, Stricklin D, Lamkowski A, Eder S, Abend M, Port M. The Incorporation of Radionuclides After Wounding by a "Dirty Bomb": The Impact of Time for Decorporation Efficacy and a Model for Cases of Disseminated Fragmentation Wounds. Adv Wound Care (New Rochelle) 2017; 6:1-9. [PMID: 28116223 PMCID: PMC5220565 DOI: 10.1089/wound.2016.0693] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/29/2016] [Indexed: 01/30/2023] Open
Abstract
Objective: In the case of a terrorist attack by a "dirty bomb" there is a risk of internal contamination with radionuclides through inhalation and wounds. We studied the efficacy of a decorporation treatment depending on the initiation time and duration. Approach: Based on biokinetic models, we simulated the impact of different diethylenetriaminepentaacetic acid treatments on the committed effective dose after the incorporation of plutonium-239. Results: For the same level of radioactivity, the dose was higher after the fast absorption from the wound than after a slow invasion following inhalation. The impact of the treatment initiation time was particularly important in the case of the internal contamination through the wound. Ending the treatment at an early point in time was followed by an augmentation of radioactivity in the blood compartment, reflecting insufficient treatment duration. Treatment efficacy increased only marginally if extended over 90 days. Innovation and Conclusion: For plutonium-239, the committed effective dose and the impact of the treatment initiation time on therapeutic efficacy predominantly depend on the speed of invasion, i.e., the pathway and the physicochemical properties of the compounds involved. Thus, it is prudent to start decorporation therapy as soon as possible, as a loss of efficacy resulting from a delay in treatment initiation cannot be compensated later on. In the case of plutonium-239 incorporation, the treatment must be continued for several months. Multiple fragmentation wounds might be aggregated to a single wound model suited for internal dosimetry calculations by using the "rule of nine."
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Affiliation(s)
- Alexis Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | | | | | - Stefan Eder
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Michael Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
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Eder S, Labopin M, Finke J, Bunjes D, Olivieri A, Santarone S, Rambaldi A, Kanz L, Messina G, Mohty M, Nagler A. Safety and efficacy of thiotepa-based conditioning for allogeneic transplantation in AML: a survey from the ALWP of the EBMT. Bone Marrow Transplant 2016; 52:238-244. [PMID: 27643865 DOI: 10.1038/bmt.2016.239] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/22/2016] [Accepted: 07/27/2016] [Indexed: 12/27/2022]
Abstract
This study evaluated the safety and efficacy of thiotepa-based regimens before allogeneic stem cell transplantation in 310 adult patients with AML. Disease status at the time of transplantation was CR1 in 50%, CR2+ in 23.5% and advanced disease in 26.5%. Transplantation was performed from haploidentical (35%), matched sibling (27%), unrelated (20%) or cord blood (18%) donors. As for safety: mucositis occurred in 46.8% of the patients and the cumulative incidence (CI) of sinusoidal obstruction syndrome was 4.0%. With a median follow-up of 37 months, the CI of acute GvHD grade>II was 26.5%, whereas CI of chronic GvHD was 28.1% at 3 years. CI for non-relapse mortality at 3 years was 38.4%, 49.7% and 45.4% for patients in CR1, CR2+ and advanced disease, respectively (P=0.10). Relapse incidence at 3 years was 20.2, 30.7 and 40.6% in these three respective groups (P=0.002). CI for 3-year leukemia-free survival and overall survival were 41.4% and 45.6% (CR1), 19.6% and 27.7% (CR2+), and 13.9% and 13.6% (advanced disease), respectively (P<10-4 for both). Our data suggest that thiotepa-based conditioning therapy in AML is feasible, effective and safe, as investigated for sinusoidal obstruction syndrome and mucositis.
