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Ali S, Shebl FM, Aboian E, Strosberg D, Fischer U, Cardella J, Guzman RJ, Ochoa Chaar CI. The Utilization of Protamine during Peripheral Vascular Interventions in the VQI. Ann Vasc Surg 2024; 101:72-79. [PMID: 38110083 DOI: 10.1016/j.avsg.2023.10.019] [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: 07/19/2023] [Revised: 09/24/2023] [Accepted: 10/22/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Protamine administration was shown to reduce bleeding after carotid surgery but the role of protamine during peripheral vascular interventions (PVIs) remains unknown. This study evaluates the trend and outcomes of protamine use in the Vascular Quality Initiative (VQI). Our hypothesis is that the use of protamine is associated with decreased bleeding after PVI. METHODS Patients undergoing elective PVI in the VQI (2016-2020) for peripheral arterial disease were reviewed and the utilization trend for protamine was described. The characteristics of patients undergoing PVI with and without protamine use were compared. After propensity score matching based on the patient's comorbidities, access site, and procedural characteristics, the perioperative outcomes of both groups were compared using multivariable Poisson regression to estimate adjusted rate ratios (aRRs) and 95% confidence intervals (95% CIs). RESULTS The total number of patients was 131,618 and patients who received protamine constituted 29.8% of the sample (N = 38,191). After propensity matching, the total number of patients was 94,582, and patients who received protamine constituted 28.8% of the sample (N = 27,275). Protamine use significantly increased during the study period from 5.2 to 22.9%. Before propensity score matching, patients who received protamine were more likely to be white (79% vs. 76.8, P ≤ 0.001), smokers (80.5% vs. 78.5%, P ≤ 0.001), with medical comorbidities including hypertension (88.9% vs. 88.5%, P = 0.074), congestive heart failure (20.5% vs. 19.8%, P = 0.006), and chronic obstructive pulmonary disease (28.2% vs. 26.5%). They were also more likely to be on perioperative medications such as P2Y12 inhibitors (44.3% vs. 45, P = 0.013%) and statin (77.4% vs. 76.5%, P = 0.001) compared to patients who did not receive protamine. After propensity matching, there were no significant differences between the 2 groups. There was a significant decrease in bleeding during procedures where protamine was administered compared to no protamine (2.0% vs. 2.2%) (aRR, 0.89 [95% CI 0.80, 0.98]). Protamine was more likely to be given in procedures complicated by perforation (0.8% vs. 0.5%) (aRR, 1.48 [95% CI 1.24, 1.76]) and less likely to be given during procedures with distal embolization (0.4% vs. 0.7%) (aRR, 0.59 [95% CI 0.49, 0.73]). However, patients receiving protamine had significantly higher cardiac complications (1.4% vs. 1.1%) (aRR, 1.27 [95% CI 1.12, 1.43]). There was no significant difference in mortality between the 2 groups. CONCLUSIONS Protamine use is associated with decreased perioperative bleeding but increased cardiac complications. Protamine should be selectively administered to patients at high risk of bleeding during PVI.
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Affiliation(s)
- Sahar Ali
- Vascular Surgery Department, Assiut University Hospital, Faculty of Medicine, Assiut, Egypt.
| | - Fatma M Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
| | - Edouard Aboian
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - David Strosberg
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Uwe Fischer
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Jonathan Cardella
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Raul J Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
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Fischer U, Diekmann F, Helbich T, Preibsch H, Püsken M, Wenkel E, Wienbeck S, Fallenberg EM. [Use of contrast-enhanced mammography for diagnosis of breast cancer]. Radiologie (Heidelb) 2023; 63:916-924. [PMID: 37889284 PMCID: PMC10692004 DOI: 10.1007/s00117-023-01222-8] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Contrast-enhanced mammography (CEM) is an imaging method that is able to improve visualization of intramammary tumors after peripheral venous administration of an iodine-containing contrast medium (ICM). OBJECTIVES AND METHODS The current significance of CEM is discussed. RESULTS Studies were able to show an advantage of CEM in the diagnosis of breast cancer compared to mammography, especially for women with dense breasts. Indications for CEM currently depend on the availability of magnetic resonance imaging (MRI). If MRI is available, CEM is indicated in those cases when MRI cannot be performed. Use of CEM for breast cancer screening is currently viewed critically. This view can change when results and updated assessments of large CEM studies in Europe and USA become available. Patients must be informed about the use of an ICM. As ICM administration for CEM is carried out in a similar manner to established imaging methods, the authors expect the use of ICM for CEM to be unproblematic as long as general contraindications are adhered to. CONCLUSIONS In the future, CEM could have greater importance for the diagnosis of breast cancer, as this imaging method has diagnostic advantages compared to conventional mammography. A great advantage of CEM is its availability. For those who use breast MRI, CEM is helpful when MRI is not feasible due to contraindications or other reasons.
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Affiliation(s)
- Uwe Fischer
- Diagnostisches Brustzentrum Göttingen, Göttingen, Deutschland.
| | - Felix Diekmann
- Institut für Radiologische Diagnostik, Krankenhaus St. Joseph-Stift, Schwachhauser Heerstr. 54, 28209, Bremen, Deutschland
| | - Thomas Helbich
- Universitätsklinik für Radiologie und Nuklearmedizin, Abteilung für Allgemeine und Pädiatrische Radiologie, Medizinische Universität Wien/AKH WIEN, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Heike Preibsch
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - Michael Püsken
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Evelyn Wenkel
- Medizinische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
- Radiologie München, München, Deutschland
| | - Susanne Wienbeck
- Radiologie Schwarzer Bär MVZ, Schwarzer Bär 8, 30449, Hannover, Deutschland
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Eva Maria Fallenberg
- Institut für diagnostische und interventionelle Radiologie, School of Medicine & Klinikum rechts der Isar Technische Universität München (TUM), Ismaninger Str. 22, 81675, München, Deutschland
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Fischer U. Breast MRI - The champion in the millimeter league: MIO breast MRI - The method of choice in women with dense breasts. Eur J Radiol 2023; 167:111053. [PMID: 37659208 DOI: 10.1016/j.ejrad.2023.111053] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/04/2023]
Abstract
We perform MRI of the breast as a first pass technique. We successfully established 10-minute-protocols (including T2 images) with a fixed dosage of 5 ml 1 M CM. A high spatial resolution of 526 × 526, better 672 × 672 or maximum (1.024 × 1.024, MIO MRI) is vital to achieve best results. We use fixation tools to avoid motion artifacts. Motion correction algorithms can, however, often eliminate such artifacts when they are present. In initial breast MRI exams, morphologic features are the most important criteria for lesion evaluation. If previous exams are available for comparison, the main criteria indicating a suspicious lesion are an increase in lesion size or the depiction of new lesions. High quality HR MRI of the breast is the method of choice in women with dense or extremely dense breasts in all cases (screening, assessment, follow up). In density type A or B, MRI can be helpful in defined constellations, e.g. when MX and US are limited or contraindicated. According to our experience, 95% or more of all carcinomas of the breast are detectable on MRI. The remaining 5% of MRI-occult lesions are intraductal tumors or very small invasive carcinomas depicted with mammography due to associated microcalcifications. MRI is, however, superior to all other imaging modalities in the detection of the clinically relevant DCIS (high risk DCIS, intermediate type). Consecutive MRI examinations in intervals of 12 to 24 months allow a reliable detection of invasive breast cancer with an average size of 7-8 mm. This corresponds to a rate of metastasis-free locoregional lymph nodes in >95% of cases. The rate of interval cancers is <2%. In conclusion, this strategy may increase the overall-lifetime survival of breast cancer patients to more than 95%. Inversely, mortality may be reduced to <5%. Taking these improvements in early breast cancer detection and survival that can be achieved through the implementation of QA HR MRI of the breast into account, it should be discussed to modify oncologic guidelines for the treatment of breast cancer. MRI is the best diagnostic tool we have and according to our experience, a first pass, quality-assured high-resolution breast MRI protocol provides best diagnostic results at minimal procedural effort.
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Affiliation(s)
- Uwe Fischer
- Diagnostic Breast Care Center, Bahnhofsallee 1d, 37081 Goettingen, Germany.
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Mujanovic A, Kurmann CC, Serrallach BL, Dobrocky T, Meinel TR, Windecker D, Grunder L, Beyeler M, Seiffge DJ, Pilgram-Pastor S, Arnold M, Piechowiak EI, Gralla J, Fischer U, Kaesmacher J. Intra-Arterial Thrombolysis is Associated with Delayed Reperfusion of Remaining Vessel Occlusions following Incomplete Thrombectomy. AJNR Am J Neuroradiol 2023; 44:1050-1056. [PMID: 37500281 PMCID: PMC10494949 DOI: 10.3174/ajnr.a7943] [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: 04/14/2023] [Accepted: 06/22/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND AND PURPOSE Intra-arterial thrombolytics may be used to treat distal vessel occlusions, which cause incomplete reperfusion following mechanical thrombectomy. Because immediate reperfusion after intra-arterial thrombolytics occurs rarely, the aim of this study was to assess the delayed effect of intra-arterial thrombolytics using follow-up perfusion imaging. MATERIALS AND METHODS We included patients from a prospective stroke registry (February 2015 to September 2022) who had undergone mechanical thrombectomy and had incomplete reperfusion (expanded TICI 2a-2c) and available 24 hour perfusion imaging. Perfusion imaging was rated as delayed reperfusion if time-sensitive perfusion maps did not show wedge-shaped delays suggestive of persisting occlusions corresponding to the post-mechanical thrombectomy angiographic deficit. Patients treated with intra-arterial thrombolytics were compared with controls using multivariable logistic regression and inverse probability of treatment weighting matching for baseline differences and factors associated with delayed reperfusion. RESULTS The median age of the final study population (n = 459) was 74 years (interquartile range, 63-81 years), and delayed reperfusion occurred in 61% of cases. Patients treated with additional intra-arterial thrombolytics (n = 40) were younger and had worse expanded TICI scores. After matching was performed, intra-arterial thrombolytics was associated with higher rates of delayed reperfusion (adjusted OR = 2.7; 95% CI, 1.1-6.4) and lower rates of new infarction in the residually hypoperfused territory after mechanical thrombectomy (adjusted OR = 0.3; 95% CI, 0.1-0.7). No difference was found in the rates of functional independence (90-day mRS, 0-2; adjusted OR = 1.4; 95% CI, 0.4-4.1). CONCLUSIONS Rescue intra-arterial thrombolytics is associated with delayed reperfusion of remaining vessel occlusions following incomplete mechanical thrombectomy. The value of intra-arterial thrombolytics as a potential therapy for incomplete reperfusions after mechanical thrombectomy should be assessed in the setting of randomized controlled trials.
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Affiliation(s)
- A Mujanovic
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - C C Kurmann
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
- Department of Diagnostic, Interventional and Pediatric Radiology (C.C.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - B L Serrallach
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - T Dobrocky
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - T R Meinel
- Department of Neurology (T.R.M., M.B., D.J.S., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - D Windecker
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - L Grunder
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - M Beyeler
- Department of Neurology (T.R.M., M.B., D.J.S., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - D J Seiffge
- Department of Neurology (T.R.M., M.B., D.J.S., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - S Pilgram-Pastor
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - M Arnold
- Department of Neurology (T.R.M., M.B., D.J.S., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - E I Piechowiak
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - J Gralla
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - U Fischer
- Department of Neurology (T.R.M., M.B., D.J.S., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
- Department of Neurology (U.F.), University Hospital Basel, University of Basel, Basel, Switzerland
| | - J Kaesmacher
- From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
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Chen JF, Loh SA, Fischer U, Nassiri N. Technical Feasibility and Safety of a Snare-Less, EVAR-First Technique for Iliac Branch Endoprosthesis. J Endovasc Ther 2023:15266028231187200. [PMID: 37449379 DOI: 10.1177/15266028231187200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the technical feasibility, safety, and early outcomes of a snare-less, endovascular abdominal aortic aneurysm repair (EVAR)-first technique (SET) for iliac branch endoprosthesis (IBE) placement. METHODS We retrospectively reviewed all patients who received IBEs between July 2018 and March 2022. Patients were divided into 2 categories based on method of IBE deployment: SET or Standard. Primary endpoints were technical success, major adverse events, mortality, reintervention, internal iliac artery (IIA) patency, and freedom from IIA branch instability. Technical success was defined by successful deployment of both the EVAR and the IBE with maintained patency of the IIA and no stent graft migration. RESULTS There were 20 patients (90% male, median age 72 [65.4-74.5] years) who underwent IBE placement. Among these, 5 (33.3%) underwent SET to treat 5 common iliac artery (CIA)/IIA aneurysms, while the remaining 15 (66.7%) underwent standard IBE deployment with through-and-through femoral access (n=13) or trans-brachial access (n=2) to treat 19 CIA/IIA aneurysms. Overall median renal to iliac bifurcation length was 169 (152-177) mm, with 9 patients falling short of the minimum of 165 mm for on-label IBE placement. Median contrast used was 148 (120-201) mL, fluoroscopy time 42.8 (35.0-49.8) minutes, estimated blood loss 200 (100-275) mL, and procedure time 192 (167-246) minutes, with no significant differences between the 2 groups. Technical success was achieved in 100% of cases. At 30 days, there were no mortalities or major adverse events in either group; there were 100% IIA patency, no IIA instability, and no reinterventions in both groups. Median follow-up in the SET group was 5.7 (5.5-6.2) months, with 1 death at 6 months and 1 type 1B endoleak at 6 months requiring reintervention. Median follow-up for the Standard group was 1.6 (0.8-2.1) years with 2 non-aneurysm-related deaths and no reinterventions at 1 year. CONCLUSIONS SET for IBE is a safe and effective approach that decreases technical complexity and mitigates anatomic barriers to IBE placement. CLINICAL IMPACT SET for IBE is a safe and effective approach to IBE placement that decreases technical complexity. A critical component to this technique is a large bore sheath with a stiff steerable tip. Importantly, this approach also mitigates anatomic barriers to IBE placement, expanding applicability of IBE technology to patients who may be otherwise ineligible.
