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Iwańczyk S, Lehmann T, Pławski A, Woźniak P, Hertel A, Araszkiewicz A, Stępień K, Krupka G, Grygier M, Lesiak M, Jagodziński PP. Novel genetic variants potentially associated with the pathogenesis of coronary artery aneurysm: whole exome sequencing analysis. Hellenic J Cardiol 2024:S1109-9666(24)00031-9. [PMID: 38417579 DOI: 10.1016/j.hjc.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/03/2024] [Accepted: 02/18/2024] [Indexed: 03/01/2024] Open
Affiliation(s)
- Sylwia Iwańczyk
- 1st Department of Cardiology, Poznan University of Medical Sciences, Długa ½ street, 61-848 Poznań, Poland.
| | - Tomasz Lehmann
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, Święcickiego 6 street, 60-781 Poznań, Poland
| | - Andrzej Pławski
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszyńska 32 street, 60-479 Poznań, Poland
| | - Patrycja Woźniak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Długa ½ street, 61-848 Poznań, Poland
| | - Agnieszka Hertel
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, Święcickiego 6 street, 60-781 Poznań, Poland
| | - Aleksander Araszkiewicz
- 1st Department of Cardiology, Poznan University of Medical Sciences, Długa ½ street, 61-848 Poznań, Poland
| | - Konrad Stępień
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Prądnicka 80 street, 31-202 Kraków, Poland
| | - Grzegorz Krupka
- 1st Department of Cardiology, Poznan University of Medical Sciences, Długa ½ street, 61-848 Poznań, Poland
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Długa ½ street, 61-848 Poznań, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Długa ½ street, 61-848 Poznań, Poland
| | - Paweł P Jagodziński
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, Święcickiego 6 street, 60-781 Poznań, Poland
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Arranz F, Lehmann T, Rauscher F, Fischer G, Koehler S, Garrido J, Rouret M, Sanchez-Herranz D. Logistics and maintenance research activities for DONES facility. Fusion Engineering and Design 2023. [DOI: 10.1016/j.fusengdes.2023.113630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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Lehmann T, Bamou R, Chapman JW, Reynolds DR, Armbruster PA, Dao A, Yaro AS, Burkot TR, Linton YM. Urban malaria may be spreading via the wind-here's why that's important. Proc Natl Acad Sci U S A 2023; 120:e2301666120. [PMID: 37104473 PMCID: PMC10160975 DOI: 10.1073/pnas.2301666120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Affiliation(s)
- T Lehmann
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, NIH, Rockville, MD 20852
| | - R Bamou
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, NIH, Rockville, MD 20852
| | - J W Chapman
- Centre for Ecology and Conservation, Department of Biosciences, University of Exeter, Penryn TR10 9FE, United Kingdom
- Environment and Sustainability Institute, University of Exeter, Penryn TR10 9FE, United Kingdom
- Department of Entomology, College of Plant Protection, Nanjing Agricultural University, Nanjing 210095, China
| | - D R Reynolds
- Natural Resources Institute, University of Greenwich, Chatham ME4 4TB, United Kingdom
- Rothamsted Research, Harpenden, Hertfordshire, AL5 2JQ, United Kingdom
| | - P A Armbruster
- Department of Biology, Georgetown University, Washington, DC 20057
| | - A Dao
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - A S Yaro
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - T R Burkot
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD 4870, Australia
| | - Y-M Linton
- Walter Reed Biosystematics Unit, Smithsonian Institution Museum Support Center, Suitland, MD 20746
- Department of Entomology, National Museum of Natural History, Smithsonian Institution, Washington, DC 20560
- One Health Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910
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Iwańczyk S, Lehmann T, Cieślewicz A, Malesza K, Woźniak P, Hertel A, Krupka G, Jagodziński PP, Grygier M, Lesiak M, Araszkiewicz A. Circulating miRNA-451a and miRNA-328-3p as Potential Markers of Coronary Artery Aneurysmal Disease. Int J Mol Sci 2023; 24:ijms24065817. [PMID: 36982889 PMCID: PMC10058788 DOI: 10.3390/ijms24065817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/22/2023] Open
Abstract
MicroRNAs (miRNAs) are currently investigated as crucial regulatory factors which may serve as a potential therapeutic target. Reports on the role of miRNA in patients with coronary artery aneurysmal disease (CAAD) are limited. The present analysis aims to confirm the differences in the expression of previously preselected miRNAs in larger study groups and evaluate their usefulness as potential markers of CAAD. The study cohort included 35 consecutive patients with CAAD (Group 1), and two groups of 35 patients matched Group 1 regarding sex and age from the overall cohort of 250 patients (Group 2 and Group 3). Group 2 included patients with angiographically documented coronary artery disease (CAD), while Group 3 enrolled patients with normal coronary arteries (NCA) assessed during coronary angiography. We applied the RT-qPCR method using the custom plates for the RT-qPCR array. We confirmed that the level of five preselected circulating miRNAs was different in patients with CAAD compared to Group 2 and Group 3. We found that miR-451a and miR-328 significantly improved the CAAD prediction. In conclusion, miR-451a is a significant marker of CAAD compared to patients with CAD. In turn, miR-328-3p is a significant marker of CAAD compared to patients with NCA.
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Affiliation(s)
- Sylwia Iwańczyk
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznań, Poland
- Correspondence: ; Tel.: +48-662-712-627
| | - Tomasz Lehmann
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, 60-781 Poznań, Poland
| | - Artur Cieślewicz
- Clinical Pharmacology, Poznan University of Medical Sciences, 61-848 Poznań, Poland
| | - Katarzyna Malesza
- Clinical Pharmacology, Poznan University of Medical Sciences, 61-848 Poznań, Poland
| | - Patrycja Woźniak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznań, Poland
| | - Agnieszka Hertel
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, 60-781 Poznań, Poland
| | - Grzegorz Krupka
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznań, Poland
| | - Paweł P. Jagodziński
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, 60-781 Poznań, Poland
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznań, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznań, Poland
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Rybarczyk A, Lehmann T, Iwańczyk-Skalska E, Juzwa W, Pławski A, Kopciuch K, Blazewicz J, Jagodziński PP. In silico and in vitro analysis of the impact of single substitutions within EXO-motifs on Hsa-MiR-1246 intercellular transfer in breast cancer cell. J Appl Genet 2023; 64:105-124. [PMID: 36394782 PMCID: PMC9837009 DOI: 10.1007/s13353-022-00730-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/19/2022]
Abstract
MiR-1246 has recently gained much attention and many studies have shown its oncogenic role in colorectal, breast, lung, and ovarian cancers. However, miR-1246 processing, stability, and mechanisms directing miR-1246 into neighbor cells remain still unclear. In this study, we aimed to determine the role of single-nucleotide substitutions within short exosome sorting motifs - so-called EXO-motifs: GGAG and GCAG present in miR-1246 sequence on its intracellular stability and extracellular transfer. We applied in silico methods such as 2D and 3D structure analysis and modeling of protein interactions. We also performed in vitro validation through the transfection of fluorescently labeled miRNA to MDA-MB-231 cells, which we analyzed by flow cytometry and fluorescent microscopy. Our results suggest that nucleotides alterations that disturbed miR-1246 EXO-motifs were able to modulate miRNA-1246 stability and its transfer level to the neighboring cells, suggesting that the molecular mechanism of RNA stability and intercellular transfer can be closely related.
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Affiliation(s)
- Agnieszka Rybarczyk
- Institute of Computing Science, Poznan University of Technology, Piotrowo 2, 60-965 Poznan, Poland
| | - Tomasz Lehmann
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, Fredry 10, 61-701 Poznan, Poland
| | - Ewa Iwańczyk-Skalska
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, Fredry 10, 61-701 Poznan, Poland
| | - Wojciech Juzwa
- Biotechnology and Food Microbiology, Poznan University of Life Sciences, Wojska Polskiego 48, 60-627 Poznan, Poland
| | - Andrzej Pławski
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszyńska 32, 60-479 Poznan, Poland
| | - Kamil Kopciuch
- Institute of Computing Science, Poznan University of Technology, Piotrowo 2, 60-965 Poznan, Poland
| | - Jacek Blazewicz
- Institute of Computing Science, Poznan University of Technology, Piotrowo 2, 60-965 Poznan, Poland
- Institute of Bioorganic Chemistry, Polish Academy of Sciences, Noskowskiego 12/14, 61-704 Poznan, Poland
| | - Paweł P. Jagodziński
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, Fredry 10, 61-701 Poznan, Poland
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Diab M, Franz M, Hamadanchi A, Faerber G, Safarov R, Kirov H, Lehmann T, Schulze PC, Doenst T. Adding troponin to echocardiography improves preoperative abscess detection in infective endocarditis. A REMOVE Trial analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1549] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Detection of cardiac abscess in patients with infective endocarditis (IE) is important for surgical planning and decision-making. While transesophageal echocardiography (TEE) is the method of choice for abscess detection, in many cases uncertainty remains. Since IE abscesses often affect ventricular muscle, biomarker release may be a helpful adjunct for abscess detection.
Purpose
We assessed the accuracy of TEE and the value of combining it with preoperative measurement of cardiac Troponin (cTn) in the diagnosis of abscess, using surgical inspection as a reference.
Methods
Data collected in the electronic clinical report form for patients included in the prospective, multicenter, randomized, controlled trial (REMOVE Trial) were analyzed. Continuous variables are presented as median (25th–75th percentile) and categorical data as absolute and relative frequencies. The diagnostic performance of TEE was identified by comparing preoperative TEE findings with intraoperative findings. The concordance rate is expressed as a percentage. Receiver operating characteristic (ROC) curve was used to assess the ability of cTn to predict the presence of abscess intraoperatively. Area under curve (AUC) with 95% confidence interval as well as sensitivity and specificity are provided as measures of accuracy. Youden index was used to estimate an optimal cut-off value for cTn.
Results
Among the 282 patients included, 84 had abscesses detected intraoperatively. The sensitivity and specificity of TEE to detect abscess were 58.3% and 86.4%, respectively. cTn-I and cTn-T were measured preoperatively in 113 and 96 patients, respectively. Median cTn-I in patients with abscess was 132 pg/ml (interquartile range (IQR): 54–1528) vs 53 pg/ml (IQR: 17–250) in patients without abscess, p=0.002. Median cTn-T in patients with abscess was 941 pg/ml (IQR: 387–1527) vs 697 pg/ml (IQR: 282–1423) in patients without abscess, p=0.353. The incidence of recent preoperative myocardial infarction was not different between patients with or without abscess (7.1% vs 5.6%, respectively, p=0.593). The AUC for predicting abscess was 0.69 (95% CI: 0.57 to 0.80, p=0.002) and 0.56 (95% CI: 0.43 to 0.69, p=0.353) for preoperative cTn-I and cTn-T, respectively. Optimal cut-offs according to the Youden index are 38 pg/ml for cTn-I and 1632 pg/ml for cTn-T. By adding preoperative cTn-I or cTn-T to the TEE findings, the AUC increased to 0.82 (95% CI: 0.73 to 0.91, p<0.001) and 0.72 (95% CI: 0.59 to 00.84, p=0.001), respectively.