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Affiliation(s)
- S Eder
- EBMT Office Paris, Hôpital Saint-Antoine, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - M Labopin
- EBMT Office Paris, Hôpital Saint-Antoine, Paris, France
| | - J Finke
- Department of Medicine-Hematology, Oncology, University of Freiburg, Freiburg, Germany
| | - D Bunjes
- Klinik fuer Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - A Olivieri
- Department of Hematology, Azienda Ospedali Riuniti di Ancona, Ancona-Torrete, Italy
| | - S Santarone
- Department of Hematology, Ospedale Civile, Pescara, Italy
| | - A Rambaldi
- USC Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - L Kanz
- Abteilung II, Universität Tübingen, Tübingen, Germany
| | - G Messina
- Centro Trapianti Midollo Osseo, Azienda Ospedaliera 'BMM', Reggio Calabria, Italy
| | - M Mohty
- EBMT Office Paris, Hôpital Saint-Antoine, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - A Nagler
- EBMT Office Paris, Hôpital Saint-Antoine, Paris, France.,Chaim Sheba Medical Center, Tel-Hashomer, Israel
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Rump A, Stricklin D, Lamkowski A, Eder S, Abend M, Port M. The Impact of Time on Decorporation Efficacy After a "Dirty Bomb" Attack Studied by Simulation. Drug Res (Stuttg) 2016; 66:607-613. [PMID: 27532439 DOI: 10.1055/s-0042-112809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: In the case of a nuclear or radiological incident, there is a risk of external and internal contamination with radionuclides in addition to external irradiation. There is no consensus whether decorporation treatment should be initiated right away on spec or pending the results of internal dosimetry to determine the indication. Method: Based on biokinetic models for plutonium-239, americium-241 and cesium-137, the efficacy of a decorporation treatment using DTPA or Prussian blue was simulated depending on the initiation time and the duration of treatment for different invasion pathways and physicochemical properties of the inhaled compounds. Results: For the same level of radioactivity incorporated, the committed effective dose increases with the speed of the invasion process. The impact of the initiation time of a decorporation treatment is particularly important when the absorption of the radionuclide is fast. Even if started early after incorporation, the therapeutic efficacy is less for americium-241 or cesium-137 compared to plutonium-239. Therapeutic efficacy increases with treatment duration up to about 90 days for plutonium-239 and cesium-137, whereas a prolongation of the treatment over this limit may further enhance efficacy in the case of americium-241. Conclusion: In the case of a nuclear incident, several fractions with different but a priori unknown physicochemical properties may be inhaled. Thus, decorporation therapy should be started as soon as possible after the incorporation of the radionuclide(s), as a loss of efficacy caused by a delay of treatment initiation possibly cannot be compensated later on. Treatment should be pursued for several months.
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Affiliation(s)
- A Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - D Stricklin
- Applied Research Associates Inc., Health Effects and Risk Assessment, Arlington, VA, USA
| | - A Lamkowski
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - S Eder
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - M Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - M Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
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Rump A, Stricklin D, Lamkowski A, Eder S, Abend M, Port M. Reconsidering Current Decorporation Strategies after Incorporation of Radionuclides. Health Phys 2016; 111:204-211. [PMID: 27356066 DOI: 10.1097/hp.0000000000000473] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In the case of a nuclear accident or a terrorist attack by a "dirty bomb," there is a risk of external and internal contamination with radionuclides in addition to external irradiation. Internal irradiation as a consequence of radionuclide incorporation is associated with a higher risk of stochastic radiation effects (e.g., tumors). Decorporation treatment will enhance the elimination of radionuclides and reduce the committed effective dose as a metric of stochastic health effects. Although treatment efficacy is better when started early, beginning the therapy without knowing the committed effective dose may unnecessarily expose the patient to the side effects of the medication. The question is: Delay the therapy to wait for the results of internal dosimetry or start the therapy promptly on spec? To prove insight into this question, a selective review of the literature was conducted. The importance of the initiation time of treatment in the efficacy of decorporation treatment can be explained with pharmacokinetic laws and first order processes determining the disposition of xenobiotics in the organism. Nevertheless, there is no internationally accepted standard on when to start a decorporation therapy (exception: iodide). The "precautionary approach," emphasizing the importance of the committed effective dose for the indication of treatment, is competing with the "urgent approach" advocating the administration of medication "a priori" within several hours. A review of the literature actually indicates that the most important drugs used for decorporation are well tolerated with few adverse effects. In consideration of the higher efficacy and the low side-effects of a short-term treatment, initiating decorporation therapy as soon as possible after internal contamination, even before the committed effective dose has been assessed, appears to be a reasonable approach. The decision of continuation or discontinuation of the therapy should be taken after internal dosimetry is completed on the basis of the committed effective dose.