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Affiliation(s)
- Julia Fayanne Chen
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sarah Ann Loh
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Uwe Fischer
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Naiem Nassiri
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
- Vascular & Endovascular Surgery, VA Connecticut Healthcare System, West Haven, CT, USA
- Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
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Wienbeck S, Andrijevska V, Kück F, Perske C, Unterberg-Buchwald C, Fischer U, Lotz J, Kunze M. Comparison between cone-beam breast-CT and full-field digital mammography for microcalcification detection depending on breast density. Medicine (Baltimore) 2023; 102:e33900. [PMID: 37266644 DOI: 10.1097/md.0000000000033900] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
The purpose of this study was to evaluate the impact of breast density on the diagnostic performance of cone-beam breast-CT (CBBCT) in comparison to full-field digital mammography (FFDM) for the detection of microcalcifications. This retrospective IRB-approved study was conducted between December 2015 and March 2017 and enrolled 171 women with Breast Imaging Reporting and Data System category 4 or 5 lesions on FFDM and additional CBBCT; 56 of which were ineligible. The inclusion was restricted to 83 women (90 breasts, 90 lesions) with microcalcifications. All lesions underwent histology or were monitored by FFDM and a clinical examination at least 2 years after enrollment. Two breast radiologists independently read each data set twice. Sensitivity, specificity and area under the curve were compared between the modalities. Thirty-two breasts (35.5%) were grouped as non-dense breasts (American College of Radiology types a/b) and 58 breasts (64.5%) as dense breasts (American College of Radiology types c/d). Histopathological assessment was performed in 61 of 90 breast lesions (32 malignant, 1 high-risk and 28 benign). Area under the curve was larger for FFDM than for CBBCT (P = .085). The sensitivity was significantly higher for FFDM compared to CBBCT (P = .009). The specificity showed no significant differences comparing FFDM (both readers: 0.62) versus CBBCT (reader 1: 0.76, reader 2: 0.60; P = .192). Inter-observer-reliability on BI-RADS readings was almost perfect for FFDM and moderate for CBBCT (κ = 0.84, κ = 0.54, respectively). Intra-observer agreement was substantial to almost perfect for both methods and readers. Compared with FFDM, CBBCT demonstrated non-comparable results for microcalcification detection in dense and non-dense breasts.
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Affiliation(s)
- Susanne Wienbeck
- University Medical Center Goettingen, Institute of Diagnostic and Interventional Radiology, Goettingen, Germany
- Radiology Practice Schwarzer Baer MVZ, Hannover, Germany
| | | | - Fabian Kück
- Core Facility Medical Biometry and Statistical Bioinformatics, University of Goettingen, Goettingen, Germany
| | - Christina Perske
- University Medical Center Goettingen, Institute for Pathology, Goettingen, Germany
| | - Christina Unterberg-Buchwald
- University Medical Center Goettingen, Institute of Diagnostic and Interventional Radiology, Goettingen, Germany
- University Medical Center Goettingen, Department of Cardiology and Pneumology, Goettingen, Germany
| | - Uwe Fischer
- Diagnostic Breast Center, Goettingen, Germany
| | - Joachim Lotz
- University Medical Center Goettingen, Institute of Diagnostic and Interventional Radiology, Goettingen, Germany
| | - Meike Kunze
- University Medical Center Goettingen, Institute of Diagnostic and Interventional Radiology, Goettingen, Germany
- Städtisches Klinikum Karlsruhe, Institute for Diagnostic and Interventional Radiology, Karlsruhe, Germany
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7
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Maulucci F, Disanto G, Bianco G, Pileggi M, Fischer U, Padlina G, Strambo D, Michel P, Kahles T, Nedeltchev K, Fisch U, Bonati L, Kägi G, Escribano Paredes JB, Carrera E, Nyffeler T, Bolognese M, Wegener S, Luft A, Schelosky L, Medlin F, von Reding A, Peters N, Renaud S, Mono ML, Remonda L, Machi P, Psychogios MN, Kaesmacher J, Mordasini P, Cereda CW. Endovascular therapy outcome in isolated posterior cerebral artery occlusion strokes: A multicenter analysis of the Swiss Stroke Registry. Eur Stroke J 2023; 8:575-580. [PMID: 37231695 PMCID: PMC10334166 DOI: 10.1177/23969873221150125] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
PURPOSE There is little data on the safety and efficacy of endovascular treatment (EVT) in comparison with intravenous thrombolysis (IVT) in acute ischemic stroke due to isolated posterior cerebral artery occlusion (IPCAO). We aimed to investigate the functional and safety outcomes of stroke patients with acute IPCAO treated with EVT (with or without prior bridging IVT) compared to IVT alone. METHODS We did a multicenter retrospective analysis of data from the Swiss Stroke Registry. The primary endpoint was overall functional outcome at 3 months in patients undergoing EVT alone or as part of bridging, compared with IVT alone (shift analysis). Safety endpoints were mortality and symptomatic intracranial hemorrhage. EVT and IVT patients were matched 1:1 using propensity scores. Differences in outcomes were examined using ordinal and logistic regression models. FINDINGS Out of 17,968 patients, 268 met the inclusion criteria and 136 were matched by propensity scores. The overall functional outcome at 3 months was comparable between the two groups (EVT vs IVT as reference category: OR = 1.42 for higher mRS, 95% CI = 0.78-2.57, p = 0.254). The proportion of patients independent at 3 months was 63.2% in EVT and 72.1% in IVT (OR = 0.67, 95% CI = 0.32-1.37, p = 0.272). Symptomatic intracranial hemorrhages were overall rare and present only in the IVT group (IVT = 5.9% vs EVT = 0%). Mortality at 3 months was also similar between the two groups (IVT = 0% vs EVT = 1.5%). CONCLUSION In this multicenter nested analysis, EVT and IVT in patients with acute ischemic stroke due to IPCAO were associated with similar overall good functional outcome and safety. Randomized studies are warranted.
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Affiliation(s)
- F Maulucci
- Stroke Centre, Neurology Department, Neurocentre of Southern Switzerland, EOC, Lugano, Switzerland
| | - G Disanto
- Stroke Centre, Neurology Department, Neurocentre of Southern Switzerland, EOC, Lugano, Switzerland
| | - G Bianco
- Stroke Centre, Neurology Department, Neurocentre of Southern Switzerland, EOC, Lugano, Switzerland
| | - M Pileggi
- Stroke Centre, Interventional and Diagnostic Neuroradiology, Neurocentre of Southern Switzerland, EOC, Lugano, Switzerland
| | - U Fischer
- Department of Neurology, University Hospital Bern, Bern, Switzerland
- Department of Neurology and Stroke Centre, University Hospital Basel, Basel, Switzerland
| | - G Padlina
- Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - D Strambo
- Lausanne University Hospital, Stroke Centre, Neurology Service, Lausanne, Switzerland
| | - P Michel
- Lausanne University Hospital, Stroke Centre, Neurology Service, Lausanne, Switzerland
| | - T Kahles
- Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
| | - K Nedeltchev
- Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
| | - U Fisch
- Department of Neurology and Stroke Centre, University Hospital Basel, Basel, Switzerland
| | - L Bonati
- Department of Neurology and Stroke Centre, University Hospital Basel, Basel, Switzerland
| | - G Kägi
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - E Carrera
- Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - T Nyffeler
- Luzerner Kantonsspital, Centre of Neurology and Neurorehabilitation, Luzern, Switzerland
| | - M Bolognese
- Luzerner Kantonsspital, Centre of Neurology and Neurorehabilitation, Luzern, Switzerland
| | - S Wegener
- Universitätsspital Zürich, Neurology, Zürich, Switzerland
| | - A Luft
- Universitätsspital Zürich, Neurology, Zürich, Switzerland
| | - L Schelosky
- Kantonsspital Münsterlingen, Division of Neurology, Münsterlingen, Switzerland
| | - F Medlin
- Stroke Unit, Division of Neurology, HFR Fribourg, Fribourg, Switzerland
| | - A von Reding
- Neurology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - N Peters
- Stroke Centre, Klinik Hirslanden, Zurich, Switzerland
| | - S Renaud
- Division of Neurology, Pourtalès Hospital, Neuchatel, Switzerland
| | - M-L Mono
- Stadtspital Waid und Triemli, Stroke Unit, Zürich, Switzerland
| | - L Remonda
- Department of Interventional Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - P Machi
- Department of Interventional Neuroradiology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - M-N Psychogios
- Department of Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - J Kaesmacher
- University Hospital Bern, Inselspital, Interventional Neuroradiology, Bern, Switzerland
| | - P Mordasini
- University Hospital Bern, Inselspital, Interventional Neuroradiology, Bern, Switzerland
| | - C W Cereda
- Stroke Centre, Neurology Department, Neurocentre of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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8
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Satam KK, Alameddine D, Aboian E, Fischer U, Guzman RJ, Ochoa Chaar CI. Endovascular fenestration and iliac stenting for acute limb ischemia caused by type B aortic dissection. J Vasc Surg Cases Innov Tech 2023; 9:101077. [PMID: 36923164 PMCID: PMC10009714 DOI: 10.1016/j.jvscit.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
A 60-year-old man presented with chest pain and acute limb ischemia of the right leg. He was found to have a type B aortic dissection with a flap occluding the origin of the right common iliac artery. The dissection flap was fenestrated endovascularly with the placement of a covered stent in the right common iliac artery. After 10 years, the dissection remains stable with a minimal increase in the aorta size. The stent is patent with no lower extremity symptoms or reintervention. Fenestration and stenting of the obstructing flap can be a durable reperfusion strategy for patients with aortic dissection presenting with acute limb ischemia.
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Affiliation(s)
- Keyuree K. Satam
- Division of Vascular Surgery and Endovascular Therapy, Yale School of Medicine, New Haven, CT
- Correspondence: Keyuree K. Satam, BA, Division of Vascular Surgery and Endovascular Therapy, Yale School of Medicine, 111 Park St, Apt 11R, New Haven, CT 06510
| | - Dana Alameddine
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Edouard Aboian
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Uwe Fischer
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Raul J. Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
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9
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Shah N, Oghenesume O, Fischer U. Using immersive externship experiences within medical education to bridge the physician-administrator divide. Med Teach 2023; 45:111-113. [PMID: 35912520 DOI: 10.1080/0142159x.2022.2104701] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The composition of early trainee medical education is highly influential as it shapes the future of medicine and healthcare. Despite being frequently neglected, education about and exposure to hospital administration should be important aspects of medical student learning. Understanding how health systems coordinate and optimize functions of different departments to enhance patient care is a critical component of being a physician. In this Personal View, we share the tangible impact that a short immersive experience with hospital administration can bring to not only enrich medical student education but also influence their future perspectives and interactions within healthcare systems. Early integration of these learning opportunities has the potential to improve the physician-administrator relationship within hospitals and encourage innovative collaboration to provide more patient-centered and financially sustainable healthcare.
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Affiliation(s)
| | | | - Uwe Fischer
- Assistant Professor of Vascular Surgery, Yale School of Medicine, New Haven, CT, USA
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10
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Phuong J, Steimers E, Hasse H, Münnemann K, Nickolaus P, Fischer U, von Harbou E, Matviychuk Y, Holland D. Benchtop NMR Spectroscopy in Wine Production: A Practical Tool for Monitoring Bioprocesses. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255157] [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: 11/09/2022]
Affiliation(s)
- J. Phuong
- TU Kaiserslautern Laboratory of Engineerig Thermodynamics (LTD) Erwin-Schrödinger-Str. 44 67663 Kaiserslautern Germany
| | - E. Steimers
- TU Kaiserslautern Laboratory of Engineerig Thermodynamics (LTD) Erwin-Schrödinger-Str. 44 67663 Kaiserslautern Germany
| | - H. Hasse
- TU Kaiserslautern Laboratory of Engineerig Thermodynamics (LTD) Erwin-Schrödinger-Str. 44 67663 Kaiserslautern Germany
| | - K. Münnemann
- TU Kaiserslautern Laboratory of Engineerig Thermodynamics (LTD) Erwin-Schrödinger-Str. 44 67663 Kaiserslautern Germany
| | - P. Nickolaus
- Dienstleistungszentrum Ländlicher Raum (DLR) Rheinpfalz Institute for Viticulture and Enology Breitenweg 71 67435 Neustadt/Wstr Germany
| | - U. Fischer
- Dienstleistungszentrum Ländlicher Raum (DLR) Rheinpfalz Institute for Viticulture and Enology Breitenweg 71 67435 Neustadt/Wstr Germany
| | - E. von Harbou
- TU Kaiserslautern Laboratory of Reaction and Fluid Process Engineering (LRF) Gottlieb-Daimler-Str. 44 67663 Kaiserslautern Germany
| | - Y. Matviychuk
- University of Canterbury Department of Chemical and Process Engineering Private Bag 4800 8140 Christchurch New Zealand
| | - D. J. Holland
- University of Canterbury Department of Chemical and Process Engineering Private Bag 4800 8140 Christchurch New Zealand
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11
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Kunze M, Schäfer B, Andrijevska V, Al Machot F, Fischer U, Lotz J, Wienbeck S. Interpretierbares maschinelles Lernen in der Diagnostik von Verkalkungen in der Brust in der Cone-beam Brust CT und digitalen Vollfeldmammographie. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M Kunze
- Universitätsmedizin Göttingen, Institut für Diagnostische und Interventionelle Radiologie, Göttingen
| | - B Schäfer
- Faculty of Science and Technology, Norwegian University of Life Sciences, 1432 Ås, Norwegen
| | | | - F Al Machot
- Faculty of Science and Technology, Norwegian University of Life Sciences, 1432 Ås, Norwegen
| | - U Fischer
- Diagnostisches Brustzentrum Göttingen, Göttingen
| | - J Lotz
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Göttingen
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12
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Ali SH, Shebl F, Aboian E, Strosberg D, Fischer U, Cardella J, Guzman RJ, Ochoa Chaar CI. The Use of Protamine During Peripheral Vascular Interventions in the Vascular Quality Initiative. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.03.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Satam K, Fischer U, Schioppo D, Cardella J, Guzman RJ, Ochoa Chaar CI. Aneurysmal degeneration of the hood of a cryopreserved vein allograft two years after thrombosis. J Vasc Surg Cases Innov Tech 2022; 8:300-304. [PMID: 35669278 PMCID: PMC9166410 DOI: 10.1016/j.jvscit.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/02/2022] [Indexed: 11/09/2022] Open
Abstract
Cryopreserved vein allografts are used as alternative conduits for infrainguinal bypass but are prone to aneurysmal degeneration. A 60-year-old man presented with a pulsatile, tender right groin mass 2 years after thrombosis of a cryopreserved vein jump graft emanating from a prosthetic axillary to profunda bypass. Intraoperatively, the aneurysm was consistent with isolated dilatation of the hood of the thrombosed cryopreserved vein graft. This was excised and repaired with bovine pericardial patch angioplasty. The patient recovered with no recurrence for 2 years. Aneurysmal degeneration of the cryopreserved vein allograft can occur even after graft thrombosis.