Conclusion
The results suggest that using TEE alone is a poor method for abscess detection in IE. Adding preoperative troponin values to TEE findings significantly improved IE abscess detection.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Federal Ministry of Education and Research (BMBF), Germany
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Affiliation(s)
- M Diab
- University Hospital Jena, Department of Cardiothoracic Surgery , Jena , Germany
| | - M Franz
- University Hospital Jena, Department of Internal Medicine I , Jena , Germany
| | - A Hamadanchi
- University Hospital Jena, Department of Internal Medicine I , Jena , Germany
| | - G Faerber
- University Hospital Jena, Department of Cardiothoracic Surgery , Jena , Germany
| | - R Safarov
- University Hospital Jena, Department of Cardiothoracic Surgery , Jena , Germany
| | - H Kirov
- University Hospital Jena, Department of Cardiothoracic Surgery , Jena , Germany
| | - T Lehmann
- University Hospital Jena, Center for Clinical Studies , Jena , Germany
| | - P C Schulze
- University Hospital Jena, Department of Internal Medicine I , Jena , Germany
| | - T Doenst
- University Hospital Jena, Department of Internal Medicine I , Jena , Germany
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Lehmann T, Paziewski P, Pacut A. Face and silhouette based age estimation for child detection system. ANNALS OF COMPUTER SCIENCE AND INFORMATION SYSTEMS 2022. [DOI: 10.15439/2022f98] [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: 11/18/2022] Open
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Iwańczyk S, Lehmann T, Grygier M, Woźniak P, Lesiak M, Araszkiewicz A. Serum matrix metalloproteinase‑8 level in patients with coronary artery abnormal dilatation. Pol Arch Intern Med 2022; 132. [PMID: 35420018 DOI: 10.20452/pamw.16241] [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: 11/23/2022]
Affiliation(s)
- Sylwia Iwańczyk
- First Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland.
| | - Tomasz Lehmann
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, Poznań, Poland
| | - Marek Grygier
- First Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Patrycja Woźniak
- First Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Maciej Lesiak
- First Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
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Iwańczyk S, Lehmann T, Cieślewicz A, Radziemski A, Malesza K, Wrotyński M, Jagodziński P, Grygier M, Lesiak M, Araszkiewicz A. Circulating microRNAs in patients with aneurysmal dilatation of coronary arteries. Exp Ther Med 2022; 23:404. [PMID: 35619635 PMCID: PMC9115642 DOI: 10.3892/etm.2022.11331] [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: 07/07/2021] [Accepted: 03/22/2022] [Indexed: 12/03/2022] Open
Abstract
To understand the mechanism underlying coronary artery abnormal dilatation (CAAD), the present study identified and compared the expression of circulating microRNAs (miRNAs) in three groups of patients. Group 1 included 20 patients with CAAD, Group 2 included 20 patients with angiographically confirmed coronary artery disease (CAD), and Group 3 included 20 patients with normal coronary arteries (control). miRNAs were isolated from plasma samples and were profiled using PCR arrays and miRCURY LNA Serum/Plasma Focus PCR Panels. The present study demonstrated that the plasma miRNA levels were significantly different in Group 1 compared with in Group 2 and Group 3 (fold change >2 and P<0.05). The comparison of Group 1 with Group 3 identified 21 significantly upregulated and two downregulated miRNAs in patients with CAAD compared with in the control group. Moreover, six upregulated and two downregulated miRNAs were identified in patients with CAD compared with in the controls. The third comparison revealed four upregulated and three downregulated miRNAs in Group 1, when compared with patients with CAD. In conclusion, the present study identified a specific signature of plasma miRNAs, which were upregulated and downregulated in patients with CAAD compared with in patients with CAD and control individuals.
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Affiliation(s)
- Sylwia Iwańczyk
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61‑848 Poznań, Poland
| | - Tomasz Lehmann
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, 60‑781 Poznań, Poland
| | - Artur Cieślewicz
- Department of Clinical Pharmacology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61‑848 Poznań, Poland
| | - Artur Radziemski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61‑848 Poznań, Poland
| | - Katarzyna Malesza
- Department of Clinical Pharmacology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61‑848 Poznań, Poland
| | - Michał Wrotyński
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61‑848 Poznań, Poland
| | - Paweł Jagodziński
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, 60‑781 Poznań, Poland
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61‑848 Poznań, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61‑848 Poznań, Poland
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Trzaskowska A, Mielcarek S, Lehmann T, Pruszyńska-Oszmałek E, Kołodziejski P, Głowacki M. Mechanical properties of the mouse femur after treatment with diclofenac and running exercises. Acta Bioeng Biomech 2022; 24:129-139. [PMID: 38314492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
PURPOSE The flexible properties of the bone are essential for the movement and protection of vital organs. The ability of a bone to resist fractures under the influence of large muscles and physical activity depends on its established mechanical properties. This article discusses how exercise such as treadmill running and taking non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, affect the musculoskeletal system by modifying the elastic and thermal properties of the left femur of a mouse. METHODS The research was conducted using 9-week-old C57BL/6J female mice. In order to investigate the elastic and thermal properties of bones, dynamic mechanical analysis (DMA) and differential scanning calorimetry (DSC) were performed. RESULTS The study of elastic properties, followed by in-depth statistical analysis, shows that taking diclofenac slightly reduces the elastic parameters of the bones under study. These changes are more pronounced in DSC studies, the shift of the observed endothermic peaks is on the order of several degrees with a simultaneous increase in the enthalpy of this process. CONCLUSIONS The opposite effect of the applied factors - diclofenac and running - on the elastic properties of the bones of the examined mice was found. The external factors - running and diclofenac - modify the basic parameters of the endothermic process associated with the release of water.
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Affiliation(s)
| | | | - Tomasz Lehmann
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, Poznań, Poland
| | - Ewa Pruszyńska-Oszmałek
- Department of Animal Physiology and Biochemistry, Poznan University of Life Sciences, Poznań, Poland
| | - Paweł Kołodziejski
- Department of Animal Physiology and Biochemistry, Poznan University of Life Sciences, Poznań, Poland
| | - Maciej Głowacki
- Department of Pediatrics Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznań, Poland
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11
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Trzaskowska A, Mielcarek S, Lehmann T, Pruszyńska-Oszmałek E, Kołodziejski P, Głowacki M. Mechanical properties of the mouse femur after treatment with diclofenac and running exercises. Acta Bioeng Biomech 2022. [DOI: 10.37190/abb-02061-2022-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose: The flexible properties of the bone are essential for the movement and protection of vital organs. The ability of a bone to resist fractures under the influence of large muscles and physical activity depends on its established mechanical properties. This article discusses how exercise such as treadmill running and taking non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, affect the musculoskeletal system by modifying the elastic and thermal properties of the left femur of a mouse. Methods: The research was conducted using 9-week-old C57BL/6J female mice. In order to investigate the elastic and thermal properties of bones, dynamic mechanical analysis (DMA) and differential scanning calorimetry (DSC) were performed. Results: The study of elastic properties, followed by in-depth statistical analysis, shows that taking diclofenac slightly reduces the elastic parameters of the bones under study. These changes are more pronounced in DSC studies, the shift of the observed endothermic peaks is on the order of several degrees with a simultaneous increase in the enthalpy of this process. Conclusions: The opposite effect of the applied factors – diclofenac and running – on the elastic properties of the bones of the examined mice was found. The external factors – running and diclofenac – modify the basic parameters of the endothermic process associated with the release of water.
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12
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Wagner F, Ruf I, Lehmann T, Hofmann R, Ortmann S, Schiffmann C, Hiller M, Stefen C, Stuckas H. Reconstruction of evolutionary changes in fat and toxin consumption reveals associations with gene losses in mammals: a case study for the lipase inhibitor PNLIPRP1 and the xenobiotic receptor NR1I3. J Evol Biol 2021; 35:225-239. [PMID: 34882899 DOI: 10.1111/jeb.13970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Abstract
The inactivation of ancestral protein-coding genes (gene loss) can be associated with phenotypic modifications. Within placental mammals, repeated losses of PNLIPRP1 (gene inhibiting fat digestion) occurred preferentially in strictly herbivorous species, while repeated NR1I3 losses (gene involved in detoxification) occurred preferentially in strictly carnivorous species. It was hypothesized that lower fat contents of herbivorous diets and lower toxin contents of carnivorous diets cause relaxed selection pressure on these genes resulting in the accumulation of mutations and ultimately to convergent gene losses. However, since herbivorous and carnivorous diets differ vastly in their composition, a fine-grained analysis is required for hypothesis testing. We generated a trait matrix recording diet and semi-quantitative estimates of fat and toxin consumption for 52 placental species. By including data from 31 fossil taxa, we reconstructed the ancestral diets in major lineages (grundplan reconstruction). We found support that PNLIPRP1 loss is primarily associated with low levels of fat intake and not simply with herbivory/carnivory. In particular, PNLIPRP1 loss also occurred in carnivorous lineages feeding on a fat-poor diet, suggesting that the loss of this gene may be beneficial for occupying ecological niches characterized by fat-poor food resources. Similarly, we demonstrated that carnivorous species are indeed less exposed to diet-related toxins suggesting that the loss of NR1I3 and related genes (NR1I2, UGT1A6) resulted from relaxed selection pressure. This study illustrates the need of detailed phenotype studies to obtain a deeper understanding of factors underlying gene losses and to progress in understanding genomic causes of phenotypic variation in mammals.