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Affiliation(s)
- A Rump
- *Institute of Radiobiology of the Bundeswehr, Munich; †Applied Research Associates Inc., Arlington
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Eder S, Lamkowski A, Priller M, Port M, Steinestel K. Radiosensitization and downregulation of heterogeneous nuclear ribonucleoprotein K (hnRNP K) upon inhibition of mitogen/extracellular signal-regulated kinase (MEK) in malignant melanoma cells. Oncotarget 2016; 6:17178-91. [PMID: 26136337 PMCID: PMC4627300 DOI: 10.18632/oncotarget.3935] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/09/2015] [Indexed: 12/21/2022] Open
Abstract
Background Heterogeneous nuclear ribonucleoprotein K (hnRNP K) is an important cofactor in the p53-mediated DNA damage response pathway upon ionizing radiation (IR) and exerts anti-apoptotic effects also independent of p53 pathway activation. Furthermore, hnRNP K is overexpressed in various neoplasms including malignant melanoma (MM). Here, we investigate the role of hnRNP K in the radioresistance of MM cells. Methods and results Our results show cytoplasmic expression of hnRNP K in human MM surgical specimens, but not in benign nevi, and a quick dose- and time-dependent upregulation in response to IR accompanied by cytoplasmic redistribution of the protein in the IPC-298 cellular tumor model carrying an activating NRAS mutation (p.Q61L). SiRNA-based knockdown of hnRNP K induced a delayed decline in γH2AX/53BP1-positive DNA repair foci upon IR. Pharmacological interference with MAPK signaling abrogated ERK phosphorylation, diminished cellular hnRNP K levels, impaired γH2AX/53BP1-foci repair and proliferative capability and increased apoptosis comparable to the observed hnRNP K knockdown phenotype in IPC-298 cells. Conclusion Our results indicate that pharmacological interference with MAPK signaling increases vulnerability of NRAS-mutant malignant melanoma cells to ionizing radiation along with downregulation of endogenous hnRNP K and point towards a possible use for combined MEK inhibition and localized radiation therapy of MM in the NRAS-mutant setting where BRAF inhibitors offer no clinical benefit.
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Affiliation(s)
- Stefan Eder
- Bundeswehr Institute of Radiobiology, 80937 Munich, Germany
| | | | - Markus Priller
- Bundeswehr Institute of Radiobiology, 80937 Munich, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, 80937 Munich, Germany
| | - Konrad Steinestel
- Bundeswehr Institute of Radiobiology, 80937 Munich, Germany.,Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, 48149 Muenster, Germany
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Klaus C, Eder S, Franz C, Müller K. Successful Cryopreservation of Domestic Cat (Felis catus) Epididymal Sperm after Slow Equilibration to 15 or 10°C. Reprod Domest Anim 2016; 51:195-203. [DOI: 10.1111/rda.12666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/16/2015] [Indexed: 11/29/2022]
Affiliation(s)
- C Klaus
- Leibniz-Institut für Zoo- und Wildtierforschung; Berlin Germany
| | - S Eder
- Leibniz-Institut für Zoo- und Wildtierforschung; Berlin Germany
| | - C Franz
- Leibniz-Institut für Zoo- und Wildtierforschung; Berlin Germany
| | - K Müller
- Leibniz-Institut für Zoo- und Wildtierforschung; Berlin Germany
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Henry F, Eder S, Reynaud K, Schön J, Wibbelt G, Fontbonne A, Müller K. Seminal fluid promotes in vitro sperm-oviduct binding in the domestic cat (Felis catus). Theriogenology 2015; 83:1373-80. [PMID: 25735636 DOI: 10.1016/j.theriogenology.2015.01.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 09/03/2014] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
Abstract
From many endangered or threatened species which are expected to profit from assisted reproduction techniques, mainly epididymal sperm of dead or freshly castrated males are available. These sperm had contact to epididymal secretion products but not to seminal fluid components. Notably, products of accessory sex glands have been shown in domestic animals to condition sperm for fertilization, in particular by mediating sperm-oviduct interaction. We report for the first time that motile epididymal sperm from domestic cats are able to bind to fresh oviduct epithelial cell explants from preovulatory females (median [min, max] of 10 [8, 16] and 10 [8, 17] sperm per 0.01 mm(2) explant surface from both isthmic and ampullar regions, respectively). More sperm attach to the explants when epididymal sperm were preincubated for 30 minutes with seminal fluid separated from electroejaculates of mature tomcats (median [min, max] of 17 [13, 25] and 16 [12, 21] sperm per 0.01 mm(2) explant surface from isthmus and ampulla, respectively). The proportion of bound sperm increased from a median of 54% to 62% by seminal fluid treatment. Sperm-oviduct binding could be facilitated by the decelerated sperm motion which was observed in seminal fluid-treated samples or supported by seminal fluid proteins newly attached to the sperm surface. Seminal fluid had no effect on the proportion of sperm with active mitochondria. Extent and pattern of sperm interaction in vitro were independent of explant origin from isthmus or ampulla. Sperm were attached to both cilia and microvilli of the main epithelial cell types present in all explants. In contrast to published sperm-binding studies with porcine and bovine oviduct explants where predominantly the anterior head region of sperm was attached to ciliated cells, the tails of some cat sperm were firmly stuck to the oviduct cell surfaces, whereas the heads were wobbling. Whether this response is a preliminary step toward phagocytosis or a precondition to capacitation and fertilization remains to be determined. In conclusion, treatment of epididymal sperm with seminal fluid or particular protein components should be considered in future investigations for its potential to improve the outcome of artificial insemination in felids.