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Affiliation(s)
| | - Uwe Fischer
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Davia Schioppo
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Jonathan Cardella
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Raul J. Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
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14
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Chen JF, Brahmandam A, Harris S, Fischer U, Nassiri N. Elucidating the role of the AFX2 endograft in endovascular treatment of aortic pathology. Ann Vasc Surg 2022; 86:328-337. [PMID: 35589028 DOI: 10.1016/j.avsg.2022.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/17/2022] [Accepted: 04/23/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study is to elucidate the role of the AFX2 platform in the endovascular treatment of aortic pathology. METHODS All procedures by a single surgeon resulting in implantation of a bifurcated unibody stent graft were retrospectively reviewed. Indications for selection of the AFX2 endograft in each case were evaluated. Aortic anatomy was determined via review of pre-operative computed tomography (CT) scans. Cumulative event probabilities for endoleak, reintervention, and mortality were estimated. Patient and procedural details were described using mean, standard deviation, medians, and interquartile range (IQR). Kaplan-Meier survival analysis estimated freedom from mortality and reintervention. Cumulative incidence probabilities were calculated as one minus the Kaplan-Meier estimator. RESULTS Between March 2018 and December 2020, the author (NN) used 142 aortic endografts in 142 patients. Of these, 46 (32.4%) were AFX2 endografts and the remaining were modular bifurcated devices, predominantly Medtronic Endurant II and Terumo Treo. No AFX-Strata or AFX-Duraply devices were placed. Amongst the patients who received an AFX2, mean age was 71.3 +/- 9.8 years with 84.8% male. Median operative time was 116 (86-166) minutes, with contrast dose of 79 (41-120) milliliters and fluoroscopy time of 12 (8.6-18) minutes. Overall, 78.3% (n=36) of AFX2 devices were placed in aortas with maximum true lumen diameter <5.0cm. Median postoperative follow-up was 1.7 years (IQR 1.0-2.4 years), with a maximum follow-up of 3.6 years. There was 1 patient lost to follow-up at 5 months. The 2-year incidence of type II endoleak, reintervention, and all-cause mortality was 12.7% (95% CI, 0-29.6%), 2.2% (95% CI, 0-6.3%), and 11.3% (95% CI, 0.1-2.1.2%), respectively. There were no type I or III endoleaks. CONCLUSION The AFX2 endograft plays a safe and effective role in treatment of infrarenal aortic pathologies that may be otherwise more technically challenging for traditional modular, bifurcated devices.
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Affiliation(s)
- Julia Fayanne Chen
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Anand Brahmandam
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Sean Harris
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Uwe Fischer
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Naiem Nassiri
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
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15
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Hourston JE, Steinbrecher T, Chandler JO, Pérez M, Dietrich K, Turečková V, Tarkowská D, Strnad M, Weltmeier F, Meinhard J, Fischer U, Fiedler‐Wiechers K, Ignatz M, Leubner‐Metzger G. Cold-induced secondary dormancy and its regulatory mechanisms in Beta vulgaris. Plant Cell Environ 2022; 45:1315-1332. [PMID: 35064681 PMCID: PMC9305896 DOI: 10.1111/pce.14264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/26/2021] [Accepted: 11/18/2021] [Indexed: 06/14/2023]
Abstract
The dynamic behaviour of seeds in soil seed banks depends on their ability to act as sophisticated environmental sensors to adjust their sensitivity thresholds for germination by dormancy mechanisms. Here we show that prolonged incubation of sugar beet fruits at low temperature (chilling at 5°C, generally known to release seed dormancy of many species) can induce secondary nondeep physiological dormancy of an apparently nondormant crop species. The physiological and biophysical mechanisms underpinning this cold-induced secondary dormancy include the chilling-induced accumulation of abscisic acid in the seeds, a reduction in the embryo growth potential and a block in weakening of the endosperm covering the embryonic root. Transcriptome analysis revealed distinct gene expression patterns in the different temperature regimes and upon secondary dormancy induction and maintenance. The chilling caused reduced expression of cell wall remodelling protein genes required for embryo cell elongation growth and endosperm weakening, as well as increased expression of seed maturation genes, such as for late embryogenesis abundant proteins. A model integrating the hormonal signalling and master regulator expression with the temperature-control of seed dormancy and maturation programmes is proposed. The revealed mechanisms of the cold-induced secondary dormancy are important for climate-smart agriculture and food security.
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Affiliation(s)
- James E. Hourston
- Department of Biological SciencesRoyal Holloway University of LondonEghamUK
| | - Tina Steinbrecher
- Department of Biological SciencesRoyal Holloway University of LondonEghamUK
| | - Jake O. Chandler
- Department of Biological SciencesRoyal Holloway University of LondonEghamUK
| | - Marta Pérez
- Department of Biological SciencesRoyal Holloway University of LondonEghamUK
| | | | - Veronika Turečková
- Laboratory of Growth Regulators, Palacký University and Institute of Experimental BotanyCzech Academy of SciencesOlomoucCzech Republic
| | - Danuše Tarkowská
- Laboratory of Growth Regulators, Palacký University and Institute of Experimental BotanyCzech Academy of SciencesOlomoucCzech Republic
| | - Miroslav Strnad
- Laboratory of Growth Regulators, Palacký University and Institute of Experimental BotanyCzech Academy of SciencesOlomoucCzech Republic
| | | | | | | | | | - Michael Ignatz
- Department of Biological SciencesRoyal Holloway University of LondonEghamUK
| | - Gerhard Leubner‐Metzger
- Department of Biological SciencesRoyal Holloway University of LondonEghamUK
- Laboratory of Growth Regulators, Palacký University and Institute of Experimental BotanyCzech Academy of SciencesOlomoucCzech Republic
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16
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Abdel-Glil MY, Fischer U, Steinhagen D, McCarthy U, Neubauer H, Sprague LD. Phylogenetic Relatedness and Genome Structure of Yersinia ruckeri Revealed by Whole Genome Sequencing and a Comparative Analysis. Front Microbiol 2021; 12:782415. [PMID: 34867924 PMCID: PMC8640586 DOI: 10.3389/fmicb.2021.782415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Yersinia ruckeri is the causative agent of enteric redmouth disease (ERM), a serious infection that affects global aquaculture with high economic impact. The present study used whole genome sequences to perform a comparative analysis on 10 Y. ruckeri strains and to explore their genetic relatedness to other members of the genus. Y. ruckeri, Yersinia entomophaga, and Yersinia nurmii formed a species complex that constitutes the most basal lineage of the genus. The results showed that the taxonomy of Y. ruckeri strains is better defined by using a core genome alignment and phylogenetic analysis. The distribution of accessory genes in all Yersinia species revealed the presence of 303 distinctive genes in Y. ruckeri. Of these, 169 genes were distributed in 17 genomic islands potentially involved in the pathogenesis of ERM via (1) encoding virulence factors such as Afp18, Yrp1, phage proteins and (2) improving the metabolic capabilities by enhancing utilization and metabolism of iron, amino acids (specifically, arginine and histidine), and carbohydrates. The genome of Y. ruckeri is highly conserved regarding gene structure, gene layout and functional categorization of genes. It contains various components of mobile genetic elements but lacks the CRISPR-Cas system and possesses a stable set of virulence genes possibly playing a critical role in pathogenicity. Distinct virulence plasmids were exclusively restricted to a specific clonal group of Y. ruckeri (CG4), possibly indicating a selective advantage. Phylogenetic analysis of Y. ruckeri genomes revealed the co-presence of multiple genetically distant lineages of Y. ruckeri strains circulating in Germany. Our results also suggest a possible dissemination of a specific group of strains in the United States, Peru, Germany, and Denmark. In conclusion, this study provides new insights into the taxonomy and evolution of Y. ruckeri and contributes to a better understanding of the pathogenicity of ERM in aquaculture. The genomic analysis presented here offers a framework for the development of more efficient control strategies for this pathogen.
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Affiliation(s)
- Mostafa Y Abdel-Glil
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses (IBIZ), Jena, Germany
| | - Uwe Fischer
- Friedrich-Loeffler-Institut, Institute of Infectiology, Greifswald-Insel Riems, Germany
| | - Dieter Steinhagen
- Fish Disease Research Unit, Institute for Parasitology, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Una McCarthy
- Marine Laboratory, Marine Scotland, Aberdeen, United Kingdom
| | - Heinrich Neubauer
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses (IBIZ), Jena, Germany
| | - Lisa D Sprague
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses (IBIZ), Jena, Germany
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17
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Leichtle D, Fischer U, Bachmann C. Strategical Approach for the Neutronics in the European Fusion Programme. Fusion Science and Technology 2021. [DOI: 10.1080/15361055.2021.1887716] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- D. Leichtle
- Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - U. Fischer
- Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - C. Bachmann
- EUROfusion – Programme Management Unit, Garching, Germany
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18
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Matsumoto M, Fischer U, Sano M, Kato G. Cell-mediated immune response against mycolic acids of Mycobacteroides salmoniphilum in rainbow trout Oncorhynchus mykiss. Dev Comp Immunol 2021; 124:104195. [PMID: 34217784 DOI: 10.1016/j.dci.2021.104195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
Mycobacteriosis caused by Mycobacterium spp. causes economic damages to the world aquaculture industry. In mammals, mycolic acids contained in the cell wall of Mycobacterium spp. are presented by CD1b molecule as lipid antigens and induce cell-mediated immunity (CMI). Here, we investigated CMI responses against the mycolic acids of Mycobacterioides salmoniphilum in a CD1-lacking teleost fish, rainbow trout. After stimulation of trout leukocytes with mycolic acids, the number and percentage of CD8α+ T cells increased. Fish immunized with mycolic acids showed an up-regulation of IFN-γ. Further, in vitro re-stimulation of leukocytes derived from immunized fish resulted in proliferation of CD8α+ cells. These data suggest that mycolic acids are recognized as lipid antigens resulting in an activation of rainbow trout CD8α+ cells and up-regulation of the Th1 cytokine IFN-γ. The mycolic acids are promising candidates for vaccines to activate CD8α+ T cells against fish mycobacteriosis.
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Affiliation(s)
- Megumi Matsumoto
- Tokyo University of Marine Science and Technology, Department of Marine Bioscience, 4-5-7 Konan, Minato-ku, Tokyo, 108-8477, Japan
| | - Uwe Fischer
- Friedrich-Loeffler-Institut, Südufer 10, 17493, Greifswald, Germany
| | - Motohiko Sano
- Tokyo University of Marine Science and Technology, Department of Marine Bioscience, 4-5-7 Konan, Minato-ku, Tokyo, 108-8477, Japan
| | - Goshi Kato
- Tokyo University of Marine Science and Technology, Department of Marine Bioscience, 4-5-7 Konan, Minato-ku, Tokyo, 108-8477, Japan.
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19
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Belachew NF, Dobrocky T, Meinel TR, Hakim A, Vynckier J, Arnold M, Seiffge DJ, Wiest R, Piechowiak EI, Fischer U, Gralla J, Mordasini P, Kaesmacher J. Risks of Undersizing Stent Retriever Length Relative to Thrombus Length in Patients with Acute Ischemic Stroke. AJNR Am J Neuroradiol 2021; 42:2181-2187. [PMID: 34649917 DOI: 10.3174/ajnr.a7313] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Results regarding the association of thrombus length, stent retriever length, and recanalization success in patients with acute ischemic stroke are inconsistent. We hypothesized that the ratio of thrombus length to stent retriever length may be of particular relevance. MATERIALS AND METHODS Patients with acute ischemic stroke undergoing stent retriever thrombectomy at our institution between January 2010 and December 2018 were reviewed retrospectively. Thrombus length was assessed by measuring the susceptibility vessel sign on SWI using a 1.5T or 3T MR imaging scanner. Multivariable logistic regression models were used to determine the association between thrombus length, stent retriever length, and thrombus length/stent retriever length ratio with first-pass recanalization, overall recanalization, and embolization in new territories. Results are shown as adjusted ORs with 95% CIs. Additional mediation analyses were performed to test for indirect effects on first-pass recanalization and overall recanalization success. RESULTS The main analysis included 418 patients (mean age, 74.9 years). Increasing stent retriever length was associated with first-pass recanalization. Decreasing thrombus length and lower thrombus length/stent retriever length ratios were associated with first-pass recanalization and overall recanalization. Thrombus length and stent retriever length showed no association with first-pass recanalization or overall recanalization once thrombus length/stent retriever length ratio was factored in, while thrombus length/stent retriever length ratio remained a significant factor in both models (adjusted OR, 0.316 [95% CI, 0.112-0.892]; P = .030 and adjusted OR, = 0.366 [95% CI, 0.194-0.689]; P = .002). Mediation analyses showed that decreasing thrombus length and increasing stent retriever length had a significant indirect effect on first-pass recanalization mediated through thrombus length/stent retriever length ratio. The only parameter associated with embolization in new territories was an increasing thrombus length/stent retriever length ratio (adjusted OR, 5.079 [95% CI, 1.332-19.362]; P = .017). CONCLUSIONS Information about thrombus and stent length is more valuable when combined. High thrombus length/stent retriever length ratios, which may raise the risk of unsuccessful recanalization and embolization in new territories, should be avoided by adapting stent retriever selection to thrombus length whenever possible.