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Affiliation(s)
- F Wagner
- Senckenberg, Leibniz Institution for Biodiversity and Earth System Research, Senckenberg Natural History Collections Dresden, Königsbrücker Landstraße 159, 01109, Dresden, Germany
| | - I Ruf
- Senckenberg, Leibniz Institution for Biodiversity and Earth System Research, Senckenberg Research Institute and Natural History Museum Frankfurt, Senckenberganlage 25, 60325, Frankfurt am Main, Germany.,Goethe-University, Department of Geosciences, Altenöferallee 1, 60438, Frankfurt am Main, Germany
| | - T Lehmann
- Senckenberg, Leibniz Institution for Biodiversity and Earth System Research, Senckenberg Research Institute and Natural History Museum Frankfurt, Senckenberganlage 25, 60325, Frankfurt am Main, Germany
| | - R Hofmann
- Senckenberg, Leibniz Institution for Biodiversity and Earth System Research, Senckenberg Research Institute and Natural History Museum Frankfurt, Senckenberganlage 25, 60325, Frankfurt am Main, Germany.,Goethe-University, Department of Geosciences, Altenöferallee 1, 60438, Frankfurt am Main, Germany
| | - S Ortmann
- Leibniz Institut für Zoo- und Wildtierforschung, Abteilung für Evolutionäre Ökologie, Alfred-Kowalke-Straße 17, 10315, Berlin, Germany
| | - C Schiffmann
- Leibniz Institut für Zoo- und Wildtierforschung, Abteilung für Evolutionäre Ökologie, Alfred-Kowalke-Straße 17, 10315, Berlin, Germany
| | - M Hiller
- Senckenberg, Leibniz Institution for Biodiversity and Earth System Research, Senckenberg Research Institute and Natural History Museum Frankfurt, Senckenberganlage 25, 60325, Frankfurt am Main, Germany.,Max Planck Institute of Molecular Cell Biology and Genetics, Pfotenhauerstr. 108, 01307, Dresden, Germany.,Max Planck Institute for the Physics of Complex Systems, Nöthnitzer Str. 38, 01187, Dresden, Germany.,Center for Systems Biology Dresden, Pfotenhauerstr. 108, 01307, Dresden, Germany.,LOEWE Centre for Translational Biodiversity Genomics, Senckenberganlage 25, 60325, Frankfurt am Main, Germany.,Goethe University, Faculty of Biosciences, Max-von-Laue-Str. 9, 60438, Frankfurt am Main, Germany
| | - C Stefen
- Senckenberg, Leibniz Institution for Biodiversity and Earth System Research, Senckenberg Natural History Collections Dresden, Königsbrücker Landstraße 159, 01109, Dresden, Germany
| | - H Stuckas
- Senckenberg, Leibniz Institution for Biodiversity and Earth System Research, Senckenberg Natural History Collections Dresden, Königsbrücker Landstraße 159, 01109, Dresden, Germany
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13
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Diab M, Franz M, Hagel S, Guenther A, Struve A, Kuehn H, Ibrahim K, Jahnecke M, Sigusch H, Ebelt H, Faerber G, Lehmann T, Schulze PC, Pletz MW, Doenst T. The impact of establishing a regional infective endocarditis (IE) network on pre-operative IE-related complications and on post-operative outcome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1721] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Infective endocarditis (IE) requires a high degree of suspicion and advanced level of multidisciplinary management. In 2015, the European guidelines recommended the formation of an endocarditis-team (ET) for optimal treatment of IE. In 2011, we already established an ET within the hospital that was only consulted on demand for certain patients. Since 2015, ET has been increasingly involved in the management of almost all patients with IE. In addition, we established in 2015 a statewide endocarditis- (E) network for the referring hospitals.
Purpose
We investigated the effect of E-network on reducing referral latency and pre-operative IE-related complications. We also investigated the adherence to the ET management recommendations in our hospital and its impact on post-operative stroke and mortality.
Methods
We retrospectively analyzed data from patients operated for IE in our center between 01/2007 and 03/2018. We conducted univariate analysis using Chi-square or Fisher's exact test, Multivariate logistic regression models for in-hospital mortality and post-operative stroke, and Kaplan-Meier estimate of 5-years survival.
Results
Among 630 patients operated for IE in our center, 409 (65%) underwent surgery in the 1st era before 12/2014. S. aureus IE was more frequent in the second era (34% vs 25%, p<0.001). The median time from the onset of symptoms to referral in the 2nd era was halved compared to the first one [7 days (IQR 2–19) vs 15 days (IQR 6–35)]. Patients in the 2nd era were admitted with less IE-related complications, i.e. less preoperative stroke (14% vs 27%, p<0.001), less heart failure (45% vs 69%, p<0.001) less cardiac abscesses (24% vs 34%, p=0.018), less acute renal insufficiency requiring hemodialysis (8% vs 14%, p=0.026). The lack of ET management recommendations was an independent predictor for in-hospital mortality (adjusted OR: 2.13, 95% CI: 1.27–3.53, p=0.004) and post-operative stroke (adjusted OR: 2.23, 95% CI: 1.12–4.39, p=0.02), and was associated with worse 5-years survival (59% compared to 40%, log rank<0.001).
Conclusion
Endocarditis-network led to earlier referral of patients, which resulted in less IE-related complications on admission. Lack of ET management recommendations was an independent predictor for post-operative stroke, in-hospital mortality and was associated with worse 5-years survival.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- M Diab
- University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Germany
| | - M Franz
- University Hospital Jena, Department of Cardiology and Internal Medicine, Jena, Germany
| | - S Hagel
- University Hospital Jena, Institute for Infectious Diseases and Infection Control, Jena, Germany
| | - A Guenther
- University Hospital Jena, Department of Neurology, Jena, Germany
| | - A Struve
- University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Germany
| | - H Kuehn
- Thueringen-Kliniken Georgius Agricola, Department of Internal Medicine III, Saalfeld, Germany
| | - K Ibrahim
- Hospital Chemnitz, Department of Internal Medicine I, Chemnitz, Germany
| | - M Jahnecke
- St. Georg Hospital, Department of Internal Medicine I, Eisenach, Germany
| | - H Sigusch
- Heinrich-Braun-Hospital, Department of Internal Medicine I, Zwickau, Germany
| | - H Ebelt
- Catholic Hospital St. Johann Nepomuk, Department of Internal Medicine II, Erfurt, Germany
| | - G Faerber
- University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Germany
| | - T Lehmann
- University Hospital Jena, Department of Medical Statistics, Computer Science and Data Science, Jena, Germany
| | - P C Schulze
- University Hospital Jena, Department of Cardiology and Internal Medicine, Jena, Germany
| | - M W Pletz
- University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Germany
| | - T Doenst
- University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Germany
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14
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Bürckenmeyer F, Diamantis I, Kriechenbauer T, Lehmann T, Franiel T, Malouhi A, Grimm MO, Teichgräber U, Aschenbach R. Prostatic Artery Embolization: Influence of Cone-Beam Computed Tomography on Radiation Exposure, Procedure Time, and Contrast Media Use. Cardiovasc Intervent Radiol 2021; 44:1089-1094. [PMID: 33660064 PMCID: PMC8190013 DOI: 10.1007/s00270-021-02787-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/23/2021] [Indexed: 12/13/2022]
Abstract
Purpose To evaluate the effect of cone-beam computed tomography (CBCT) on radiation exposure, procedure time, and contrast media (CM) use in prostatic artery embolization (PAE). Materials and Methods Seventy-eight patients were enrolled in this retrospective, single-center study. All patients received PAE without (group A; n = 39) or with (group B; n = 39) CBCT. Total dose-area product (DAPtotal; Gycm2), total entrance skin dose (ESDtotal; mGy), and total effective dose (EDtotal; mSv) were primary outcomes. Number of digital subtraction angiography (DSA) series, CM use, fluoroscopy time, and procedure time were secondary outcomes. PAE in group A was performed by a single radiologist with 15 years experience, PAE in group B was conducted by four radiologists with 4 to 6 years experience. Results For groups A vs. B, respectively, median (IQR): DAPtotal 236.94 (186.7) vs. 281.20 (214.47) Gycm2(p = 0.345); EDtotal 25.82 (20.35) vs. 39.84 (23.75) mSv (p = < 0.001); ESDtotal 2833 (2278) vs. 2563 (3040) mGy(p = 0.818); number of DSA series 25 (15) vs. 23 (10)(p = 0.164); CM use 65 (30) vs. 114 (40) mL(p = < 0.001); fluoroscopy time 23 (20) vs. 28 (25) min(p = 0.265), and procedure time 70 (40) vs.120 (40) min(p = < 0.001). Bilateral PAE was achieved in 33/39 (84.6%) group A and 32/39 (82.05%) group B(p = 0.761), all other patients received unilateral PAE. There were no significant differences between clinical parameters and origins of the prostatic arteries (PA) (p = 0.206–1.00). Conclusion Operators with extensive expertise on PAE may not benefit from addition of CBCT to DSA runs, whereas for operators with less expertise, CBCT when used alongside with DSA runs increased the overall radiation exposure.
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Affiliation(s)
- F Bürckenmeyer
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - I Diamantis
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - T Kriechenbauer
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - T Lehmann
- Center for Clinical Studies, University Hospital Jena, Jena, Germany
| | - T Franiel
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - A Malouhi
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - M O Grimm
- Clinic for Urology, University Hospital Jena, Jena, Germany
| | - U Teichgräber
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - R Aschenbach
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
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15
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Everts-Graber J, Reichenbach S, Gahl B, Ziswiler HR, Studer U, Lehmann T. Risk factors for vertebral fractures and bone loss after denosumab discontinuation: A real-world observational study. Bone 2021; 144:115830. [PMID: 33359006 DOI: 10.1016/j.bone.2020.115830] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Denosumab discontinuation without subsequent bisphosphonates (BPs) is associated with bone loss and multiple vertebral fractures. OBJECTIVE Identifying risk factors for bone loss and vertebral fractures after denosumab discontinuation. METHODS This retrospective study measured the outcome of 219 women with osteoporosis who discontinued denosumab treatment and received subsequent treatment with zoledronate, other BPs or a selective estrogen receptor modulator (SERM), or no therapy. Fracture rate, longitudinal bone mineral density (BMD) changes and bone turnover markers (BTMs) within 2 years after denosumab discontinuation were analysed. Linear regression analysis evaluated loss of BMD and age, BMI (kg/m2), denosumab treatment duration, pre-treatment, prior fracture state, baseline T-scores, use of glucocorticoids or aromatase inhibitors and BMD gains under denosumab therapy. RESULTS 171 women received zoledronate after denosumab discontinuation, 26 had no subsequent treatment and 22 received other therapies (other BPs or a SERM). Zoledronate was associated with the fewest vertebral fractures (hazard ratio 0.16, p = 0.02) and all subsequent therapies retained BMD at all sites to some extent. Higher BMD loss was associated with younger age, lower BMI, longer denosumab treatment, lack of prior antiresorptive treatment and BMD gain under denosumab treatment. BTM levels correlated with denosumab treatment duration and bone loss at the total hip, but not the lumbar spine. CONCLUSIONS Compared to no subsequent therapy, zoledronate was associated with fewer vertebral fractures after denosumab. Further, BMD loss depended on denosumab treatment duration, age, prior BP therapy and BMD gain under denosumab therapy, whereas BTM levels were associated with bone loss at the total hip and denosumab treatment duration.