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Affiliation(s)
- F Henry
- Service de Reproduction, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - S Eder
- Abteilung Reproduktionsbiologie, Leibniz-Institut für Zoo- und Wildtierforschung, Berlin, Germany
| | - K Reynaud
- Physiologie de la Reproduction et des Comportements, UMR 7247 INRA-CNRS-Université de Tours-Haras Nationaux, Nouzilly, France
| | - J Schön
- Abteilung Reproduktionszellbiologie, Leibniz-Institut für Nutztierbiologie, Dummerstorf, Germany
| | - G Wibbelt
- Abteilung Reproduktionsbiologie, Leibniz-Institut für Zoo- und Wildtierforschung, Berlin, Germany
| | - A Fontbonne
- Service de Reproduction, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - K Müller
- Abteilung Reproduktionsbiologie, Leibniz-Institut für Zoo- und Wildtierforschung, Berlin, Germany.
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Abstract
The concept of epithelial-mesenchymal transition (EMT), a process where cells change their epithelial towards a mesenchymal phenotype, has gained overwhelming attention especially in the cancer research community. Thousands of scientific reports investigated changes in gene, mRNA and protein expression compatible with EMT and their possible correlation with tumor invasion, metastatic spread or patient prognosis; however, up to now, a proof of clinical significance of the concept is still missing. This review, with a main focus on the role of EMT in tumors, will summarize the basic molecular events underlying EMT including the signaling pathways capable of its induction as well as changes in EMT-associated protein expression and will very briefly touch the role of microRNAs in EMT. We then outline protein markers that are used most frequently for the assessment of EMT in research and diagnostic evaluation of tumor specimens and depict the link between EMT, a cancer stem cell (CSC) phenotype and resistance to conventional antineoplastic therapies. Furthermore, we evaluate a possible correlation between EMT marker expression and patient prognosis as well as current therapeutic concepts targeting the EMT process to slow down or prevent metastatic spread of malignant tumors.
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Affiliation(s)
- Konrad Steinestel
- Bundeswehr Institute of Radiobiology, Neuherbergstrasse 11, Munich 80937, Germany
- Institute of Pathology and Molecular Pathology, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, Ulm 89081, Germany
| | - Stefan Eder
- Bundeswehr Institute of Radiobiology, Neuherbergstrasse 11, Munich 80937, Germany
| | - Andres Jan Schrader
- Department of Urology, Ulm University Medical Center, Prittwitzstrasse 43, Ulm 89075, Germany
| | - Julie Steinestel
- Department of Urology, Ulm University Medical Center, Prittwitzstrasse 43, Ulm 89075, Germany
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Lamm W, Drach-Schauer B, Eder S, Drach J. Bortezomib administered subcutaneously is well tolerated in bortezomib-based combination regimens used in patients with multiple myeloma. Oncology 2013; 85:223-7. [PMID: 24080991 DOI: 10.1159/000355197] [Citation(s) in RCA: 14] [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] [Received: 06/28/2013] [Accepted: 08/19/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Bortezomib (Btz) has emerged as a standard of care in the treatment of patients with multiple myeloma (MM), but Btz-induced peripheral neuropathy (PNP) has a particularly negative impact on patients' quality of life. According to a recent study, PNP was significantly less frequent with subcutaneous administration of Btz. Here, we report our experience regarding the efficacy and tolerability of standard combination regimens in MM with subcutaneous Btz. METHODS 14 consecutive patients with newly diagnosed MM were included in this analysis. Btz was used in different combination regimens (Btz with dexamethasone with/without thalidomide or Btz combined with melphalan and prednisone). Standard criteria were applied to evaluate response and toxicity. RESULTS Hematological toxicities occurred only at grades 1-2 and included anemia (71%) and thrombocytopenia (21%). Nonhematologic side effects at grades 1-2 were local skin reactions at the subcutaneous injection site, which were self-limited. No notable gastrointestinal toxicity was observed with subcutaneous Btz, and therefore routine use of intravenous hydration and antiemetics was abandoned. Overall response rate for transplant-eligible patients was 86%. CONCLUSIONS Our results confirm the improved toxicity profile of the subcutaneous administration of Btz in various standard Btz-based combination regimens. In addition, patient management with subcutaneous administration has been markedly ameliorated at our center.