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Affiliation(s)
- N F Belachew
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - T Dobrocky
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - T R Meinel
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - A Hakim
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - J Vynckier
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - M Arnold
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - D J Seiffge
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - R Wiest
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - E I Piechowiak
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - U Fischer
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - J Gralla
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - P Mordasini
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - J Kaesmacher
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.).,Diagnostic, Interventional and Pediatric Radiology (J.K.), Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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Belachew NF, Dobrocky T, Aleman EB, Meinel TR, Hakim A, Vynckier J, Arnold M, Seiffge DJ, Wiest R, Mordasini P, Gralla J, Fischer U, Piechowiak EI, Kaesmacher J. SWI Susceptibility Vessel Sign in Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke. AJNR Am J Neuroradiol 2021; 42:1949-1955. [PMID: 34593377 DOI: 10.3174/ajnr.a7281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/27/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The frequency and clinical significance of the susceptibility vessel sign in patients with acute ischemic stroke remains unclear. We aimed to assess its prevalence in patients with acute ischemic stroke undergoing mechanical thrombectomy and to analyze its association with interventional and clinical outcome parameters in that group. MATERIALS AND METHODS Six hundred seventy-six patients with acute ischemic stroke and admission MR imaging were reviewed retrospectively. Of those, 577 met the eligibility criteria for further analysis. Imaging was performed using a 1.5T or 3T MR imaging scanner. Associations between baseline variables, interventional and clinical outcome parameters, and susceptibility vessel sign were determined with multivariable logistic regression models. Results are shown as adjusted ORs with 95% CIs. RESULTS The susceptibility vessel sign was present in 87.5% (n = 505) of patients and associated with tandem occlusion (adjusted OR, 3.3; 95% CI, 1.1-10.0; P = .032) as well as successful reperfusion, defined as an expanded TICI score of ≥2b (adjusted OR, 2.4; 95% CI, 1.28-4.6; P = .007). The susceptibility vessel sign was independently associated with functional independence (mRS ≤ 2: adjusted OR, 2.1; 95% CI, 1.1-4.0; P = .028) and lower mortality (adjusted OR, 0.4; 95% CI, 0.2-0.7; P = .003) at 90 days, even after adjusting for successful reperfusion. The susceptibility vessel sign did not influence the number of passes performed during mechanical thrombectomy, the first-pass reperfusion, or the risk of peri- or postinterventional complications. CONCLUSIONS The susceptibility vessel sign is an MR imaging phenomenon frequently observed in patients with acute ischemic stroke and is associated with successful reperfusion after mechanical thrombectomy. However, superior clinical functional outcome and lower mortality noted in patients showing the susceptibility vessel sign could not be entirely attributed to higher reperfusion rates.
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Affiliation(s)
- N F Belachew
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - T Dobrocky
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - E B Aleman
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - T R Meinel
- Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - A Hakim
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - J Vynckier
- Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - M Arnold
- Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - D J Seiffge
- Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - R Wiest
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - P Mordasini
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - J Gralla
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - U Fischer
- Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - E I Piechowiak
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - J Kaesmacher
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.).,Diagnostic, Interventional and Pediatric Radiology (J.K.), Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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21
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Brahmandam A, Chen JF, Tonnessen BH, Chaar CIO, Fischer U, Dardik A, Guzman RJ, Nassiri N. Alternative Endograft Aortoiliac Reconstruction for Iliac Branch Endoprostheses. Ann Vasc Surg 2021; 77:38-46. [PMID: 34455041 DOI: 10.1016/j.avsg.2021.05.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/08/2021] [Accepted: 05/31/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Endovascular treatment of complex common iliac artery (CIA) and internal iliac artery (IIA) aneurysms using iliac branch endoprostheses (IBE) has proven safe and effective. Instructions for use (IFU) require deployment of current IBE technology with the corresponding manufacturer's modular bifurcated aortic endograft. Concomitant aortoiliac occlusive disease, inadequate renal artery-iliac bifurcation length, and unfavorable aortic anatomy preclude on-label IBE deployment. This study aimed to evaluate the technical feasibility and safety of Alternative Endograft Aortoiliac Reconstruction (AEGAR) for branched endovascular treatment of complex iliac artery aneurysms. METHODS In 7 consecutive patients with CIA or IIA aneurysms, computed tomography angiography (CTA) and center-line reconstruction revealed aortoiliac anatomy incompatible with the current IBE IFU due to inadequate proximal CIA landing zone (n = 7), inadequate renal artery to iliac bifurcation length (n = 2), compromised aortic anatomy (n = 3), or short infrarenal neck <15 mm (n = 1), either alone or in combination. To overcome these restrictions and facilitate IBE deployment, aortoiliac reconstruction was performed using the Endologix AFX, Endologix Ovation limbs or the Medtronic Endurant II platforms (AEGAR technique). All internal iliac artery reconstructions and external iliac artery extensions were performed using the Gore VBX or Viabahn stent grafts. Technical success was defined as successful delivery of all endograft components without migration or endoleak. RESULTS The mean patient age was 69 years (range 52-82 years; 6 male). Four patients had bilateral CIA aneurysms and 3 patients had unilateral CIA aneurysms (mean diameter 4.3cm; range 2.2-7 cm). There were 13 IIA VBX stent grafts used for a total of 9 IIAs treated with IBE (bilateral IBE = 2 patients). The mean fluoroscopy time was 38.8 min (range 21.3-64.3 min) and the mean contrast volume was 168.5 mL (range 122-226 mL). Technical success was achieved in all patients and there were no perioperative complications. Mean hospital-stay was 2.2 days (range 1-3 days). Follow-up ranged from 82-957 days (mean = 487 days). At last follow-up, all patients were alive without cardiovascular morbidity; and CTA revealed stable or decreased aneurysm size, patent endografts, and no evidence of endoleak or migration. CONCLUSIONS The AEGAR technique can be used to safely and effectively overcome certain aortoiliac anatomic constraints that preclude use of current IBE technology. We encourage broader use of these alternative endografts in pertinent anatomic configurations.
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Affiliation(s)
- Anand Brahmandam
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
| | - Julia Fayanne Chen
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
| | - Britt H Tonnessen
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT; VA Connecticut Healthcare System, West Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
| | - Uwe Fischer
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
| | - Alan Dardik
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT; VA Connecticut Healthcare System, West Haven, CT
| | - Raul J Guzman
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
| | - Naiem Nassiri
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT; VA Connecticut Healthcare System, West Haven, CT.
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22
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Pan C, Humbatova A, Zheng L, Cesarato N, Grimm C, Chen F, Blaumeiser B, Catalán-Lambán A, Patiño-García A, Fischer U, Cheng R, Li Y, Yu X, Yao Z, Li M, Betz RC. Additional causal SNRPE mutations in hereditary hypotrichosis simplex. Br J Dermatol 2021; 185:439-441. [PMID: 33792916 DOI: 10.1111/bjd.20089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/24/2021] [Accepted: 03/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
- C Pan
- Department of Dermatology, Xinhua Hospital, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - A Humbatova
- Institute of Human Genetics, University of Bonn, School of Medicine and University Hospital Bonn, Bonn, Germany
| | - L Zheng
- Department of Dermatology, Xinhua Hospital, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - N Cesarato
- Institute of Human Genetics, University of Bonn, School of Medicine and University Hospital Bonn, Bonn, Germany
| | - C Grimm
- Department of Biochemistry, University of Würzburg, Würzburg, Germany
| | - F Chen
- Department of Dermatology, Xinhua Hospital, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - B Blaumeiser
- Department of Medical Genetics, University of Antwerp, Antwerp, Belgium
| | - A Catalán-Lambán
- Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain
| | - A Patiño-García
- Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain
| | - U Fischer
- Department of Biochemistry, University of Würzburg, Würzburg, Germany
| | - R Cheng
- Department of Dermatology, Xinhua Hospital, Shanghai, China
| | - Y Li
- Department of Dermatology, Xinhua Hospital, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - X Yu
- Department of Dermatology, Xinhua Hospital, Shanghai, China
| | - Z Yao
- Department of Dermatology, Xinhua Hospital, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - M Li
- Department of Dermatology, Xinhua Hospital, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Center for Rare Diseases Diagnosis, Shanghai, China
| | - R C Betz
- Institute of Human Genetics, University of Bonn, School of Medicine and University Hospital Bonn, Bonn, Germany
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23
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Konradt N, Kuhlen JG, Rohns HP, Schmitt B, Fischer U, Binder T, Schumacher V, Wagner C, Kamphausen S, Müller U, Sacher F, Janknecht P, Hobby R, ElSherbiny IMA, Panglisch S. Removal of Trace Organic Contaminants by Parallel Operation of Reverse Osmosis and Granular Activated Carbon for Drinking Water Treatment. Membranes (Basel) 2021; 11:membranes11010033. [PMID: 33401762 PMCID: PMC7823482 DOI: 10.3390/membranes11010033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022]
Abstract
In response to increasingly stringent restrictions for drinking water quality, a parallel operation of two common technologies, low-pressure reverse osmosis (LPRO) and activated carbon filtration (ACF), was investigated in a comprehensive five-month pilot study for the removal of 32 typical trace organic contaminants (TrOCs) from Rhine bank filtrates employing a semi- technical plant. TrOCs have been divided into three groups: polyfluorinated aliphatic compounds; pharmaceuticals, pesticides and metabolites; in addition to volatiles, nitrosamines and aminopolycarboxylic acids, which were also examined. The net pressure behavior, normalized salt passage and rejection of TrOCs by LPRO were investigated and compared with ACF operation. In addition, autopsies from the leading and last membrane modules were performed using adenosine triphosphate (ATP), total organic carbon (TOC), ICP-OES and SEM-EDX techniques. Generally, rather stable LPRO membrane performance with limited membrane fouling was observed. TrOCs with a molecular weight of ≥ 150 Da were completely retained by LPRO, while the rejection of di- and trichloro compounds improved as the filtration progressed. ACF also showed significant removal for most of the TrOCs, but without desalination. Accordingly, the ACF and LPRO can be operated in parallel such that the LPRO permeate and the ACF-treated bypass can be mixed to produce drinking water with adjustable hardness and significantly reduced TrOCs.
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Affiliation(s)
- Norbert Konradt
- Department of Waterworks, Stadtwerke Düsseldorf AG, Wiedfeld 50, 40589 Düsseldorf, Germany; (H.-P.R.); (B.S.); (U.F.); (T.B.); (C.W.); (S.K.)
- Correspondence: (N.K.); (U.M.)
| | - Jan Gerrit Kuhlen
- Viega Technology GmbH & Co. KG, Viegaplatz 1, 57439 Attendorn, Germany;
| | - Hans-Peter Rohns
- Department of Waterworks, Stadtwerke Düsseldorf AG, Wiedfeld 50, 40589 Düsseldorf, Germany; (H.-P.R.); (B.S.); (U.F.); (T.B.); (C.W.); (S.K.)
| | - Birgitt Schmitt
- Department of Waterworks, Stadtwerke Düsseldorf AG, Wiedfeld 50, 40589 Düsseldorf, Germany; (H.-P.R.); (B.S.); (U.F.); (T.B.); (C.W.); (S.K.)
| | - Uwe Fischer
- Department of Waterworks, Stadtwerke Düsseldorf AG, Wiedfeld 50, 40589 Düsseldorf, Germany; (H.-P.R.); (B.S.); (U.F.); (T.B.); (C.W.); (S.K.)
| | - Timo Binder
- Department of Waterworks, Stadtwerke Düsseldorf AG, Wiedfeld 50, 40589 Düsseldorf, Germany; (H.-P.R.); (B.S.); (U.F.); (T.B.); (C.W.); (S.K.)
| | - Vera Schumacher
- Berliner Wasserbetriebe, Motardstraße 35, 13629 Berlin, Germany;
| | - Christoph Wagner
- Department of Waterworks, Stadtwerke Düsseldorf AG, Wiedfeld 50, 40589 Düsseldorf, Germany; (H.-P.R.); (B.S.); (U.F.); (T.B.); (C.W.); (S.K.)
| | - Stefan Kamphausen
- Department of Waterworks, Stadtwerke Düsseldorf AG, Wiedfeld 50, 40589 Düsseldorf, Germany; (H.-P.R.); (B.S.); (U.F.); (T.B.); (C.W.); (S.K.)
| | - Uwe Müller
- DVGW-Technologiezentrum Wasser, Karlsruher Straße 84, 76139 Karlsruhe, Germany;
- Correspondence: (N.K.); (U.M.)
| | - Frank Sacher
- DVGW-Technologiezentrum Wasser, Karlsruher Straße 84, 76139 Karlsruhe, Germany;
| | - Peter Janknecht
- Enercity Netz GmbH, Auf der Papenburg 18, 30459 Hannover, Germany;
| | - Ralph Hobby
- Chair for Mechanical Process Engineering and Water Technology, University of Duisburg-Essen, 47057 Duisburg, Germany; (R.H.); (I.M.A.E.); (S.P.)
| | - Ibrahim M. A. ElSherbiny
- Chair for Mechanical Process Engineering and Water Technology, University of Duisburg-Essen, 47057 Duisburg, Germany; (R.H.); (I.M.A.E.); (S.P.)
| | - Stefan Panglisch
- Chair for Mechanical Process Engineering and Water Technology, University of Duisburg-Essen, 47057 Duisburg, Germany; (R.H.); (I.M.A.E.); (S.P.)