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Affiliation(s)
| | - S Reichenbach
- Department of Rheumatology, Immunology and Allergology, University Hospital, Bern, Switzerland; Institute for Social and Preventive Medicine, University of Bern, Switzerland
| | - B Gahl
- Clinical Trial Unit (CTU) Bern, University of Bern, Switzerland
| | - H R Ziswiler
- OsteoRheuma Bern, Bahnhofplatz 1, Bern, Switzerland
| | - U Studer
- OsteoRheuma Bern, Bahnhofplatz 1, Bern, Switzerland
| | - T Lehmann
- OsteoRheuma Bern, Bahnhofplatz 1, Bern, Switzerland
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16
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Erdmann N, Schilling T, Lehmann T, Zagoya C, Hentschel J, Mainz J. WS05.1 Dynamics of inflammatory mediators during airway infection in cystic fibrosis patients and healthy controls – serial non-invasive upper airway sampling by nasal lavage. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)00939-5] [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: 11/30/2022]
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17
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Stichling K, Krause M, Ditscheid B, Hach M, Jansky M, Kaufmann M, Lehmann T, Meißner W, Nauck F, Schneider W, Schulz S, Vollmar HC, Wedding U, Bleidorn J, Freytag A. Factors influencing GPs' perception of specialised palliative homecare (SPHC) importance - results of a cross-sectional study. BMC Palliat Care 2020; 19:117. [PMID: 32746825 PMCID: PMC7401213 DOI: 10.1186/s12904-020-00603-3] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 06/24/2020] [Indexed: 11/29/2022] Open
Abstract
Background General Practitioners (GPs) are the main providers of primary palliative care (PPC). At the same time they are the main initiators of specialised palliative homecare (SPHC). In Germany, little is known about factors which influence GPs in their involvement of SPHC. Aim of our study is to identify factors that drive GPs to give value to and involve SPHC. Methods A cross-sectional survey was performed. In 2018, questionnaires were mailed to 6000 randomly selected GPs from eight German federal states, focusing on the extent of GPs’ palliative care activities and their involvement of SPHC. Results With a response rate of 19.4% and exclusion of GPs working in SPHC-teams, n = 1026 questionnaires were appropriate for analysis. GPs valued SPHC support as the most “important/very important” for both “technical/invasive treatment measures” (95%) and availability outside practice opening hours (92%). The most relevant factor influencing perceived SPHC-importance was GPs’ self-reported extent of engagement in palliative care (β = − 0.283; CI 95% = − 0.384;−0.182), followed by the perceived quality of utilised SPHC (β = 0.119; CI 95% = 0.048;0.190), involvement in treatment of palliative patients after SPHC initiation (β = 0.088; CI 95% = 0.042;0.134), and conviction that palliative care should be a central part of GPs’ work (β = − 0.062; CI 95% = − 0.116;−0.008). Perceived SPHC-importance is also associated with SPHC-referrals (β =0.138; p < 0.001). The lower the engagement of GPs in palliative care, the more they involve SPHC and vice versa. Conclusions GPs with low reported activity in palliative care are more likely to initialise SPHC for palliative care activities they do not deliver themselves for various reasons, which might mean that the involvement of SPHC is substitutive instead of complementary to primary palliative care. This finding and its interpretation should be given more attention in the future policy framework for (specialised) palliative homecare. Trial registration German Clinical Trials Register DRKS00014726, 14.05.2018.
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Affiliation(s)
- K Stichling
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - M Krause
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - B Ditscheid
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - M Hach
- German Working Group for SAPV, Berlin, Germany
| | - M Jansky
- Clinic for Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - M Kaufmann
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - T Lehmann
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - W Meißner
- Department of Palliative Care, Jena University Hospital, Jena, Germany
| | - F Nauck
- Clinic for Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - W Schneider
- Center for Interdisciplinary Health Research, University of Augsburg, Augsburg, Germany
| | - S Schulz
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - H C Vollmar
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany.,Institute of General Practice and Family Medicine, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - U Wedding
- Department of Palliative Care, Jena University Hospital, Jena, Germany
| | - J Bleidorn
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - A Freytag
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany.
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18
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Müller N, Lehmann T, Klöss A, Günster C, Kloos C, Müller UA. Changes in incidence of severe hypoglycaemia in people with type 2 diabetes from 2006 to 2016: analysis based on health insurance data in Germany considering the anti-hyperglycaemic medication. Diabet Med 2020; 37:1326-1332. [PMID: 32145093 DOI: 10.1111/dme.14294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 01/10/2023]
Abstract
AIM To investigate the incidence of severe hypoglycaemia over the past 10 years, taking into account changes in anti-hyperglycaemic therapy. METHODS This retrospective population-based study used German health insurance data. All adults diagnosed with documented type 2 diabetes (extrapolated to the German population: 6.6 million in 2006; 7.9 million in 2011; 8.86 million in 2016) were screened for severe hypoglycaemia. Anti-hyperglycaemic agents were identified by Anatomical Therapeutic Chemical (ATC) code. RESULTS The event rate for severe hypoglycaemia was 460 per 100 000 people in 2006, 490 per 100 000 in 2011 and 360 per 100 000 in 2016. The proportion of people with severe hypoglycaemia receiving sulfonylureas, as well as receiving combination therapy of metformin and sulfonylureas decreased from 2006 to 2016 (23.6% vs. 6.2%) Among those with severe hypoglycaemia in 2006, there were no prescriptions for dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists or sodium-glucose co-transporter 2 (SGLT2) agonists. The proportions of people with severe hypoglycaemia receiving DPP-4 inhibitors, GLP-1 receptor agonists or SGLT2 agonists in 2011 and 2016 were low. The proportion of people receiving human insulin also decreased (from 11.3% in 2006 to 10.3% in 2011 and 4.3% in 2016); the proportion of people receiving insulin analogues increased from 5.4% in 2006 to 11.5% in 2016. Therapy with mixed insulins was used by 19.7% of people with severe hypoglycaemia in 2006, by 14.0% in 2011 and by 7.3% in 2016. People undergoing therapy with insulin analogues have the highest risk of severe hypoglycaemia adjusted by age, gender, nephropathy diagnosis and year of survey [odds ratio (OR) 14.4, 95% confidence interval (95% CI) 13.5-15.5]. CONCLUSION The incidence of severe hypoglycaemic events in Germany increased between 2006 and 2011, and decreased in 2016.
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Affiliation(s)
- N Müller
- Department for Internal Medicine III, Jena University Hospital, Jena, Germany
| | - T Lehmann
- Centre for Clinical Studies, Jena University Hospital, Jena, Germany
| | - A Klöss
- Research Institute of the Local Health Care Funds, Berlin, Germany
| | - C Günster
- Research Institute of the Local Health Care Funds, Berlin, Germany
| | - C Kloos
- Department for Internal Medicine III, Jena University Hospital, Jena, Germany
| | - U A Müller
- Department for Internal Medicine III, Jena University Hospital, Jena, Germany
- Centre for Outpatient Care, Jena University Hospital, Jena, Germany
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19
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Groten T, Lehmann T, Schleußner E. Does Pentaerytrithyltetranitrate reduce fetal growth restriction in pregnancies complicated by uterine mal-perfusion? Study protocol of the PETN-study: a randomized controlled multicenter-trial. BMC Pregnancy Childbirth 2019; 19:336. [PMID: 31521118 PMCID: PMC6744635 DOI: 10.1186/s12884-019-2456-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/13/2019] [Indexed: 04/25/2023] Open
Abstract
Background Affecting approximately 10% of pregnancies, fetal growth restriction (FGR), is the most important cause of perinatal mortality and morbidity. Impaired placental function and consequent mal-perfusion of the placenta is the leading cause of FGR. Although, screening for placental insufficiency based on uterine artery Doppler measurement is well established, there is no treatment option for pregnancies threatened by FGR. The organic nitrate pentaerithrityl tetranitrate (PETN) is widely used for the treatment of cardiovascular disease and has been shown to have protective effects on human endothelial cells. In a randomized placebo controlled pilot-study our group could demonstrate a risk reduction of 39% for the development of FGR, and FGR or death, by administering PETN to patients with impaired uterine artery Doppler at mid gestation. To confirm these results a prospective randomized placebo controlled double-blinded multicentre trial was now initiated. Method The trial has been initiated in 14 centres in Germany. Inclusion criteria are abnormal uterine artery Doppler, defined by mean PI > 1.6, at 190 to 226 weeks of gestation in singleton pregnancies. Included patients will be monitored in 4-week intervals. Primary outcome measures are development of FGR (birth weight < 10th percentile), severe FGR (birth weight < 3rd centile) and perinatal death. Placental abruption, birth weight below the 3rd, 5th and 10th centile, development of FGR requiring delivery before 34 weeks` gestation, neonatal intensive care unit admission, and spontaneous preterm delivery < 34 weeks` and 37 weeks` gestation will be assessed as secondary endpoints. Patient enrolment was started in August 2017. Results are expected in 2020. Discussion During the past decade therapeutic agents with possible perfusion optimizing potential have been evaluated in clinical trials to treat FGR. Meta-analysis and sub-analysis of trials targeting preeclampsia revealed ASS to have a potential in reducing FGR. Phosphodiesterase-type-5 inhibitors have recently been tested in a worldwide RCT for therapy of established FGR, failing to show an effect on neonatal outcome. The ongoing multicenter trial will, by confirming our previous results, finally provide a therapeutic option in cases at risk for FGR. Trial registration DRKS00011374 registered at September 29th, 2017 and NCT03669185, registered September 13th, 2018.
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Affiliation(s)
- T Groten
- Department of Obstetrics, University Hospital Jena, Am Klinkum 1, 07740, Jena, Germany.