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Affiliation(s)
- W Lamm
- Clinical Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
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Eder S, Müller P, Schulze M, Müller K. Differences in membrane fluidity of boar (Sus scrofa domestica) and cat (Felis catus) spermatozoa during cooling. Reprod Biol 2013. [DOI: 10.1016/j.repbio.2013.01.015] [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: 10/27/2022]
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41
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Eder S, Müller K, Jewgenow K, Hribal R, Schumann K. Cryopreservation of guinea pig spermatozoa – Challenges and first success. Reprod Biol 2013. [DOI: 10.1016/j.repbio.2013.01.014] [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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42
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Vernes A, Eder S, Vorlaufer G, Betz G. On the three-term kinetic friction law in nanotribological systems. Faraday Discuss 2012; 156:173-96; discussion 197-215. [DOI: 10.1039/c2fd00120a] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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43
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Eder S, Vernes A, Vorlaufer G, Betz G. Molecular dynamics simulations of mixed lubrication with smooth particle post-processing. J Phys Condens Matter 2011; 23:175004. [PMID: 21493976 DOI: 10.1088/0953-8984/23/17/175004] [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: 05/30/2023]
Abstract
A post-processing method for molecular dynamics (MD) simulations of friction based on the smooth particle approach is proposed, allowing--among other features--the introduction and evaluation of a solid-solid contact area arising due to direct asperity interaction. In order to illustrate the feasibility of this scheme, a large number of MD calculations of lubricated nanotribological systems with various asperity geometries and carefully selected numbers of lubricant molecules were carried out and analysed. In this manner, it is shown that the friction force as a function of load agrees very well with a three-parameter friction law which, in addition to the adhesion- and the load-controlled terms, contains a load-independent offset.
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Affiliation(s)
- S Eder
- Austrian Center of Competence for Tribology, Viktor-Kaplan-Strasse 2, 2700 Wiener Neustadt, Austria
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Sonnweber T, Theurl I, Seifert M, Schroll A, Eder S, Mayer G, Weiss G. Impact of iron treatment on immune effector function and cellular iron status of circulating monocytes in dialysis patients. Nephrol Dial Transplant 2010; 26:977-87. [DOI: 10.1093/ndt/gfq483] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Eder S, Markert K, Jablonski A, Wandelt K. Substrate Dependence of the 2D Gas-Solid Phase Transition in Adsorbed Xenon Layers. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/bbpc.19860900313] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [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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von Hodenberg E, Eder S, Grunebaum P, Melichercik J. [Cardiology quality assessment in Germany--pro and contra]. Dtsch Med Wochenschr 2009; 134 Suppl 6:S198-9. [PMID: 19834840 DOI: 10.1055/s-0029-1241908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The German National Institute for Quality in Healthcare has also developed a program of external quality assessment in the field of cardiology. Hospitals are committed to collect certain data of diagnostic coronary angiography, percutaneous coronary interventions and pacemaker implantations. If statistical abnormalities are observed a so called structured dialogue is implemented. The responsible physicians of the hospitals are asked to comment possible quality deficits. Appointed members of quality commissions examine the answers and can invite the responsible physicians for interviews or also visit the hospital. However the validity of the quality data is problematic, because audits or check-ups of quality assessment in place are lacking. Therefore the results should not be misused for a comparison or ranking of hospitals with each other. As long as the validity of the quality assessment has not been improved, the results should also not be accessible for other parties, such as health insurances.
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Affiliation(s)
- E von Hodenberg
- Klinik für Innere Medizin und Kardiologie, MediClin Herzzentrum Lahr/Baden, Lahr.