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24
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Dietz J, Spengler U, Müllhaupt B, Schulze Zur Wiesch J, Piecha F, Mauss S, Seegers B, Hinrichsen H, Antoni C, Wietzke-Braun P, Peiffer KH, Berger A, Matschenz K, Buggisch P, Backhus J, Zizer E, Boettler T, Neumann-Haefelin C, Semela D, Stauber R, Berg T, Berg C, Zeuzem S, Vermehren J, Sarrazin C, Giostra E, Berning M, Hampe J, De Gottardi A, Rauch A, Semmo N, Discher T, Trauth J, Fischer J, Gress M, Günther R, Heinzow H, Schmidt J, Herrmann A, Stallmach A, Hilgard G, Deterding K, Lange C, Ciesek S, Wedemeyer H, Hoffmann D, Klinker H, Schulze P, Kocheise F, Müller-Schilling M, Kodal A, Kremer A, Ganslmayer M, Siebler J, Lammert F, Rissland J, Löbermann M, Götze T, Canbay A, Lohse A, von Felden J, Jordan S, Maieron A, Moradpour D, Chave JP, Moreno C, Müller T, Muche M, Epple HJ, Port K, von Hahn T, Cornberg M, Manns M, Reinhardt L, Ellenrieder V, Rockstroh J, Schattenberg J, Sprinzl M, Galle P, Roeb E, Steckstor M, Schmiegel W, Brockmeyer N, Seufferlein T, Stremmel W, Strey B, Thimme R, Teufel A, Vogelmann R, Ebert M, Tomasiewicz K, Trautwein C, Tacke F, Koenen T, Weber T, Zachoval R, Mayerle J, Raziorrouh B, Angeli W, Beckebaum S, Doberauer C, Durmashkina E, Hackelsberger A, Erhardt A, Garrido-Lüneburg A, Gattringer H, Genné D, Gschwantler M, Gundling F, Hametner S, Schöfl R, Hartmann C, Heyer T, Hirschi C, Jussios A, Kanzler S, Kordecki N, Kraus M, Kullig U, Wollschläger S, Magenta L, Beretta-Piccoli BT, Menges M, Mohr L, Muehlenberg K, Niederau C, Paulweber B, Petrides A, Pinkernell M, Piso R, Rambach W, Reiser M, Riecken B, Rieke A, Roth J, Schelling M, Schlee P, Schneider A, Scholz D, Schott E, Schuchmann M, Schulten-Baumer U, Seelhoff A, Stich A, Stickel F, Ungemach J, Walter E, Weber A, Winzer T, Abels W, Adler M, Audebert F, Baermann C, Bästlein E, Barth R, Barthel K, Becker W, Behrends J, Benninger J, Berger F, Berzow D, Beyer T, Bierbaum M, Blaukat O, Bodtländer A, Böhm G, Börner N, Bohr U, Bokemeyer B, Bruch H, Bucholz D, Burkhard O, Busch N, Chirca C, Delker R, Diedrich J, Frank M, Diehl M, Dienethal A, Dietel P, Dikopoulos N, Dreck M, Dreher F, Drude L, Ende K, Ehrle U, Baumgartl K, Emke F, Glosemeyer R, Felten G, Hüppe D, Fischer J, Fischer U, Frederking D, Frick B, Friese G, Gantke B, Geyer P, Schwind H, Glas M, Glaunsinger T, Goebel F, Göbel U, Görlitz B, Graf R, Gruber H, Härter G, Herder M, Heuchel T, Heuer S, Höffl KH, Hörster H, Sonne JU, Hofmann W, Holst F, Hunstiger M, Hurst A, Jägel-Guedes E, John C, Jung M, Kallinowski B, Kapzan B, Kerzel W, Khaykin P, Klarhof M, Klüppelberg U, Klugewitz K, Knapp B, Knevels U, Kochsiek T, Körfer A, Köster A, Kuhn M, Langekamp A, Künzig B, Link R, Littman M, Löhr H, Lutz T, Knecht G, Lutz U, Mainz D, Mahle I, Maurer P, Mayer C, Meister V, Möller H, Heyne R, Moritzen D, Mroß M, Mundlos M, Naumann U, Nehls O, Ningel K, Oelmann A, Olejnik H, Gadow K, Pascher E, Petersen J, Philipp A, Pichler M, Polzien F, Raddant R, Riedel M, Rietzler S, Rössle M, Rufle W, Rump A, Schewe C, Hoffmann C, Schleehauf D, Schmidt K, Schmidt W, Schmidt-Heinevetter G, Schmidtler-von Fabris J, Schnaitmann E, Schneider L, Schober A, Niehaus-Hahn S, Schwenzer J, Seidel T, Seitel G, Sick C, Simon K, Stähler D, Stenschke F, Steffens H, Stein K, Steinmüller M, Sternfeld T, Strey B, Svensson K, Tacke W, Teuber G, Teubner K, Thieringer J, Tomesch A, Trappe U, Ullrich J, Urban G, Usadel S, von Lucadou A, Weinberger F, Werheid-Dobers M, Werner P, Winter T, Zehnter E, Zipf A. Efficacy of Retreatment After Failed Direct-acting Antiviral Therapy in Patients With HCV Genotype 1-3 Infections. Clin Gastroenterol Hepatol 2021; 19:195-198.e2. [PMID: 31706062 DOI: 10.1016/j.cgh.2019.10.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Received: 06/04/2019] [Revised: 09/19/2019] [Accepted: 10/25/2019] [Indexed: 02/07/2023]
Abstract
Hepatitis C virus infection is causing chronic liver disease, cirrhosis, and hepatocellular carcinoma. By combining direct-acting antivirals (DAAs), high sustained virologic response rates (SVRs) can be achieved. Resistance-associated substitutions (RASs) are commonly observed after DAA failure, and especially nonstructural protein 5A (NS5A) RASs may impact retreatment options.1-3 Data on retreatment of DAA failure patients using first-generation DAAs are limited.4-7 Recently, a second-generation protease- and NS5A-inhibitor plus sofosbuvir (voxilaprevir/velpatasvir/sofosbuvir [VOX/VEL/SOF]) was approved for retreatment after DAA failure.8 However, this and other second-generation regimens are not available in many resource-limited countries or are not reimbursed by regular insurance, and recommendations regarding the selection of retreatment regimens using first-generation DAAs are very important. This study aimed to analyze patients who were re-treated with first-generation DAAs after failure of a DAA combination therapy.
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Affiliation(s)
- Julia Dietz
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Ulrich Spengler
- Department of Internal Medicine I, University of Bonn, Bonn, and German Center for Infection Research (DZIF), Partner Site, Cologne-Bonn, Germany
| | - Beat Müllhaupt
- Swiss Hepato-Pancreato-Biliary Center and Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Julian Schulze Zur Wiesch
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, and German Center for Infection Research (DZIF), Partner Site, Hamburg-Lübeck-Borstel-Riems, Germany
| | - Felix Piecha
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, and German Center for Infection Research (DZIF), Partner Site, Hamburg-Lübeck-Borstel-Riems, Germany
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Barbara Seegers
- Gastroenterologisch-Hepatologisches Zentrum Kiel, Kiel, Germany
| | | | - Christoph Antoni
- Department of Internal Medicine II, University Hospital Mannheim, Mannheim, Germany
| | | | - Kai-Henrik Peiffer
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Annemarie Berger
- Institute for Medical Virology, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Peter Buggisch
- Institute for Interdisciplinary Medicine IFI, Hamburg, Germany
| | - Johanna Backhus
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Eugen Zizer
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Tobias Boettler
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David Semela
- Division of Gastroenterology and Hepatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Rudolf Stauber
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Berg
- Department of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Christoph Berg
- Department of Internal Medicine I, University of Tübingen, Tübingen, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Johannes Vermehren
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Christoph Sarrazin
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany; Medizinische Klinik 2, St Josefs-Hospital, Wiesbaden, Germany.
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Veenstra KA, Hodneland K, Fischer S, Takehana K, Belmonte R, Fischer U. Cellular Immune Responses in Rainbow Trout ( Onchorhynchus mykiss) Following Vaccination and Challenge Against Salmonid Alphavirus (SAV). Vaccines (Basel) 2020; 8:vaccines8040725. [PMID: 33276596 PMCID: PMC7761581 DOI: 10.3390/vaccines8040725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 01/25/2023] Open
Abstract
Viral disease outbreaks remain a significant limiting factor for aquaculture. The majority of licensed vaccines used in the industry are administered as oil-adjuvanted formulations carrying inactivated whole pathogens. Cell-mediated immune responses, in particular those based on virus-specific cytotoxic T-cells (CTLs) to conventional inactivated oil-based vaccines, are largely unexplored. As vaccines cannot be optimized against viral pathogens if knowledge of host cellular immune mechanisms remains unknown, in this study we examined fundamental cell-mediated immune responses after vaccination of rainbow trout with an oil-adjuvanted inactivated vaccine against salmonid alphavirus (SAV) and after infection with SAV. A unique in vitro model system was developed to examine MHC class I restricted CTL responses in a clonal line of rainbow trout. The levels of cell-mediated cytotoxicity were compared to pathology, virus load, specific antibody response, changes in immune cell populations, and mRNA expression. Our results hint that different protective mechanisms are being triggered by infection compared to vaccination. While vaccination itself did not cause a strong cytotoxic or humoral response, subsequent challenge of vaccinated fish resulted in significantly stronger and faster specific cytotoxicity, alongside reduced viral titers and pathology. Hence, testing a vaccine on the capacity to induce cell-mediated cytotoxicity will still require a challenge test. Examination of cellular markers additionally indicates that the initial innate response induced by the vaccine could play an important role in steering adaptive mechanisms.
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Affiliation(s)
- Kimberly A. Veenstra
- Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Institute of Infectology, Südufer 10, 17493 Greifswald-Insel Riems, Germany; (K.A.V.); (S.F.)
| | - Kjartan Hodneland
- MSD Animal Health Innovation, Thormøhlens Gate 55, 5006 Bergen, Norway; (K.H.); (R.B.)
| | - Susanne Fischer
- Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Institute of Infectology, Südufer 10, 17493 Greifswald-Insel Riems, Germany; (K.A.V.); (S.F.)
| | - Kota Takehana
- Nagano Prefectural Fisheries Experimental Station, 2871 Oaza-Nakagawate, Akashina, Azumino-shi, Nagano 399-7102, Japan;
| | - Rodrigo Belmonte
- MSD Animal Health Innovation, Thormøhlens Gate 55, 5006 Bergen, Norway; (K.H.); (R.B.)
| | - Uwe Fischer
- Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Institute of Infectology, Südufer 10, 17493 Greifswald-Insel Riems, Germany; (K.A.V.); (S.F.)
- Correspondence: ; Tel.: +49-38351-71175
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Brahmandam A, Chen J, Tonnessen B, Fischer U, Dardik A, Nassiri N. Alternative Aortic Endografts Overcome Aortoiliac Anatomy Preclusive to Iliac Branch Endoprostheses. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.08.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Yamaguchi T, Chang CJ, Karger A, Keller M, Pfaff F, Wangkahart E, Wang T, Secombes CJ, Kimoto A, Furihata M, Hashimoto K, Fischer U, Dijkstra JM. Ancient Cytokine Interleukin 15-Like (IL-15L) Induces a Type 2 Immune Response. Front Immunol 2020; 11:549319. [PMID: 33193315 PMCID: PMC7658486 DOI: 10.3389/fimmu.2020.549319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/28/2020] [Indexed: 12/20/2022] Open
Abstract
Related interleukin-2, -15, and -15-like (IL-2, -15, and -15L) are ancient cytokines, with all three genes surviving in extant fish and some mammals. The present study is the first to identify IL-15L functions, namely in rainbow trout. In isolated trout splenocytes, and in vivo, purified recombinant IL-15L+IL-15Rα molecules induced expression of IL-4 and IL-13 homologs, which are markers of type 2 immunity. In contrast, trout IL-15 stimulated type 1 immunity markers, thus IL-15 and IL-15L can have opposing functions. Trout IL-15L was more dependent on "in trans" presentation by the receptor chain IL-15Rα than IL-15, and stimulated CD4-CD8-(IgM-) lymphocytes from thymus and spleen. We propose an important role for IL-15L early in the type 2 immunity cytokine cascade. Trout IL-2 and IL-15 exhibited features reminiscent of their mechanistic and functional dichotomy observed in mammals; for example, IL-15 but not IL-2 required a receptor alpha chain (only IL-15Rα in the case of fish) for its stability, and only IL-15 was efficient in stimulating lymphocytes from mucosal tissues. Data suggest that IL-15L and IL-15 may be particularly effective in stimulating innate lymphocyte type 2 cells (ILC2) and natural killer (NK) cells, respectively, but further identification of the cell types is needed. An interesting finding different from in mammals was the efficient stimulation of CD4+CD8+ thymocytes by IL-2. In short, this study presents fundamental information on the evolution of the IL-2/15/15L cytokine family.