| | - T Lehmann
- Institute of Medical Statistics and Computer Science, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
| | - E Schleußner
- Department of Obstetrics, University Hospital Jena, Am Klinkum 1, 07740, Jena, Germany
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20
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Diab M, Tasar R, Sponholz C, Bauer M, Lehmann T, Faerber G, Brunkhorst F, Doenst T. Can Preoperative Measurement of Mid-regional Proadrenomedullin Predict Postoperative Organ Dysfunction and Mortality in Patients Undergoing Valvular Surgery? Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M. Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
- Center for Infectious Diseases and Infection Control, Friedrich-Schiller-University Jena, Jena, Germany
| | - R. Tasar
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
| | - C. Sponholz
- Department of Anesthesiology and Critical Care Medicine, Friedrich-Schiller-University Jena, Jena, Germany
| | - M. Bauer
- Department of Anesthesiology and Critical Care Medicine, Friedrich-Schiller-University Jena, Jena, Germany
| | - T. Lehmann
- Center of Clinical Studies, Friedrich-Schiller-University Jena, Jena, Germany
| | - G. Faerber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
| | - F. Brunkhorst
- Center of Clinical Studies, Friedrich-Schiller-University Jena, Jena, Germany
| | - T. Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
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21
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Musleh R, Diab M, Guenther A, Faerber G, Lehmann T, Tasar R, Franz M, Witte W, Doenst T. Preoperative Intracranial Hemorrhage Affecting Surgical Decision Making in Endocarditis Patients: A Literature Review and a Single-Centre Retrospective Study. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- R. Musleh
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
| | - M. Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
| | - A. Guenther
- Department of Neurology, Friedrich-Schiller-University Jena, Jena, Germany
| | - G. Faerber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
| | - T. Lehmann
- Center of Clinical Studies, Friedrich-Schiller-University Jena, Jena, Germany
| | - R. Tasar
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
| | - M. Franz
- Department of Internal Medicine I, Friedrich-Schiller-University Jena, Jena, Germany
| | - W. Witte
- Department of Neurology, Friedrich-Schiller-University Jena, Jena, Germany
| | - T. Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
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22
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Nicolaus K, Zschauer S, Lehmann T, Runnebaum IB. Erfassung postoperativer Komplikationen bei 400 Endometrioseoperationen mittels der Clavien-Dindo-Klassifikation. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- K Nicolaus
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Jena, Deutschland
| | - S Zschauer
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Jena, Deutschland
| | - T Lehmann
- Institut für Biometrie und Klinische Epidemiologie, Jena, Deutschland
| | - IB Runnebaum
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Jena, Deutschland
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23
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Zschauer S, Lehmann T, Nicolaus K, Runnebaum IB. Erfassung postoperativer Komplikationen bei 400 Endometrioseoperationen mittels der Clavien-Dindo-Klassifikation. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1645895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- S Zschauer
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin des Universitätsklinikums Jena
| | - T Lehmann
- Institut für Medizinische Statistik, Informatik und Datenwissenschaften des Universitätsklinikum Jena
| | - K Nicolaus
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin des Universitätsklinikums Jena
| | - IB Runnebaum
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin des Universitätsklinikums Jena
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Müller N, Lehmann T, Günster C, Müller UA, Wolf G, Busch M. Inzidenz schwerer Hypoglykämien bei Patienten mit chronischer Nierenerkrankung (CKD) 2006 und 2011. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- N Müller
- Universitätsklinikum Jena, Klinik für Innere Medizin III, Jena, Germany
| | - T Lehmann
- Universitätsklinikum Jena, Zentrum für Klinische Studien, Jena, Germany
| | - C Günster
- Wissenschaftliches Institut der AOK, Berlin, Germany
| | - UA Müller
- Universitätsklinikum Jena, Klinik für Innere Medizin III, Jena, Germany
| | - G Wolf
- Universitätsklinikum Jena, Klinik für Innere Medizin III, Jena, Germany
| | - M Busch
- Universitätsklinikum Jena, Klinik für Innere Medizin III, Jena, Germany
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Busch M, Lehmann T, Günster C, Wolf G, Müller UA, Müller N. Entwicklung der Therapie des Diabetes mellitus Typ 2 in Bezug zur Prävalenz einer chronischen Nierenerkrankung. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Busch
- Universitätsklinikum Jena, Klinik für Innere Medizin III, Jena, Germany
| | - T Lehmann
- Universitätsklinikum Jena, Zentrum für Klinische Studien, Jena, Germany
| | - C Günster
- Wissenschaftliches Institut der AOK, Berlin, Germany
| | - G Wolf
- Universitätsklinikum Jena, Klinik für Innere Medizin III, Jena, Germany
| | - UA Müller
- Universitätsklinikum Jena, Klinik für Innere Medizin III, Jena, Germany
| | - N Müller
- Universitätsklinikum Jena, Klinik für Innere Medizin III, Jena, Germany
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Diab M, Tasar R, Sponholz C, Bauer M, Lehmann T, Färber G, Brunkhorst F, Doenst T. Inflammatory and Vasoactive Mediator Profiles during Valvular Surgery for Infective Endocarditis versus Noninfectious Valvular Heart Disease. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M. Diab
- Klinik für Herz- und Thoraxchirurgie, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - R. Tasar
- Klinik für Herz- und Thoraxchirurgie, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - C. Sponholz
- Department of Anesthesiology, Universitätsklinikum Jena, Jena, Germany
| | - M. Bauer
- Department of Anesthesiology, Universitätsklinikum Jena, Jena, Germany
| | - T. Lehmann
- Department of Statistics and Biometry, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - G. Färber
- Klinik für Herz- und Thoraxchirurgie, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - F. Brunkhorst
- Center for Clinical Studies, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - T. Doenst
- Center for Clinical Studies, Friedrich-Schiller-Universität Jena, Jena, Germany
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Teichgräber U, Aschenbach R, Scheinert D, Zeller T, Brechtel K, Thieme M, Blessing E, Treitl M, Lichtenberg M, von Flotow P, Vogel B, Werk M, Riambau V, Wienke A, Lehmann T, Sixt S. Erratum to: The effectiveness of the paclitaxel-coated Luminor® balloon catheter versus an uncoated balloon catheter in superficial femoral and popliteal arteries in preventing vessel restenosis or reocclusion: study protocol for a randomized controlled trial. Trials 2017; 18:193. [PMID: 28446251 PMCID: PMC5405525 DOI: 10.1186/s13063-017-1884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/09/2017] [Indexed: 11/18/2022] Open
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28
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Lehmann T, Aeberli D. Possible protective effect of switching from denosumab to zoledronic acid on vertebral fractures. Osteoporos Int 2017; 28:3067-3068. [PMID: 28589418 DOI: 10.1007/s00198-017-4108-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
Affiliation(s)
- T Lehmann
- Rheumatological Practice OsteoRheuma Bern, 3011, Bern, Switzerland
| | - D Aeberli
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, CH-3012, Bern, Switzerland.
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Müller N, Lehmann T, Gerste B, Adler JB, Kloos C, Hartmann M, Kramer G, Kuniss N, Müller UA. Increase in the incidence of severe hypoglycaemia in people with Type 2 diabetes in spite of new drugs: analysis based on health insurance data from Germany. Diabet Med 2017; 34:1212-1218. [PMID: 28586530 DOI: 10.1111/dme.13397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2017] [Indexed: 12/22/2022]
Abstract
AIM To evaluate the use of new anti-hyperglycaemic agents that offer effective glycaemic control while reducing risk of hypoglycaemia, by analysing the incidence rates of severe hypoglycaemia in 2006 vs 2011 in relation to the medication. METHODS This cross-sectional, population-based study used German health insurance data. All adults diagnosed with Type 2 diabetes mellitus (extrapolated to the German population: 6.35 million in 2006 and 7.52 million in 2011) were screened for severe hypoglycaemia. Anti-hyperglycaemic agents were identified by their Anatomical Therapeutic Chemical code, and defined daily doses of each medication were calculated. RESULTS The severe hypoglycaemic event rate was 460 per 100,000 people/year in 2006 and 490 per 100,000 people/year in 2011. In 2006 and 2011, 10.9% and 7.3%, respectively, of all people with severe hypoglycaemia were on sulfonylureas, while 12.7% and 9.3%, respectively, were on a combination therapy of metformin and sulfonylureas. Among those with severe hypoglycaemia, there were no prescriptions of dipeptidyl peptidase-4 inhibitors or glucagon-like peptide-1 receptor agonists in 2006, but in 2011, 1.55% and 0.17%, of those with severe hypoglycaemia were receiving the respective treatments. In 2006 vs 2011, human insulin was prescribed for 11.3% vs 10.3% of people with severe hypoglycaemia, while insulin analogues were prescribed for 5.4% vs 8.1%, and mixed human insulins for 19.7% vs 14.0% of patients with severe hypoglycaemia. People receiving insulin analogue therapy had a higher risk of severe hypoglycaemia than those receiving metformin, after adjusting for age, gender, nephropathy diagnosis and year of survey (odds ratio 14.6; CI 13.3-15.9). CONCLUSION The incidence of severe hypoglycaemic events in Germany increased between 2006 and 2011, despite increased use of newer anti-hyperglycaemic agents and decreased use of insulins.
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Affiliation(s)
- N Müller
- Department for Internal Medicine III, Jena University Hospital, Jena, Germany
| | - T Lehmann
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - B Gerste
- Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany
| | - J-B Adler
- Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany
| | - C Kloos
- Department for Internal Medicine III, Jena University Hospital, Jena, Germany
| | - M Hartmann
- Department of Pharmacy, Jena University Hospital, Jena, Germany
| | - G Kramer
- Department for Internal Medicine III, Jena University Hospital, Jena, Germany
| | - N Kuniss
- Department for Internal Medicine III, Jena University Hospital, Jena, Germany
| | - U A Müller
- Department for Internal Medicine III, Jena University Hospital, Jena, Germany
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Diab M, Sponholz C, von Loeffelholz C, Scheffel P, Bauer M, Kortgen A, Lehmann T, Färber G, Pletz MW, Doenst T. Impact of perioperative liver dysfunction on in-hospital mortality and long-term survival in infective endocarditis patients. Infection 2017; 45:857-866. [DOI: 10.1007/s15010-017-1064-6] [Citation(s) in RCA: 18] [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: 03/22/2017] [Accepted: 08/23/2017] [Indexed: 12/15/2022]
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31
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Mainz J, Jaudszus A, Arnold C, Mentzel HJ, Reinsch S, Lorenz M, Michl R, Lehmann T, Renz D, Tabori H. WS21.3 Relation of abdominal symptoms obtained with a novel multidimensional score (JenAbdomen CF-score) and ultrasound findings in cystic fibrosis patients. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30270-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Heller T, Kloos C, Lehmann T, Schiel R, Lorkowski S, Wolf G, Müller UA, Müller N. Type 1 diabetes and mortality risk in a German cohort following 20 years: The JEVIN trial. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- T Heller
- Universitätsklinikum Jena, Klinik für Innere Medizin III, Jena, Germany
| | - C Kloos
- Universitätsklinikum Jena, Klinik für Innere Medizin III, Jena, Germany
| | - T Lehmann
- Universitätsklinikum Jena, Institut für Medizinische Statistik, Informatik und Dokumentation, Jena, Germany
| | - R Schiel
- Inselklinikum Heringsdorf, Haus Gothensee, Heringsdorf, Germany
| | - S Lorkowski
- Friedrich-Schiller-Universität, Lehrstuhl für Biochemie und Physiologie der Ernährung, Jena, Germany
| | - G Wolf
- Universitätsklinikum Jena, Klinik für Innere Medizin III, Jena, Germany
| | - UA Müller
- Universitätsklinikum Jena, Klinik für Innere Medizin III, Jena, Germany
| | - N Müller
- Universitätsklinikum Jena, Klinik für Innere Medizin III, Jena, Germany
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Wutschke M, Franiel T, Teichgräber U, Katenkamp K, Lehmann T. Assessment of Gadoxetic Acid-enhanced MRI phases for LI-RADS categorization and non-invasive grading of hepatocellular carcinoma. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M Wutschke
- Universitätsklinikum Jena, Institut für diagnostische und interventionelle Radiologie, Jena
| | - T Franiel
- Universitätsklinikum Jena, Institut für Diagnostische und Interventionelle Radiologie, Jena
| | - U Teichgräber
- Universitätsklinikum Jena, Institut für diagnostische und interventionelle Radiologie, Jena
| | - K Katenkamp
- Universitätsklinikum Jena, Pathologisches Institut, Jena
| | - T Lehmann
- Universitätsklinikum Jena, Institut fuer Medizinische Statistik, Informatik und Dokumentation, Jena
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Diab M, Günther A, Fink J, Raphael T, Seyitoglu M, Goebel B, Hamadanchi A, Lehmann T, Färber G, Doenst T. Does Coronary Artery Bypass Grafting Concomitant to Valve Surgery Influence the Outcome in Patients with Active Infective Endocarditis? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Diab
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - A. Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - J. Fink
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - T. Raphael
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - M. Seyitoglu
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - B. Goebel
- Department of Cardiology, Jena University Hospital, Jena, Germany
| | - A. Hamadanchi
- Department of Cardiology, Jena University Hospital, Jena, Germany
| | - T. Lehmann
- Center of Clinical Studies, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - G. Färber
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - T. Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
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Diab M, Färber G, Sponholz C, Tasar R, Lehmann T, Tkebuchava S, Schulze C, Doenst T. Off-Pump Bilateral Internal Mammary Artery Grafting Through a Left-Sided Mini-Thoracotomy. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Diab
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - G. Färber
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - C. Sponholz
- Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Jena, Germany
| | - R. Tasar
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - T. Lehmann
- Department of Statistics, Computer Science and Documentation, Jena University Hospital, Jena, Germany
| | - S. Tkebuchava
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - C. Schulze
- Department of Cardiology, Jena University Hospital, Jena, Germany
| | - T. Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
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Heller T, Reise K, Roth J, Lehmann T, Schiel R, Lorkowski S, Müller UA, Müller N. Changes in Quality of Diabetes Care and Morbidity over 20 Years in People with Type 1 Diabetes and Long Diabetes Duration: The JEVIN Trial. Exp Clin Endocrinol Diabetes 2016; 125:122-129. [PMID: 28008584 DOI: 10.1055/s-0042-117717] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: The JEVIN trial started as a cross-sectional study in 1989/90 in Jena, a city of the former German Democratic Republic. At that time, the centralized diabetes care system was broken down and restarted 10 years later; structured treatment and teaching programs were implemented, blood glucose self-monitoring, insulin pump-systems and analogue insulin were introduced. We surveyed people with type-1-diabetes of the baseline JEVIN trial in a 20-year follow-up. Methods: 131 patients with type-1-diabetes were analyzed in 1989/90. Of the living population in 2009/10 (n=104), 83 persons were identified and 75 persons with a mean diabetes duration of 35 years were reexamined regarding HbA1c, self-monitoring, diabetes therapy, severe hypoglycemia, diabetic late complications and compared with the results of the same persons in 1989/90. Results: HbA1c decreased from 57.1 mmol/mol in 1989/90 to 52.7 mmol/mol in 2009/10 (7.4 -7.0%; p=0.049). Self-monitoring of blood glucose increased from 2 to 35 tests/week (p<0.001). 100%-use of animal insulin changed to human and analogue insulin therapy. The incidence of severe hypoglycemia increased from 0.1 to 0.16/patient-year. Retinopathy increased from 29 to 69% (p<0.001), nephropathy from 5 to 27% (p<0.001) and neuropathy from 13 to 43% (p<0.001). 17% had no diabetic late complications. Conclusions: The JEVIN trial shows a significant improve in HbA1c in the past 20 years. Severe hypoglycemia occurred rarely and 17% were still free of any diabetic late complication after 35 years of diabetes. This indicates a good quality of diabetes care in a German setting.