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Weiss G, Theurl I, Eder S, Koppelstaetter C, Kurz K, Sonnweber T, Kobold U, Mayer G. Serum hepcidin concentration in chronic haemodialysis patients: associations and effects of dialysis, iron and erythropoietin therapy. Eur J Clin Invest 2009; 39:883-90. [PMID: 19563467 DOI: 10.1111/j.1365-2362.2009.02182.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hepcidin, a liver-derived peptide induced by iron overload and inflammation, is a major regulator of iron homeostasis. As hepcidin decreases gastrointestinal iron absorption and recirculation from monocytes, over-expression is associated with the development of anaemia. METHODS We studied the associations between circulating hepcidin levels and various laboratory parameters related to anaemia and/or inflammation in 20 patients on chronic haemodialysis. Furthermore, we determined the impact of dialysis and iron and/or erythropoietin (rhEpo) supplementation therapy on hepcidin serum concentrations. The patients were withheld from iron and rhEpo for 2 weeks before study entry. Hepcidin was measured by liquid chromatography-mass spectrometry (LC-MS/MS); serum iron and haematological parameters, cytokines and pro-hepcidin by commercially available enzyme-linked immunosorbent assays (ELISA) or standard automated methods. RESULTS While hepcidin levels at baseline were not correlated to pro-hepcidin, interleukin-6 or transforming growth factor-beta concentrations, we found significant associations with reticulocyte count (r = -0.55; P = 0.015), serum iron (r = 0.7; P = 0.004) and ferritin levels (r = 0.63; P = 0.004) and transferrin saturation (r = 0.69, P = 0.001). Dialysis using either a high or a low flux biocompatible dialyser resulted in a significant decrease of hepcidin concentrations, which returned to pre-dialysis values before the next dialysis session. When studying the effects of anaemia treatment, we observed a significant reduction of hepcidin levels following administration of rhEpo but not iron. CONCLUSIONS Hepcidin levels in stable haemodialysis patients appear to reflect systemic iron load, but not inflammation. Due to the negative association between reticulocyte counts and hepcidin, the reduction of circulating hepcidin concentrations by dialysis and/or rhEpo treatment may positively affect erythropoiesis.
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Affiliation(s)
- G Weiss
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, A - 6020 Innsbruck, Austria
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Thonhofer R, Kriessmayr M, Thonhofer U, Wipfler E, Uitz E, Bahadori B, Eder S. Rheumatoid arthritis patients with therapy‐induced myelodysplastic syndrome present with long‐term remission after recovery. Scand J Rheumatol 2009; 36:149-51. [PMID: 17476623 DOI: 10.1080/03009740600844506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Thonhofer R, Soleiman A, Kriessmayr M, Thonhofer U, Wipfler E, Gaugg M, Eder S, Erlacher L. Decrease of proteinuria in a patient with adult‐onset Still's disease and glomerulonephritis after anti‐TNFα therapy. Scand J Rheumatol 2009; 35:485-8. [PMID: 17343260 DOI: 10.1080/03009740600844688] [Citation(s) in RCA: 6] [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: 10/23/2022]
Abstract
We report the case of a 41-year-old man diagnosed with Still's disease. Multiple disease-modifying anti-rheumatic drug (DMARD) therapies failed to induce disease remission or to prevent progressive joint destruction. The man presented with active arthritis and classical Still's rash accompanied by fever. Anti-tumour necrosis factor-alpha (TNFalpha) therapy was planned but during the medical check-up prior to the biological therapy, renal insufficiency with marked proteinuria (PU) was discovered. With PU of 912 mg/24 h a renal biopsy was performed and a histopathological evaluation revealed the diagnosis of a residual mesangio-proliferative immunocomplex-based glomerulonephritis (GN). After excluding contraindications, infliximab therapy was initiated and a good response of the arthritis was documented after 6 weeks. A significant decrease in PU (279 mg/24 h) was noted after the third infliximab infusion. Because of an allergic reaction during the fifth dose, the infliximab was discontinued. During the time frame without anti-TNFalpha therapy, active joint disease reoccurred and the proteinuria increased significantly. Because of the active disease entanercept therapy was initiated. The arthritis diminished and the PU was reduced markedly within 4 weeks. In the follow-up period of 12 months a good response to therapy was sustained. As described by other investigators, the joint disease showed a rapid and sustained response to anti-TNFalpha therapy. The decrease in proteinuria during biological therapy was notable. It was concluded that the significant decrease in PU in this patient was achieved by eliminating the inflammatory activity of the underlying kidney disease.
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Affiliation(s)
- R Thonhofer
- Department of Internal Medicine, State Hospital Muerzzuschlag, Austria.
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Nasseri BA, Alexi-Meskishvili V, Schmitt B, Eder S, Hübler M, Weng Y, Stamm C, Berger F, Hetzer R. Is myocardial damage completely reversible after direct aortic re-implantation of the anomalous origin of the left coronary artery from the pulmonary artery. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191627] [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: 10/21/2022]
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