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Affiliation(s)
- Takuya Yamaguchi
- Institute of Infectology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Chia Jung Chang
- Institute of Infectology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Axel Karger
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Markus Keller
- Institute of Novel and Emerging Infectious Diseases, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Florian Pfaff
- Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Eakapol Wangkahart
- Scottish Fish Immunology Research Centre, School of Biological Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Tiehui Wang
- Scottish Fish Immunology Research Centre, School of Biological Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Christopher J Secombes
- Scottish Fish Immunology Research Centre, School of Biological Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Azusa Kimoto
- Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | - Mitsuru Furihata
- Nagano Prefectural Fisheries Experimental Station, Nagano, Japan
| | - Keiichiro Hashimoto
- Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | - Uwe Fischer
- Institute of Infectology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Johannes M Dijkstra
- Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
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Burghes A, Blatnik A, Ruhno C, McGovern V, Le T, Pessino V, Driscoll S, Iyer C, Corlett K, Likhite S, Kaspar B, Pfaff S, Fischer U. SMA: REGISTRIES, BIOMARKERS & OUTCOME MEASURES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Konobeyev A, Fischer U, Pereslavtsev P, Simakov S. New evaluation of general purpose neutron data for stable W-isotopes up to 200 MeV. EPJ Web Conf 2020. [DOI: 10.1051/epjconf/202023911002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In the frame of the Power Plant Physics and Technology of EUROfusion, new evaluations of general purpose neutron cross-section data were performed for the 180,182,183,184,186W isotopes covering the neutron energy up to 200 MeV. A special version of the TALYS nuclear model code implementing the geometry dependent hybrid model supplied with models for the non-equilibrium cluster emission was applied for calculations of the nuclide production and the energy distribution of the emitted particles. The parameters of the GDH model were properly estimated using measured data for individual tungsten isotopes. The neutron cross-sections were evaluated making use of available experimental data, systematics including estimated A-dependence of components of gas production cross-sections, and covariance information produced as part of the evaluation process. The BEKED code package, developed at KIT, was applied for calculations of co-variances using a dedicated Monte Carlo method. The evaluated data were processed into standard ENDF data format using the TEFAL code and the FOX module of the BEKED system. The evaluated data files were checked for errors and inconsistencies, processed with the NJOY code into ACE data format, and benchmarked against available integral experiments with MCNP neutron transport calculations.
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Comolli L, Goeldlin M, Gaschen J, Kammer C, Sauter TC, Caversaccio MD, Kalla R, Fischer U, Mantokoudis G. [Dizziness and vertigo in a tertiary ENT emergency department]. HNO 2020; 68:763-772. [PMID: 32221628 DOI: 10.1007/s00106-020-00857-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although vestibular symptoms are amongst the most frequent reasons for seeking emergency medical help, many patients remain undiagnosed. OBJECTIVE In this cross-sectional study, we investigated the spectrum of vertigo and dizziness in a tertiary ear, nose, and throat (ENT) emergency department (ED). Furthermore, we investigated the attendant symptoms, clinical signs, and the diagnostic tests performed. METHODS We screened all ED reports from 01/2013 to 12/2013 for adult patients with vestibular symptoms referred to the ENT department. RESULTS In total, we found 2596 cases with reported vestibular symptoms in the ED as a main or accompanying complaint. Of these, 286 were referred to the ENT specialist directly (n = 98) or via other major medical specialties (n = 188). Benign paroxysmal positional vertigo (BPPV) was the most frequent diagnosis in our study (n = 46, 16.1%), followed by vestibular neuritis (n = 44, 15.4%), otitis media (n = 20, 7%), and 9 patients (3.1%) had an ischemic stroke or a transient ischemic attack. In 70 (24.5%) cases, dizziness was not further specified. CONCLUSION BPPV is the most frequent diagnosis seen in the ED; however, physicians need to document nystagmus more precisely and perform diagnostic tests systematically, in order to make an accurate diagnosis. To avoid misdiagnoses, ED physicians and ENT specialists should be able to recognize central signs in patients with an acute vestibular syndrome. Every fourth patient does not receive a definitive diagnosis. Diagnostic ED workup for patients with dizziness needs further improvement.
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Affiliation(s)
- L Comolli
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz
| | - M Goeldlin
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz
| | - J Gaschen
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz
| | - C Kammer
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz
| | - T C Sauter
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Schweiz
| | - M D Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz
| | - R Kalla
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz
| | - U Fischer
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz
| | - G Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz.
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Kim TI, Aboian E, Fischer U, Zhang Y, Guzman RJ, Ochoa Chaar CI. Lower Extremity Revascularization for Chronic Limb-Threatening Ischemia among Patients at the Extremes of Age. Ann Vasc Surg 2020; 72:517-528. [PMID: 32927042 DOI: 10.1016/j.avsg.2020.08.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with chronic limb-threatening ischemia (CLTI) at the extremes of age are thought to have distinct risk factor profiles and poor outcomes after lower extremity revascularization (LER). The aim of this study is to examine the relationships among age, risk factor profiles, and outcomes of LER in patients with CLTI in a large database focusing on the extreme age groups. METHODS Patients undergoing LER for CLTI in the Vascular Quality Initiative suprainguinal bypass, infrainguinal bypass, and peripheral vascular intervention files were reviewed through 2019. Patients were stratified into 3 groups: premature peripheral artery disease (PAD) (≤50 years old), 51-84 years old, and elderly (≥85 years old). Trends in major amputation and mortality by age group were analyzed. RESULTS There were 156,513 patients who underwent LER for CLTI. Of these, 9,063 (5.79%) patients had premature PAD, 131,694 (84.14%) patients were 51-84 years old, and 15,756 (10.07%) were elderly. Patients with premature PAD were more likely to have insulin-dependent diabetes, be dialysis-dependent, and be active smokers compared to patients 51-84 years old and the elderly. Elderly patients were more likely to undergo an endovascular procedure for tissue loss compared to younger groups. Perioperative and 1-year major amputation rates were highest among patients with premature PAD and decreased with increasing age (P < 0.001), while perioperative and 1-year mortality increased with age (P < 0.001). On multivariable analysis, premature PAD was associated with an increased risk of major amputation (odds ratio, OR = 1.41 [1.22-1.62]), while elderly age was associated with decreased odds of major amputation compared to patients 51-84 years old (OR = 0.61 [0.51-0.73]). CONCLUSIONS Patients at the extremes of age have significantly different outcomes after LER for CLTI. Although mortality increases with age, the risk of major amputation decreases. Patients with premature PAD constitute a group of patients with a high risk of perioperative and 1-year major amputation.
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Affiliation(s)
- Tanner I Kim
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Edouard Aboian
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Uwe Fischer
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Yawei Zhang
- Department of Surgery, Yale School of Medicine, New Haven, CT; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Raul J Guzman
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
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Dusel M, Betzold S, Egorov OA, Klembt S, Ohmer J, Fischer U, Höfling S, Schneider C. Room temperature organic exciton-polariton condensate in a lattice. Nat Commun 2020; 11:2863. [PMID: 32514026 PMCID: PMC7280250 DOI: 10.1038/s41467-020-16656-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 02/25/2020] [Accepted: 05/04/2020] [Indexed: 12/02/2022] Open
Abstract
Interacting Bosons in artificial lattices have emerged as a modern platform to explore collective manybody phenomena and exotic phases of matter as well as to enable advanced on-chip simulators. On chip, exciton–polaritons emerged as a promising system to implement and study bosonic non-linear systems in lattices, demanding cryogenic temperatures. We discuss an experiment conducted on a polaritonic lattice at ambient conditions: We utilize fluorescent proteins providing ultra-stable Frenkel excitons. Their soft nature allows for mechanically shaping them in the photonic lattice. We demonstrate controlled loading of the coherent condensate in distinct orbital lattice modes of different symmetries. Finally, we explore the self-localization of the condensate in a gap-state, driven by the interplay of effective interaction and negative effective mass in our lattice. We believe that this work establishes organic polaritons as a serious contender to the well-established GaAs platform for a wide range of applications relying on coherent Bosons in lattices. Many studies of polariton condensates have been limited to low temperatures. Here the authors demonstrate ambient polariton condensation in lattices using organic traps that profit from the stability of organic excitons and the large Rabi splitting.
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Affiliation(s)
- M Dusel
- Technische Physik, Physikalisches Institut and Würzburg-Dresden Cluster of Excellence ct.qmat, Universität Würzburg, Am Hubland, Würzburg, 97074, Germany.
| | - S Betzold
- Technische Physik, Physikalisches Institut and Würzburg-Dresden Cluster of Excellence ct.qmat, Universität Würzburg, Am Hubland, Würzburg, 97074, Germany
| | - O A Egorov
- Institute of Condensed Matter Theory and Solid State Optics, Abbe Center of Photonics, Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, Jena, 07743, Germany
| | - S Klembt
- Technische Physik, Physikalisches Institut and Würzburg-Dresden Cluster of Excellence ct.qmat, Universität Würzburg, Am Hubland, Würzburg, 97074, Germany
| | - J Ohmer
- Department of Biochemistry, Universität Würzburg, Am Hubland, Würzburg, 97074, Germany
| | - U Fischer
- Department of Biochemistry, Universität Würzburg, Am Hubland, Würzburg, 97074, Germany
| | - S Höfling
- Technische Physik, Physikalisches Institut and Würzburg-Dresden Cluster of Excellence ct.qmat, Universität Würzburg, Am Hubland, Würzburg, 97074, Germany.,SUPA, School of Physics and Astronomy, University of St. Andrews, St. Andrews, KY16 9SS, UK
| | - C Schneider
- Technische Physik, Physikalisches Institut and Würzburg-Dresden Cluster of Excellence ct.qmat, Universität Würzburg, Am Hubland, Würzburg, 97074, Germany.
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Ospel JM, Kashani N, Fischer U, Menon BK, Almekhlafi M, Wilson AT, Foss MM, Saposnik G, Goyal M, Hill MD. How Do Physicians Approach Intravenous Alteplase Treatment in Patients with Acute Ischemic Stroke Who Are Eligible for Intravenous Alteplase and Endovascular Therapy? Insights from UNMASK-EVT. AJNR Am J Neuroradiol 2020; 41:262-267. [PMID: 31974081 DOI: 10.3174/ajnr.a6396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/11/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE With increasing use of endovascular therapy, physicians' attitudes toward intravenous alteplase in endovascular therapy-eligible patients may be changing. We explored current intravenous alteplase treatment practices of physicians in endovascular therapy- and alteplase-eligible patients with acute stroke using prespecified case scenarios and compared how their current local treatment practices differ compared with an assumed ideal environment. MATERIALS AND METHODS In an international multidisciplinary survey, 607 physicians involved in acute stroke care were randomly assigned 10 of 22 case scenarios, among them 14 with guideline-based alteplase recommendations (9 with level 1A and 5 with level 2B recommendation) and were asked how they would treat the patient: A) under their current local resources, and B) under assumed ideal conditions. Answer options were the following: 1) anticoagulation/antiplatelet therapy, 2) endovascular therapy, 3) endovascular therapy plus intravenous alteplase, and 4) intravenous alteplase. Decision rates were calculated, and multivariable regression analysis was performed to determine variables associated with the decision to abandon intravenous alteplase. RESULTS In cases with guideline recommendations for alteplase, physicians favored alteplase in 82.0% under current local resources and in 79.3% under assumed ideal conditions (P < .001). Under assumed ideal conditions, interventional neuroradiologists would refrain from intravenous alteplase most often (6.28%, OR = 2.40; 95% CI, 1.01-5.71). When physicians' current and ideal decisions differed, most would like to add endovascular therapy to intravenous alteplase in an ideal setting (196/3861 responses, 5.1%). CONCLUSIONS In patients eligible for endovascular therapy and intravenous alteplase, we observed a slightly lower decision rate in favor of intravenous alteplase under assumed ideal conditions compared with the decision rate under current local resources.
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Affiliation(s)
- J M Ospel
- From the Departments of Clinical Neurosciences (J.M.O., B.K.M., M.A., A.T.W., M.M.F., M.G., M.D.H.)
- Division of Neuroradiology (J.M.O.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - N Kashani
- Radiology (N.K., B.K.M., M.A., M.G., M.D.H.), University of Calgary, Calgary, Alberta, Canada
| | - U Fischer
- University Hospital Bern (U.F.), Inselspital, University of Bern, Bern, Switzerland
| | - B K Menon
- From the Departments of Clinical Neurosciences (J.M.O., B.K.M., M.A., A.T.W., M.M.F., M.G., M.D.H.)
- Radiology (N.K., B.K.M., M.A., M.G., M.D.H.), University of Calgary, Calgary, Alberta, Canada
| | - M Almekhlafi
- From the Departments of Clinical Neurosciences (J.M.O., B.K.M., M.A., A.T.W., M.M.F., M.G., M.D.H.)
- Radiology (N.K., B.K.M., M.A., M.G., M.D.H.), University of Calgary, Calgary, Alberta, Canada
| | - A T Wilson
- From the Departments of Clinical Neurosciences (J.M.O., B.K.M., M.A., A.T.W., M.M.F., M.G., M.D.H.)
| | - M M Foss
- From the Departments of Clinical Neurosciences (J.M.O., B.K.M., M.A., A.T.W., M.M.F., M.G., M.D.H.)
| | - G Saposnik
- Division of Neurology (G.S.), Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - M Goyal
- From the Departments of Clinical Neurosciences (J.M.O., B.K.M., M.A., A.T.W., M.M.F., M.G., M.D.H.)
- Radiology (N.K., B.K.M., M.A., M.G., M.D.H.), University of Calgary, Calgary, Alberta, Canada
| | - M D Hill
- From the Departments of Clinical Neurosciences (J.M.O., B.K.M., M.A., A.T.W., M.M.F., M.G., M.D.H.)