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Affiliation(s)
- T Heller
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
| | - K Reise
- Ilm-Kreis-Kliniken, Clinic for Children and Adolescence Medicine, Arnstadt, Germany
| | - J Roth
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
| | - T Lehmann
- Institute of Medical Statistics, Information Sciences and Documentation, Friedrich Schiller University Jena, Jena, Germany
| | - R Schiel
- Medigreif Inselklinik Heringsdorf GmbH, Fachklinik für Diabetes und Stoffwechselerkrankungen, Ostseebad Heringsdorf, Germany
| | - S Lorkowski
- Institute of Nutrition, Friedrich Schiller University Jena, Jena, Germany
| | - U A Müller
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
| | - N Müller
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
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Teichgräber U, Aschenbach R, Scheinert D, Zeller T, Brechtel K, Thieme M, Blessing E, Treitl M, Lichtenberg M, von Flotow P, Vogel B, Werk M, Riambau V, Wienke A, Lehmann T, Sixt S. The effectiveness of the paclitaxel-coated Luminor® balloon catheter versus an uncoated balloon catheter in superficial femoral and popliteal arteries in preventing vessel restenosis or reocclusion: study protocol for a randomized controlled trial. Trials 2016; 17:528. [PMID: 27793175 PMCID: PMC5084407 DOI: 10.1186/s13063-016-1657-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 10/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this investigator-initiated trial is to evaluate the safety and efficacy of the novel Luminor® paclitaxel-coated drug-eluting balloon (DEB) catheter (iVascular, S.L.U., Barcelona, Spain) in inhibiting restenosis and in ensuring long-term vascular patency. METHODS/DESIGN This is a multicenter randomized controlled trial to evaluate the Luminor® paclitaxel-coated DEB catheter for stenotic or occlusive lesions (length ≤15 cm) in the superficial femoral artery (SFA) and the popliteal artery (PA) up to the P1 segment compared to the noncoated, plain old balloon angioplasty (POBA) catheter. In total 172 subjects will be treated with either the DEB catheter or the POBA catheter in 11 German study centers in a 1:1 randomization study design. The primary endpoint is late lumen loss (LLL) at 6 months. Secondary endpoints are patency rate, target lesion/vessel revascularization, quality of life (assessed with the Walking Impairment Questionnaire (WIQ) and the EQ-5D), change of Rutherford stage and ankle-brachial index, major and minor amputation rate at the index limb, number of dropouts and all-cause mortality. DISCUSSION EffPac represents a randomized controlled trial that will provide evidence on the effectiveness of the Luminor® paclitaxel-coated DEB catheter for the reduction of restenosis compared to the POBA catheter for the SFA and the PA. The results of EffPac will allow direct comparison to other already-completed RCTs applying paclitaxel-coated DEBs from different manufacturers with different coating technologies in the same target vessel. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02540018 , registered on 17 August 2015. Protocol version: CIP Version Final04, 11 February 2016. EUDAMED No: CIV-15-03-013204.
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Affiliation(s)
- U Teichgräber
- Universitätsklinikum Jena, Institut für Diagnostische und Interventionelle Radiologie, Am Klinikum 1, 07747, Jena, Germany.
| | - R Aschenbach
- Universitätsklinikum Jena, Institut für Diagnostische und Interventionelle Radiologie, Am Klinikum 1, 07747, Jena, Germany
| | - D Scheinert
- Universitätsklinikum Leipzig, Abteilung für Interventionelle Angiologie, Philipp-Rosenthal-Straße 27 C, 04103, Leipzig, Germany
| | - T Zeller
- Herzzentrum Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - K Brechtel
- Ihre-Radiologen Berlin Gemeinschaftspraxis für Radiologie, Budapester Straße 15-19, 13347, Berlin, Germany
| | - M Thieme
- Medinos Kliniken Sonneberg Angiologie/Kardiologie/Diabetologie, Neustadter Str. 61, 96515, Sonneberg, Germany
| | - E Blessing
- SRH Klinikum Karlsbad-Langensteinbach, Guttmannstr. 1, 76307, Karlsbad, Germany
| | - M Treitl
- Klinikum der Ludwig Maximilians Universität München - Campus Innenstadt, Institut für Klinische Radiologie, Pettenkoferstraße 8a, 80336, München, Germany
| | - M Lichtenberg
- Klinikum Arnsberg Angiologie, Stolte Ley 5, 59759, Arnsberg, Germany
| | - P von Flotow
- Westpfalz-Klinikum GmbH Standort II Kusel, Im Flur 1, 66869, Kusel, Germany
| | - B Vogel
- Ruprecht-Karls-Universität Heidelberg, Analysezentrum III/Innere Medizin III, Im Neuenheimer Feld 669, 69120, Heidelberg, Germany
| | - M Werk
- Martin-Luther-Krankenhausbetrieb GmbH, Caspar-Theyß-Straße 27-31, 14193, Berlin, Germany
| | - V Riambau
- Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - A Wienke
- Martin-Luther-Universität Halle-Wittenberg, Institut für Medizinische Epidemiologie, Biometrie und Informatik, 06097, Halle (Saale), Germany
| | - T Lehmann
- Universitätsklinikum Jena, Zentrum für Klinische Studien (ZKS), Postfach, 07740, Jena, Germany
| | - S Sixt
- Angiologikum Hamburg, Wördemanns Weg 25-27, 22527, Hamburg, Germany
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Mothes A, Lehmann T, Kwetkat A, Radosa M, Runnebaum I. Gynäkologische Deszensus-Chirurgie bei hochaltrigen Patientinnen: Eine Fall-Kontroll-Studie zu Co-Morbidität und chirurgischen Komplikationen. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593105] [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: 10/20/2022] Open
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Mothes AR, Lehmann T, Kwetkat A, Radosa MP, Runnebaum IB. Gynaecological Prolapse Surgery in Very Old Female Patients: A Case-Control Study on Co-Morbidity and Surgical Complications. Geburtshilfe Frauenheilkd 2016; 76:869-874. [PMID: 27582580 DOI: 10.1055/s-0042-109868] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The aim of this study is to compare very elderly female patients with a younger control group after prolapse surgery with regard to co-morbidity and complications. METHOD In a case-control design, the consecutive data of patients after prolapse surgery at the age of over 80 years and those of a control group were analysed by means of the Clavien-Dindo (CD) classification of surgical complications, the Charlson Comorbidity Index and the Cumulative Illness Rating Scale Geriatrics (CIRS-G). Statistics: Student's t, Fisher's exact and Mann-Whitney U tests. RESULTS The analysis comprised n = 57 vs. n = 60 operations. In the very elderly patients there was often a grade IV prolapse (p < 0.001), apical fixations were more frequent (p < 0.001), but the operating times were not different. In the very elderly patients 21 % CD II+III complications were observed, in the control group 6.6 % (p = 0.031). No CD IV and V complications occurred in either group, the duration of inpatient stay amounted to 5 (± 1) vs. 4.1 (± 0.8; p < 0.001) days, the very elderly patients needed an inpatient follow-up more frequently (p < 0.001). The co-morbidities of the very elderly patients differed from those of the control group in number (median 2.0 vs. 1.5; p < 0.001), in CIRS-G (4.1 ± 2.2 vs. 2.4 ± 1.7; p < 0.01) and in Charlson Index (1.6 ± 1.6 vs. 0.5 ± 0.7; p < 0.001). CONCLUSIONS A prolapse in very elderly women can be safely managed by surgery. In no case did the complications require intensive care treatment nor were they life-threatening, but they did lead to a longer duration of hospital stay and more frequently to further treatment geriatric or inpatient internal medicine facilities.