- Radiology (N.K., B.K.M., M.A., M.G., M.D.H.), University of Calgary, Calgary, Alberta, Canada
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Yamaguchi T, Takizawa F, Furihata M, Soto-Lampe V, Dijkstra JM, Fischer U. Teleost cytotoxic T cells. Fish Shellfish Immunol 2019; 95:422-439. [PMID: 31669897 DOI: 10.1016/j.fsi.2019.10.041] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 06/10/2023]
Abstract
Cell-mediated cytotoxicity is one of the major mechanisms by which vertebrates control intracellular pathogens. Two cell types are the main players in this immune response, natural killer (NK) cells and cytotoxic T lymphocytes (CTL). While NK cells recognize altered target cells in a relatively unspecific manner CTLs use their T cell receptor to identify pathogen-specific peptides that are presented by major histocompatibility (MHC) class I molecules on the surface of infected cells. However, several other signals are needed to regulate cell-mediated cytotoxicity involving a complex network of cytokine- and ligand-receptor interactions. Since the first description of MHC class I molecules in teleosts during the early 90s of the last century a remarkable amount of information on teleost immune responses has been published. The corresponding studies describe teleost cells and molecules that are involved in CTL responses of higher vertebrates. These studies are backed by functional investigations on the killing activity of CTLs in a few teleost species. The present knowledge on teleost CTLs still leaves considerable room for further investigations on the mechanisms by which CTLs act. Nevertheless the information on teleost CTLs and their regulation might already be useful for the control of fish diseases by designing efficient vaccines against such diseases where CTL responses are known to be decisive for the elimination of the corresponding pathogen. This review summarizes the present knowledge on CTL regulation and functions in teleosts. In a special chapter, the role of CTLs in vaccination is discussed.
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Affiliation(s)
- Takuya Yamaguchi
- Federal Research Institute for Animal Health, Friedrich-Loeffler-Institut, 17493, Greifswald-Insel Riems, Germany
| | - Fumio Takizawa
- Laboratory of Marine Biotechnology, Faculty of Marine Science and Technology, Fukui Prefectural University, Obama, Fukui, 917-0003, Japan
| | - Mitsuru Furihata
- Nagano Prefectural Fisheries Experimental Station, 2871 Akashina-nakagawate, Azumino-shi, Nagano-ken, 399-7102, Japan
| | - Veronica Soto-Lampe
- Federal Research Institute for Animal Health, Friedrich-Loeffler-Institut, 17493, Greifswald-Insel Riems, Germany
| | - Johannes M Dijkstra
- Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Uwe Fischer
- Federal Research Institute for Animal Health, Friedrich-Loeffler-Institut, 17493, Greifswald-Insel Riems, Germany.
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Ignatz M, Hourston JE, Turečková V, Strnad M, Meinhard J, Fischer U, Steinbrecher T, Leubner-Metzger G. The biochemistry underpinning industrial seed technology and mechanical processing of sugar beet. Planta 2019; 250:1717-1729. [PMID: 31414204 PMCID: PMC6790189 DOI: 10.1007/s00425-019-03257-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/06/2019] [Indexed: 05/12/2023]
Abstract
Seed-processing technologies such as polishing and washing enhance crop seed quality by limited removal of the outer layers and by leaching. Combined, this removes chemical compounds that inhibit germination. Industrial processing to deliver high-quality commercial seed includes removing chemical inhibitors of germination, and is essential to produce fresh sprouts, achieve vigorous crop establishment, and high yield potential in the field. Sugar beet (Beta vulgaris subsp. vulgaris var. altissima Doell.), the main sugar source of the temperate agricultural zone, routinely undergoes several processing steps during seed production to improve germination performance and seedling growth. Germination assays and seedling phenotyping was carried out on unprocessed, and processed (polished and washed) sugar beet fruits. Pericarp-derived solutes, known to inhibit germination, were tested in germination assays and their osmolality and conductivity assessed (ions). Abscisic acid (ABA) and ABA metabolites were quantified in both the true seed and pericarp tissue using UPLC-ESI(+)-MS/MS. Physical changes in the pericarp structures were assessed using scanning electron microscopy (SEM). We found that polishing and washing of the sugar beet fruits both had a positive effect on germination performance and seedling phenotype, and when combined, this positive effect was stronger. The mechanical action of polishing removed the outer pericarp (fruit coat) tissue (parenchyma), leaving the inner tissue (sclerenchyma) unaltered, as revealed by SEM. Polishing as well as washing removed germination inhibitors from the pericarp, specifically, ABA, ABA metabolites, and ions. Understanding the biochemistry underpinning the effectiveness of these processing treatments is key to driving further innovations in commercial seed quality.
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Affiliation(s)
- Michael Ignatz
- Department of Biological Sciences, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
| | - James E Hourston
- Department of Biological Sciences, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
| | - Veronika Turečková
- Laboratory of Growth Regulators, Palacký University and Institute of Experimental Botany, Czech Academy of Sciences, 78371, Olomouc, Czech Republic
| | - Miroslav Strnad
- Laboratory of Growth Regulators, Palacký University and Institute of Experimental Botany, Czech Academy of Sciences, 78371, Olomouc, Czech Republic
| | - Juliane Meinhard
- KWS SAAT SE & Co. KGaA, Grimsehlstr. 31, 37555, Einbeck, Germany
| | - Uwe Fischer
- KWS SAAT SE & Co. KGaA, Grimsehlstr. 31, 37555, Einbeck, Germany
| | - Tina Steinbrecher
- Department of Biological Sciences, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
| | - Gerhard Leubner-Metzger
- Department of Biological Sciences, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK.
- Laboratory of Growth Regulators, Palacký University and Institute of Experimental Botany, Czech Academy of Sciences, 78371, Olomouc, Czech Republic.
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Pacilè S, Dullin C, Baran P, Tonutti M, Perske C, Fischer U, Albers J, Arfelli F, Dreossi D, Pavlov K, Maksimenko A, Mayo SC, Nesterets YI, Taba ST, Lewis S, Brennan PC, Gureyev TE, Tromba G, Wienbeck S. Free propagation phase-contrast breast CT provides higher image quality than cone-beam breast-CT at low radiation doses: a feasibility study on human mastectomies. Sci Rep 2019; 9:13762. [PMID: 31551475 PMCID: PMC6760215 DOI: 10.1038/s41598-019-50075-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/18/2019] [Accepted: 08/22/2019] [Indexed: 12/09/2022] Open
Abstract
In this study we demonstrate the first direct comparison between synchrotron x-ray propagation-based CT (PB-CT) and cone-beam breast-CT (CB-CT) on human mastectomy specimens (N = 12) including different benign and malignant lesions. The image quality and diagnostic power of the obtained data sets were compared and judged by two independent expert radiologists. Two cases are presented in detail in this paper including a comparison with the corresponding histological evaluation. Results indicate that with PB-CT it is possible to increase the level of contrast-to-noise ratio (CNR) keeping the same level of dose used for the CB-CT or achieve the same level of CNR reached by CB-CT at a lower level of dose. In other words, PB-CT can achieve a higher diagnostic potential compared to the commercial breast-CT system while also delivering a considerably lower mean glandular dose. Therefore, we believe that PB-CT technique, if translated to a clinical setting, could have a significant impact in improving breast cancer diagnosis.
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Affiliation(s)
- S Pacilè
- Elettra Sincrotrone Trieste S.C.p.A., Basovizza, Italy. .,Department of Engineering and Architecture, University of Trieste, Trieste, Italy.
| | - C Dullin
- Elettra Sincrotrone Trieste S.C.p.A., Basovizza, Italy.,Institute for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany.,Translational Molecular Imaging, Max-Plank-Institute for Experimental Medicine, Goettingen, Germany
| | - P Baran
- ARC Centre of Excellence in Advanced Molecular Imaging, School of Physics, The University of Melbourne, Parkville, Australia
| | - M Tonutti
- Department of Radiology, Academic Hospital of Trieste, Trieste, Italy
| | - C Perske
- Institute for Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - U Fischer
- Diagnostic Breast Center Goettingen, Goettingen, Germany
| | - J Albers
- Institute for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - F Arfelli
- Department of Physics, University of Trieste, Trieste, Italy
| | - D Dreossi
- Elettra Sincrotrone Trieste S.C.p.A., Basovizza, Italy
| | - K Pavlov
- School of Physical and Chemical Sciences, University of Canterbury, Christchurch, New Zealand.,School of Science and Technology, University of New England, Armidale, Australia.,School of Physics and Astronomy, Monash University, Clayton, Australia
| | | | - S C Mayo
- Commonwealth Scientific and Industrial Research Organisation, Clayton, Australia
| | - Y I Nesterets
- Commonwealth Scientific and Industrial Research Organisation, Clayton, Australia.,School of Science and Technology, University of New England, Armidale, Australia
| | - S Tavakoli Taba
- The University of Sydney, BREAST, Faculty of Health Sciences, Lidcombe, New South Wales, Australia
| | - S Lewis
- The University of Sydney, BREAST, Faculty of Health Sciences, Lidcombe, New South Wales, Australia
| | - P C Brennan
- The University of Sydney, BREAST, Faculty of Health Sciences, Lidcombe, New South Wales, Australia
| | - T E Gureyev
- ARC Centre of Excellence in Advanced Molecular Imaging, School of Physics, The University of Melbourne, Parkville, Australia.,School of Science and Technology, University of New England, Armidale, Australia.,School of Physics and Astronomy, Monash University, Clayton, Australia.,The University of Sydney, BREAST, Faculty of Health Sciences, Lidcombe, New South Wales, Australia
| | - G Tromba
- Elettra Sincrotrone Trieste S.C.p.A., Basovizza, Italy
| | - S Wienbeck
- Institute for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
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Bernardi D, Arbeiter F, Cappelli M, Fischer U, García A, Heidinger R, Krolas W, Martín-Fuertes F, Miccichè G, Muñoz A, Nitti F, Pérez M, Pinna T, Tian K, Ibarra A. Towards the EU fusion-oriented neutron source: The preliminary engineering design of IFMIF-DONES. Fusion Engineering and Design 2019. [DOI: 10.1016/j.fusengdes.2018.12.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wienbeck S, Uhlig J, Fischer U, Hellriegel M, von Fintel E, Kulenkampff D, Surov A, Lotz J, Perske C. Breast lesion size assessment in mastectomy specimens: Correlation of cone-beam breast-CT, digital breast tomosynthesis and full-field digital mammography with histopathology. Medicine (Baltimore) 2019; 98:e17082. [PMID: 31517829 PMCID: PMC6750260 DOI: 10.1097/md.0000000000017082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
To compare the accuracy of breast lesion size measurement of cone-beam breast-CT (CBBCT), digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM).Patients scheduled for mastectomy due to at least 1 malignant breast lesion were included. Mastectomy specimens were examined by CBBCT, DBT, FFDM, and histopathology.A total of 94 lesions (40 patients) were included. Histopathological analyses revealed 47 malignant, 6 high-risk, and 41 benign lesions. Mean histopathological lesion size was 20.8 mm (range 2-100). Mean absolute size deviation from histopathology was largest for FFDM (5.3 ± 6.7 mm) and smallest for CBBCT 50 mA, high-resolution mode (4.3 ± 6.7 mm). Differences between imaging modalities did not reach statistical significance (P = .85).All imaging methods tend to overestimate breast lesion size compared to histopathological gold standard. No significant differences were found regarding size measurements, although in tendency CBBCT showed better lesion detection and cT classification over FFDM.
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Affiliation(s)
- Susanne Wienbeck
- Institute of Diagnostic and Interventional Radiology, University Medical Center Goettingen
| | - Johannes Uhlig
- Institute of Diagnostic and Interventional Radiology, University Medical Center Goettingen
| | | | - Martin Hellriegel
- Department of Gynecology and Obstetrics, University Medical Center Goettingen
| | - Eva von Fintel
- Institute of Diagnostic and Interventional Radiology, University Medical Center Goettingen
| | - Dietrich Kulenkampff
- Department of Gynecology and Obstetrics, Agaplesion Hospital Neu Bethlehem Goettingen
| | - Alexey Surov
- University of Leipzig, Department of Diagnostic and Interventional Radiology
| | - Joachim Lotz
- Institute of Diagnostic and Interventional Radiology, University Medical Center Goettingen
| | - Christina Perske
- Institute for Pathology, University Medical Center Goettingen, Germany
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Noterdaeme JM, Messiaen A, Ragona R, Zhang W, Bader A, Durodié F, Fischer U, Franke T, Smigelskis E, Ongena J, Tran M, Van Eester D, Van Schoor M. Progress on an ion cyclotron range of frequency system for DEMO. Fusion Engineering and Design 2019. [DOI: 10.1016/j.fusengdes.2019.02.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yamaguchi T, Quillet E, Boudinot P, Fischer U. What could be the mechanisms of immunological memory in fish? Fish Shellfish Immunol 2019; 85:3-8. [PMID: 29410093 DOI: 10.1016/j.fsi.2018.01.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/18/2018] [Accepted: 01/21/2018] [Indexed: 05/04/2023]
Abstract
Vaccination is the most effective strategy to control infectious diseases in species with adaptive immunity. In human and in mouse, vaccination typically induces specific memory cells, which can mediate a fast anamnestic response upon infection by the targeted pathogen. In these species, successful vaccination induces a long-lasting protection, long after the titres of specific antibodies and the frequency of specific T cells have returned to steady state. Vaccination is also an important challenge in aquaculture, since alternative treatments are either too costly, or, in the case of antibiotics, are harmful for the environment or may result in dangerous resistances. However, the mechanisms of the long-term protection elicited by vaccines in fish remain poorly understood. Although fish possess typical B- and T-cells expressing diverse repertoires of immunoglobulins and T-cell receptors, many features of antigen specific responses are different from what is known in mouse and in human. Memory is one of the most elusive properties of fish adaptive immunity, and its basis is widely unknown. In this opinion article, we discuss the concept of immune memory in the context of the fish immunity. We illustrate the complexity of this question by discussing the results of experiments showing that protection can be passed through adoptive transfer of leukocytes from vaccinated donor fish to naive histocompatible recipients. Combined with tools developed in Targetfish and in previous projects, such as monoclonal antibodies against B- and T-cell markers, we propose that such models of protection transfer provide excellent systems to dissect the mechanisms of B- and T-cell memory in the future.