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Affiliation(s)
- A R Mothes
- Universitätsfrauenklinik, Friedrich-Schiller-Universität, Jena
| | - T Lehmann
- Institut für Medizinische Statistik, Informatik und Dokumentation, Friedrich-Schiller-Universität, Jena
| | - A Kwetkat
- Klinik für Geriatrie, Universitätsklinikum, Friedrich-Schiller-Universität, Jena
| | - M P Radosa
- Universitätsfrauenklinik, Friedrich-Schiller-Universität, Jena
| | - I B Runnebaum
- Universitätsfrauenklinik, Friedrich-Schiller-Universität, Jena
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Kramer G, Kuniss N, Kloos C, Lehmann T, Müller N, Sämann A, Wolf G, Müller UA. Metabolic control and hypoglycaemia in people with type 2 diabetes on conventional or intensified insulin therapy: a 22 year retrospective single centre survey. Diabetes Metab Res Rev 2016; 32:652-8. [PMID: 26789274 DOI: 10.1002/dmrr.2783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 12/07/2015] [Accepted: 12/27/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Multiple insulin injection therapy can easily be adapted to the patient's needs. Therefore, it is supposed that more intensive insulin therapy is associated with better metabolic control and less hypoglycaemia compared with a conventional insulin strategy in patients with type 2 diabetes. METHODS HbA1c and incidence of non-severe and severe hypoglycaemia were analysed with regard to the strategy of insulin therapy [multiple insulin injection therapy with preprandial insulin with or without basal insulin or conventional insulin therapy with twice-daily premix insulin] from 20 943 visits of 1417 people treated with insulin with type 2 diabetes in a university outpatient department for endocrinology and metabolic diseases over a period of 22 years. RESULTS Multiple insulin injection therapy was used in 13 896 (66.4%) of all 20 942 visits. Compared with conventional insulin therapy, these patients were younger (62.0 vs 68.7 years; p < 0.001), had a slightly longer diabetes duration (16.5 vs 15.8 years; p < 0.001) and higher body mass index (32.8 vs 30.9 kg/m(2) ; p < 0.001), a higher insulin dose (76.4 vs 46.5 IU/day; p < 0.001), more frequent blood glucose monitorings/week (24.2 vs 14.8; p < 0.001), a slightly lower HbA1c [7.7 (61.2) vs 7.9% (62.9 mmol/mol); p < 0.001] but more non-severe hypoglycaemic incidences per week (0.3 vs 0.2; p = 0.01). Episodes of severe hypoglycaemia were rare and comparable (0.01/patient/year) with both insulin therapy strategies. CONCLUSIONS Multiple insulin injection therapy and conventional insulin therapy yielded comparable metabolic control with HbA1c below 8% (63.9 mmol/mol), but multiple insulin injection therapy is associated with higher body mass index and higher incidence of non-severe hypoglycaemia. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- G Kramer
- Department Internal Medicine III, Jena University Hospital, Jena, Germany
| | - N Kuniss
- Department Internal Medicine III, Jena University Hospital, Jena, Germany
| | - C Kloos
- Department Internal Medicine III, Jena University Hospital, Jena, Germany
| | - T Lehmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany
| | - N Müller
- Department Internal Medicine III, Jena University Hospital, Jena, Germany
| | - A Sämann
- Department Internal Medicine III, Jena University Hospital, Jena, Germany
| | - G Wolf
- Department Internal Medicine III, Jena University Hospital, Jena, Germany
| | - U A Müller
- Department Internal Medicine III, Jena University Hospital, Jena, Germany
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Groten T, Schmitz S, Schippert C, Schleußner E, Hillemanns P, Lehmann T, von Versen-Höynck F. Knowledge and Implementation of the S3 Guideline on Gestational Diabetes among Gynecologists and Diabetologists Four Years after Publication: Results of a Survey of 773 Gynecologists and 76 Diabetologists on their Knowledge of the Guideline on Gestational Diabetes (AWMF 057-008, 2011). Geburtshilfe Frauenheilkd 2016; 76:771-778. [PMID: 27582574 DOI: 10.1055/s-0042-109396] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND An S3 guideline on the diagnosis and differentiated management of gestational diabetes (GDM) was published in Germany in 2011. This guideline replaced the previously applicable recommendations for the diagnosis and treatment of GDM and, for the first time, compiled evidence-based recommendations for the care of patients with GDM. The new guideline has focused particularly on the counselling offered to all patients with GDM about the associated long-term health risks. In this study we investigated the state of knowledge about the guideline among gynecologists and diabetologists in Thuringia and Lower Saxony. METHOD A questionnaire with 23 questions was sent out to 773 gynecologists and 76 diabetologists providing outpatient care in Lower Saxony and Thuringia. The statistical analysis was descriptive and inferential for comparisons between groups. RESULTS The response rate was 54 %; an average of 47.6 % of the individual questions were answered correctly in the completed questionnaires. The questions were answered correctly significantly more frequently by persons in the group with a good knowledge of the guidelines (75 vs. 61 %, p < 0.001). There were no significant differences between groups when differences between federal states or medical specialties were compared. CONCLUSIONS The results of our study show a good general state of knowledge of the guideline and point to a high level of willingness to implement the recommendations of the S3 guideline on GDM. With regard to the follow-up care provided to patients with GDM and depression, this study found a significant need for further training.
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Affiliation(s)
- T Groten
- Abteilung für Geburtshilfe, Universitätsklinikum Jena, Jena, Germany
| | - S Schmitz
- Abteilung für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - C Schippert
- Abteilung für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - E Schleußner
- Abteilung für Geburtshilfe, Universitätsklinikum Jena, Jena, Germany
| | - P Hillemanns
- Abteilung für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - T Lehmann
- Institut für Medizinische Statistik, Informatik und Dokumentation, Universitätsklinikum Jena, Jena, Germany
| | - F von Versen-Höynck
- Abteilung für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
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42
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Kramer G, Kuniss N, Kloos C, Lehmann T, Müller N, Sanow B, Lorkowski S, Wolf G, Müller UA. Principles of self-adjustment of insulin dose in people with diabetes type 2 and flexible insulin therapy. Diabetes Res Clin Pract 2016; 116:165-70. [PMID: 27321332 DOI: 10.1016/j.diabres.2016.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/23/2016] [Accepted: 04/18/2016] [Indexed: 11/26/2022]
Abstract
AIMS Structured treatment and education programmes for people with type 2 diabetes mellitus (T2DM) and flexible insulin therapy provide rules for self-adjustment of insulin dose, that are extensively trained. The aim of this cohort study was to register current principles and the frequency of self-adjustment of insulin dose and their association with metabolic control in people with T2DM. METHODS Details of insulin dose adjustment were assessed by a structured interview in 149 people with T2DM on flexible insulin therapy (mean HbA1c 7.1%/53.8mmol/mol, age 65y, diabetes duration 19.0y, BMI 33.8kg/m(2)) in a tertiary care centre. The frequency of insulin dose adjustments was obtained from the last 28days of the patients' diaries. RESULTS Insulin dose adjustment by adjustment rules was used by 33 people (22.1%) and by personal experience/feeling in 111 participants (74.5%). People adjusting by rules were younger (60.9±9.8 vs. 65.7±9.2, p=0.011) and did more insulin dose adjustments per 28days (50.0±31.0 vs. 33.4±23.5, p=0.016). HbA1c and incidence of hypoglycaemia were comparable. There were no differences in satisfaction of treatment, quality of life as well as current well-being between the groups. CONCLUSIONS Only a fifth of the participants used the rule trained within the education programme to adjust their insulin dose. The majority adjusted their insulin dose by personal experience/feeling. However, people in both groups were able to adjust their insulin dose. Although people using adjustment rules adjust their insulin dose more frequently, HbA1c and the incidence of hypoglycaemia was similar compared to those using personal experience/feeling.
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Affiliation(s)
- G Kramer
- Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany.
| | - N Kuniss
- Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - C Kloos
- Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - T Lehmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany
| | - N Müller
- Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - B Sanow
- Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - S Lorkowski
- Institute of Nutrition, Friedrich Schiller University Jena, Germany; Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-Leipzig, Germany
| | - G Wolf
- Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - U A Müller
- Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
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Tabori H, Arnold C, Mentzel HJ, Renz D, Reinsch S, Lorenz M, Michl R, Gerber A, Lehmann T, Boer K, Mainz J. 161 Elaboration and first evaluation of a new questionnaire on abdominal symptoms in cystic fibrosis. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30399-x] [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: 11/16/2022]
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Montemagno A, Schleußner E, Lehmann T, Groten T, Battefeld W. Prädiktoren in der Indexgravidität für postpartale metabolische Erkrankungen bei Gestationsdiabetes. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0042-105954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - E. Schleußner
- Klinik für Frauenheilkunde und Geburtshilfe, Friedrich-Schiller-Universität Jena, Germany
| | - T. Lehmann
- Institut für medizinische Statistik, Informatik und Dokumentation, Friedrich-Schiller-Universität Jena, Germany
| | - T. Groten
- Klinik für Frauenheilkunde und Geburtshilfe, Friedrich-Schiller-Universität Jena, Germany
| | - W. Battefeld
- Medizinisches Versorgungszentrum Kempten-Allgäu, Germany
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Abstract
Objective: Target HbA1c values given in the most National Therapeutic Guidelines for patients with diabetes and cut-off HbA1c values for diabetes diagnosis are usually not taking the age of the respective patients into account; despite the fact that an increase in HbA1c in subjects without diabetes with age is known for some time. In order to further quantify the association between age and HbA1c in non-diabetic subjects an analysis of one German register was performed. Methods: In this cross-sectional study we analyzed data from 7 699 visits of 2 921 patients without diabetes (age 46.6 y [range 18-93 y]; 69.1% women; BMI 27.6±6.4 kg/m²) who had at least one HbA1c and blood glucose measurement. Data were drawn from an electronic patient record system (EMIL™) in which data were collected between 01/1992 and 01/2014. The patients were divided in 6 age groups (< 30 years [n=1 057];>30-40 years [n=1 160];>40-50 years [n=1 693];>50-60 years [n=1 523];>60-70 years [n=1 310];>70 years [n=956]) and the HbA1c values of these groups were compared. Patients with: gestational diabetes, use of systemic glucocorticoids, malignant neoplasm, age<18 y at time of first visit and IGT were excluded. HbA1c measurements were DCCT adjusted. Results: Patients with age>70 years have a 0.47% [5.14 mmol/mol] higher HbA1c compared to those<30 years. The mean HbA1c of the age groups was:<30 4.98% [30.96 mmol/mol],>30-40 5.07% [31.99 mmol/mol],>40-50 5.17% [33.10 mmol/mol],>50-60 5.33% [34.79 mmol/mol],>60-70 5.42% [35.79 mmol/mol] and>70 years 5.45% [36.10 mmol/mol]. In a multiple linear model the regression coefficient for each year of age increase was β=0.0074 (p<0.001); thus age results in an increase of 0.074% in HbA1c per decade. Conclusion: HbA1c increases significantly with ageing in people without diabetes. The use of different cut-off values for every age range for diagnosis of diabetes should be discussed.
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Affiliation(s)
- J Roth
- Endocrinology and Metabolic Diseases, Department Internal Medicine III, Jena University Hospital Jena, Jena, Germany
| | - N Müller
- Endocrinology and Metabolic Diseases, Department Internal Medicine III, Jena University Hospital Jena, Jena, Germany
| | - T Lehmann
- Institute of Medical Statistics, Information Sciences and Documentation, University Hospital Jena, Jena, Germany
| | | | - G Wolf
- Endocrinology and Metabolic Diseases, Department Internal Medicine III, Jena University Hospital Jena, Jena, Germany
| | - U A Müller
- Endocrinology and Metabolic Diseases, Department Internal Medicine III, Jena University Hospital Jena, Jena, Germany
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Kuniss N, Kramer G, Müller N, Kloos C, Lehmann T, Lorkowski S, Wolf G, Müller U. Diabetes-Related Burden and Distress is Low in People with Diabetes at Outpatient Tertiary Care Level. Exp Clin Endocrinol Diabetes 2016; 124:307-12. [DOI: 10.1055/s-0042-103685] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 10/21/2022]
Affiliation(s)
- N. Kuniss
- Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - G. Kramer
- Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - N. Müller
- Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - C. Kloos
- Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - T. Lehmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany
| | - S. Lorkowski
- Institute of Nutrition, Friedrich Schiller University Jena, Germany
| | - G. Wolf
- Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - U. Müller
- Department of Internal Medicine III, Jena University Hospital, Jena, Germany
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Abstract
Aims Single event multilevel surgery (SEMLS) has been shown to improve gait in children with cerebral palsy (CP). However, there is limited evidence regarding long-term outcomes and factors influencing them. Methods In total 39 children (17 females and 22 males; mean age at SEMLS ten years four months, standard deviation 37 months) with bilateral CP (20 Gross Motor Function Classification System (GMFCS) level II and 19 GMFCS level III) treated with SEMLS were included. Children were evaluated using gait analysis and the Gait Deviation Index (GDI) before SEMLS and one, two to three, five and at least ten years after SEMLS. A linear mixed model was used to estimate the effect of age at the surgery, GMFCS and follow-up period on GDI. Results There was a mean improvement of 12.1 (-15.3 to 45.1) GDI points one year after SEMLS (p < 0.001) and 10.3 (-23.1 to 44.2) GDI points ten years after SEMLS compared with before SEMLS (p < 0.001). GMFCS level III children aged ten to 12 years had the most improvement. The GMFCS III group had more surgical procedures at the index SEMLS (p < 0.001) and during the follow-up period (p = 0.039). After correcting for other factors, age at surgery was the only factor predictive of long-term results. Our model was able to explain 45% of the variance of the change in GDI at the different time points. Take home message: Children with GMFCS III level aged ten to 12 are the benchmark responders to SEMLS in the long-term. Cite this article: Bone Joint J 2016;98-B:278–81.
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Affiliation(s)
- M. Švehlík
- Medical University of Graz, Auenbruggerplatz
34, 8036 Graz, Austria
| | - G. Steinwender
- Medical University of Graz, Auenbruggerplatz
34, 8036 Graz, Austria
| | - T. Lehmann
- Jena University Hospital, Bachstraße
18, Jena, 07743, Germany
| | - T. Kraus
- Medical University of Graz, Auenbruggerplatz
34, 8036 Graz, Austria
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Kloos C, Müller N, Hartmann P, Lehmann T, Sämann A, Roth J, Wolf G, Müller UA. High Quality of Diabetes Care Based Upon Individualised Treatment Goals - A Cross Sectional Study in 4784 Patients in Germany. Exp Clin Endocrinol Diabetes 2016; 124:294-9. [PMID: 26824283 DOI: 10.1055/s-0035-1569380] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Recent guidelines recommend an individualized approach towards patients with diabetes mellitus. Data of a programme dealing with quality of diabetes care, "Diabetes TÜV" of the Deutsche BKK was reappraised in the light of recent evidence applying these recommendations. PATIENTS AND METHODS Data originates from a population-based study in primary diabetes care in Germany. Patients with diabetes mellitus insured by the Deutsche BKK were invited to participate. From 2000 to 2004 data of 4 784 patients participated. Double or multiple visits were not included. HbA1c was analysed in 0.5% categories and in age groups below and above 70 years. HbA1c was DCCT adjusted. RESULTS A total of 368 patients with diabetes mellitus type 1 (DM1) (42% women, HbA1c 54 mmol/mol (7.1%), BP 136/79 mmHg) and 4 416 patients with diabetes type 2 (DM2) (44% women, HbA1c 48.6 mmol/mol (6.6%), BP 142/81 mmHg) were included.). An HbA1c of 53 mmol/mol (7%) or less was found in 70%, less than 64 mmol/mol (8%) in 87% of all patients, and higher than 86 mmol/mol (10%) in 2.8%. The detailed analysis shows that an HbA1c of <=47.6 mmol/mol (6.5%) is achieved of 38% of people with DM1 and 56% with DM2, an HbA1c <=66 mmol/mol (8.0%) of 79% and 88%, respectively.The mean systolic blood pressure (BP) was 142 mmHg, the diastolic BP was 81 mmHg. Systolic BP increased with age (systolic BP: < 50 years 131 mmHg; 50-70 years 142 mmHg; > 70 years 144 mmHg/diastolic BP: < 50 years 81 mmHg; 50-70 years 82 mmHg; > 70 years 80 mmHg). Using WHO grading, BP is mainly mildly elevated (grade 1: 41% (n=1942); grade 2, 17% (n=820) grade 3 6% (n=281). In 10 patients (0.2%) HbA1c above 86 mmol/mol (10.0%) coincides with a BP WHO grade 3. CONCLUSIONS In recent years new evidence is available regarding treatment targets. The reappraisal of a cross sectional study of a quality assurance programme of a German health insurance in a differentiated way demonstrates that more than 2/3 of the people with diabetes mellitus meet their specific goals. Only very few patients are at imminent risk due to bad glycaemic control and high blood pressure. Old patients may be at risk of overtreatment. Strategies aiming at adapting pharmacological interventions in older patients must be conceived.
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Affiliation(s)
- C Kloos
- Endocrinology and Metabolic Diseases, University Hospital Jena, Jena, Germany
| | - N Müller
- Endocrinology and Metabolic Diseases, University Hospital Jena, Jena, Germany
| | | | - T Lehmann
- Computer Sciences and Documentation, Institute of Medical Statistics, University Hospital Jena, Jena, Germany
| | - A Sämann
- Practice for Dialysis, Saalfeld, Germany
| | - J Roth
- Endocrinology and Metabolic Diseases, University Hospital Jena, Jena, Germany
| | - G Wolf
- Endocrinology and Metabolic Diseases, University Hospital Jena, Jena, Germany
| | - U A Müller
- Endocrinology and Metabolic Diseases, University Hospital Jena, Jena, Germany
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Diab M, Sponholz C, Bauer M, Kortgen A, Scheffel P, Lehmann T, Faerber G, Pletz M. W, Doenst T. Impact of Perioperative Liver Dysfunction on In-Hospital Mortality and Long-Term Survival in Infective Endocarditis Patients. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Neumann T, Lodes S, Kästner B, Franke S, Kiehntopf M, Lehmann T, Müller UA, Wolf G, Sämann A. Osteocalcin, adipokines and their associations with glucose metabolism in type 1 diabetes. Bone 2016; 82:50-5. [PMID: 25888930 DOI: 10.1016/j.bone.2015.04.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 03/27/2015] [Accepted: 04/08/2015] [Indexed: 01/26/2023]
Abstract
To determine osteocalcin (OC) and adipokines in type 1 diabetes (T1D) and healthy controls, and to explore possible associations between glucose and bone metabolism, body composition and adipokines. Serum levels of total OC, undercarboxylated (UC-OC), leptin, adiponectin, and other parameters of glucose and bone metabolism were measured in 128 patients with T1D (mean duration 21.2years) and in 77 healthy controls, matched for gender, age, and body mass index (BMI). Partial correlations (adjusted for age and gender) with parameters of body composition (BMI, fat body mass [derived from bone mineral density scans]), glycaemic control (hemoglobin A1c (HbA1c), daily insulin dose in T1D), skeletal homeostasis (osteoprotegerin (OPG), receptor activator of NF-κB ligand (RANKL), all measured in serum), and serum insulin-like growth factor 1 (IGF-1) were also examined. Independent predictors of total and UC-OC were then explored. Total OC was lower in males with T1D (16.3±6.4 vs. 22.2±9.9ng/ml; p=0.001), whereas UC-OC did not show group differences. Adiponectin was higher in T1D patients, both for males and females (8.9±6.6 vs. 5.7±2.5μg/ml; p=0.004 and 13.8±6.4 vs. 8.8±4.0μg/ml; p<0.001). IGF-1 was lower only in females with T1D (146.6±68.8 vs. 203.0±74.4ng/ml; p<0.001). BMI and fat body mass were similar in T1D and controls. In T1D patients, total OC was inversely correlated with BMI and HbA1c, and UC-OC inversely correlated with HbA1c. In T1D patients, leptin positively correlated with BMI, fat body mass and daily insulin dose, while adiponectin inversely correlated with BMI and daily insulin dose. Multivariate regression modelling showed that determinants of higher total OC levels were male gender (p=0.04, ß-coefficient=2.865) and lower HbA1c (p=0.04, ß-coefficient=-0.117), whereas determinants of UC-OC levels were T1D (p=0.016, ß-coefficient=2.015), higher IGF-1 (p=0.004, ß-coefficient=0.011) and lower HbA1c (p=0.011, ß-coefficient=- 0.061). Total OC and UC-OC are associated with good glycaemic control in T1D, with gender-specific differences for total-OC. The association of leptin and adiponectin with glycaemic control, as observed in controls, does not seem to be a feature in T1D, although both adipokines appear to be related to the insulin demand. This article is part of a Special Issue entitled "Bone and diabetes".
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Affiliation(s)
- T Neumann
- Department of Internal Medicine III, Jena University-Hospital, Jena, Germany.
| | - S Lodes
- Department of Internal Medicine III, Jena University-Hospital, Jena, Germany
| | - B Kästner
- Department of Internal Medicine III, Jena University-Hospital, Jena, Germany
| | - S Franke
- Department of Internal Medicine III, Jena University-Hospital, Jena, Germany
| | - M Kiehntopf
- Institute of Clinical Chemistry and Laboratory Diagnostics, Jena University-Hospital, Jena, Germany
| | - T Lehmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University-Hospital, Jena, Germany
| | - U A Müller
- Department of Internal Medicine III, Jena University-Hospital, Jena, Germany
| | - G Wolf
- Department of Internal Medicine III, Jena University-Hospital, Jena, Germany
| | - A Sämann
- Department of Internal Medicine III, Jena University-Hospital, Jena, Germany
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