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Affiliation(s)
- Takuya Yamaguchi
- Laboratory of Fish Immunology, Institute of Infectology, Friedrich-Loeffler-Institut, Südufer 10, Greifswald-Insel Riems 17493, Germany.
| | - Edwige Quillet
- Génétique animale et biologie intégrative, INRA, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France
| | - Pierre Boudinot
- Virologie et Immunologie Moléculaires, INRA, Université Paris-Saclay, 78350 Jouy-en-Josas, France
| | - Uwe Fischer
- Laboratory of Fish Immunology, Institute of Infectology, Friedrich-Loeffler-Institut, Südufer 10, Greifswald-Insel Riems 17493, Germany.
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Charvet S, Riemann L, Alneberg J, Andersson AF, von Borries J, Fischer U, Labrenz M. AFISsys - An autonomous instrument for the preservation of brackish water samples for microbial metatranscriptome analysis. Water Res 2019; 149:351-361. [PMID: 30469021 DOI: 10.1016/j.watres.2018.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/02/2018] [Accepted: 11/09/2018] [Indexed: 06/09/2023]
Abstract
Microbial communities are the main drivers of biogeochemical cycling of multiple elements sustaining life in the ocean. The rapidity of their response to stressors and abrupt environmental changes implies that even fast and infrequent events can affect local transformations of organic matter and nutrients. Modern molecular techniques now allow for monitoring of microbial activities and functions in the environment through the analysis of genes and expressed genes contained in natural microbial assemblages. However, messenger RNA turnover in cells can be as short as 30 seconds and stability varies greatly between transcripts. Sampling of in situ communities involves an inevitable delay between the collection of seawater and the extraction of its RNA, leaving the bacterial communities plenty of time to alter their gene expression. The characteristics of microbial RNA turnover make time-series very difficult because samples need to be processed immediately to limit alterations to the metatranscriptomes. To address these challenges we designed an autonomous in situ fixation multi-sampler (AFISsys) for the reliable sampling of microbial metatranscriptomes at frequent intervals, for refined temporal resolution. To advance the development of this instrument, we examined the minimal seawater volume necessary for adequate coverage of community gene expression, and the suitability of phenol/ethanol fixation for immediate and long-term preservation of transcripts from a microbial community. We then evaluated the field eligibility of the instrument itself, with two case studies in a brackish system. AFISsys is able to collect, fix, and store water samples independently at a predefined temporal resolution. Phenol/ethanol fixation can conserve metatranscriptomes directly in the environment for up to a week, for later analysis in the laboratory. Thus, the AFISsys constitutes an invaluable tool for the integration of molecular functional analyses in environmental monitoring in brackish waters and in aquatic environments in general.
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Affiliation(s)
- Sophie Charvet
- IOW - Leibniz Institute for Baltic Sea Research, Warnemuende, Germany
| | - Lasse Riemann
- Marine Biological Section, Department of Biology, University of Copenhagen, Denmark
| | - Johannes Alneberg
- KTH - Royal Institute of Technology, Science for Life Laboratory, Sweden
| | - Anders F Andersson
- KTH - Royal Institute of Technology, Science for Life Laboratory, Sweden
| | | | - Uwe Fischer
- HYDRO-BIOS Apparatebau GmbH, Altenholz, Germany
| | - Matthias Labrenz
- IOW - Leibniz Institute for Baltic Sea Research, Warnemuende, Germany.
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42
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Eckart V, Yamaguchi T, Franzke K, Bergmann SM, Boudinot P, Quillet E, Kawanobe M, de Haro NA, Fischer U. New cell lines for efficient propagation of koi herpesvirus and infectious salmon anaemia virus. J Fish Dis 2019; 42:181-187. [PMID: 30537062 DOI: 10.1111/jfd.12921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 06/09/2023]
Abstract
The production of piscine viruses, in particular of koi herpesvirus (KHV, CyHV-3) and infectious salmon anaemia virus (ISAV), is still challenging due to the limited susceptibility of available cell lines to these viruses. A number of cell lines from different fish species were compared to standard diagnostic cell lines for KHV and ISAV regarding their capability to exhibit a cytopathic effect (CPE) and to accumulate virus. Two cell lines, so far undescribed, appeared to be useful for diagnostic purposes. Fr994, a cell line derived from ovaries of rainbow trout (Oncorhynchus mykiss), produced constantly high ISA virus (ISAV) titres and developed a pronounced CPE even at high cell passage numbers, while standard cell lines are reported to gradually loose these properties upon propagation. Another cell line isolated from the head kidney of common carp (Cyprinus carpio), KoK, showed a KHV induced CPE earlier than the standard cell line used for diagnostics. A third cell line, named Fin-4, established from the fin epithelium of rainbow trout did not promote efficient replication of tested viruses, but showed antigen sampling properties and might be useful as an in vitro model for virus uptake or phagocytosis.
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Affiliation(s)
- Valentin Eckart
- Friedrich-Loeffler-Institut (FLI), Institute of Infectology, Greifswald-Insel Riems, Germany
| | - Takuya Yamaguchi
- Friedrich-Loeffler-Institut (FLI), Institute of Infectology, Greifswald-Insel Riems, Germany
| | - Kati Franzke
- Friedrich-Loeffler-Institut (FLI), Institute of Infectology, Greifswald-Insel Riems, Germany
| | - Sven M Bergmann
- Friedrich-Loeffler-Institut (FLI), Institute of Infectology, Greifswald-Insel Riems, Germany
| | - Pierre Boudinot
- Institut National de la Recherche Agronomique (INRA), Unité de Virologie et Immunologie Moléculaires, Université Paris-Saclay, Jouy-en-Josas, France
| | - Edwige Quillet
- IGABI, INRA, AgroParisTech, Université Paris-Saclay, Jouy-en-Josas, France
| | - Motokazu Kawanobe
- Nagano Prefectural Fisheries Experimental Station, Akashina-Nakagawate, Japan
| | | | - Uwe Fischer
- Friedrich-Loeffler-Institut (FLI), Institute of Infectology, Greifswald-Insel Riems, Germany
- Faculty of Agriculture and Environmental Sciences, University of Rostock, Rostock, Germany
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Volbers B, Fischer U, Huttner HB. Inflammation, edema, hematoma and etiology - a rectangular relationship? Eur J Neurol 2018; 26:e11. [PMID: 30520236 DOI: 10.1111/ene.13829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/08/2018] [Indexed: 01/05/2023]
Affiliation(s)
- B Volbers
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Neurology, University of Erlangen, Erlangen, Germany
| | - U Fischer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - H B Huttner
- Department of Neurology, University of Erlangen, Erlangen, Germany
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Webb A, Heldner MR, Aguiar de Sousa D, Sandset EC, Randall G, Bejot Y, van der Worp B, Caso V, Fischer U. Availability of secondary prevention services after stroke in Europe: An ESO/SAFE survey of national scientific societies and stroke experts. Eur Stroke J 2018; 4:110-118. [PMID: 31259259 PMCID: PMC6572590 DOI: 10.1177/2396987318816136] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 11/01/2018] [Indexed: 11/15/2022] Open
Abstract
Background Recurrent stroke is associated with increased disability and cognitive impairment, but the availability of secondary prevention measures after transient ischaemic attack (TIA) or stroke in Europe is uncertain. This limits prioritisation of investment and development of national stroke strategies. Methods National stroke representatives throughout Europe were surveyed. Consensus panels reported national data if available, or else expert opinion, estimating the availability of each intervention by quintiles of patients, dichotomised for analysis at 60%. Countries were classified into tertiles of gross domestic product per capita. Results Of 50 countries, 46 responded; 14/45 (31%) had national stroke registries and 25/46 (54.3%) had national stroke strategies incorporating secondary prevention. Respondents reported that the majority of TIA patients were assessed by specialist services within 48 hours in 74.4% of countries, but in nine countries more than 20% of patients were seen after more than seven days and usually assessed by non-specialists (7/46 countries). Eighty percent of countries deferred blood pressure assessment to primary care, whilst lifestyle management programmes were commonly available in only 46% of countries. Although basic interventions were widely available, interventions frequently not available to more than 60% of patients included: ambulatory cardiac monitoring (40% countries); prescription (26%) and continuation (46%) of statins; blood pressure control at follow-up (44%); carotid endarterectomy within one month (15%); face-to-face follow-up in hospital (33%); direct oral anticoagulants (21%). Gross domestic product per capita and reimbursement of interventions were the commonest predictors of availability of interventions. Conclusions Provision of secondary prevention varied, with gaps in care prevalent throughout Europe, particularly in lower income countries.
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Affiliation(s)
- A Webb
- Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, UK
| | - M R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Aguiar de Sousa
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - E C Sandset
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Department of Research and Development, the Norwegian Air Ambulance Foundation, Oslo, Norway
| | - G Randall
- Stroke Alliance for Europe, Brussels, Belgium
| | - Y Bejot
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - B van der Worp
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - V Caso
- Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - U Fischer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Federici G, Bachmann C, Barucca L, Biel W, Boccaccini L, Brown R, Bustreo C, Ciattaglia S, Cismondi F, Coleman M, Corato V, Day C, Diegele E, Fischer U, Franke T, Gliss C, Ibarra A, Kembleton R, Loving A, Maviglia F, Meszaros B, Pintsuk G, Taylor N, Tran M, Vorpahl C, Wenninger R, You J. DEMO design activity in Europe: Progress and updates. Fusion Engineering and Design 2018. [DOI: 10.1016/j.fusengdes.2018.04.001] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Villari R, Batistoni P, Bradnam S, Colling B, Fischer U, Flammini D, Fonnesu N, Ghani Z, Klix A, Loreti S, Naish J, Packer L, Pillon M, Popovichev S, Stamatelatos I, Vasilopoulou T. Shutdown dose rate neutronics experiment during high performances DD operations at JET. Fusion Engineering and Design 2018. [DOI: 10.1016/j.fusengdes.2018.05.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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47
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Gilbert M, Eade T, Bachmann C, Fischer U, Taylor N. Waste assessment of European DEMO fusion reactor designs. Fusion Engineering and Design 2018. [DOI: 10.1016/j.fusengdes.2017.12.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bachmann C, Ciattaglia S, Cismondi F, Eade T, Federici G, Fischer U, Franke T, Gliss C, Hernandez F, Keep J, Loughlin M, Maviglia F, Moro F, Morris J, Pereslavtsev P, Taylor N, Vizvary Z, Wenninger R. Overview over DEMO design integration challenges and their impact on component design concepts. Fusion Engineering and Design 2018. [DOI: 10.1016/j.fusengdes.2017.12.040] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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49
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Kaesmacher J, Gralla J, Mosimann PJ, Zibold F, Heldner MR, Piechowiak E, Dobrocky T, Arnold M, Fischer U, Mordasini P. Reasons for Reperfusion Failures in Stent-Retriever-Based Thrombectomy: Registry Analysis and Proposal of a Classification System. AJNR Am J Neuroradiol 2018; 39:1848-1853. [PMID: 30166434 DOI: 10.3174/ajnr.a5759] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/25/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE In 5%-10% of patients with acute ischemic stroke with an intention to treat with mechanical thrombectomy, no reperfusion can be achieved (Thrombolysis in Cerebral Infarction score = 0/1). Purpose of this analysis was a systematic assessment of underlying reasons for reperfusion failures. MATERIALS AND METHODS An intention-to-treat single-center cohort (n = 592) was re-evaluated for all patients in whom no reperfusion could be achieved (n = 63). Baseline characteristics of patients were compared between patients with and without reperfusion failures. After qualitative review of all cases with reperfusion failures, a classification system was proposed and relative frequencies were reported. In a second step, occurrence of delayed recanalization at 24 hours after reperfusion failure and dependency on IV-tPA were evaluated. RESULTS In 63/592 patients with an intention to perform stent-retriever thrombectomy, no reperfusion was achieved (TICI 0/1, 10.6%, 95% CI, 8.2%-13.1%). Older patients (adjusted OR per yr = 1.03; 95% CI, 1.01-1.05) and patients with M2 occlusion (adjusted OR = 3.36; 95% CI, 1.82-6.21) were at higher risk for reperfusion failure. In most cases, no reperfusion was a consequence of technical difficulties (56/63, 88.9%). In one-third of these cases, reperfusion failures were due to the inability to reach the target occlusion (20/63, 31.7%), while "stent-retriever failure" occurred in 39.7% (25/63) of patients. Delayed recanalization was very rare (18.2%), without dependence on IV-tPA pretreatment status. CONCLUSIONS Reasons for reperfusion failure in stent-retriever thrombectomy are heterogeneous. The failure to establish intracranial or cervical access is almost as common as stent-retriever failure after establishing intracranial access. Systematic reporting standards of reasons may help to further estimate relative frequencies and thereby guide priorities for technical development and scientific effort.
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Affiliation(s)
- J Kaesmacher
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G., P.J. Mosimann, F.Z., E.P., T.D., P. Mordasini)
- Department of Neurology (J.K., M.R.H., M.A., U.F.), University Hospital Bern and University of Bern, Inselspital, Bern, Switzerland
| | - J Gralla
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G., P.J. Mosimann, F.Z., E.P., T.D., P. Mordasini)
| | - P J Mosimann
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G., P.J. Mosimann, F.Z., E.P., T.D., P. Mordasini)
| | - F Zibold
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G., P.J. Mosimann, F.Z., E.P., T.D., P. Mordasini)
| | - M R Heldner
- Department of Neurology (J.K., M.R.H., M.A., U.F.), University Hospital Bern and University of Bern, Inselspital, Bern, Switzerland
| | - E Piechowiak
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G., P.J. Mosimann, F.Z., E.P., T.D., P. Mordasini)
| | - T Dobrocky
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G., P.J. Mosimann, F.Z., E.P., T.D., P. Mordasini)
| | - M Arnold
- Department of Neurology (J.K., M.R.H., M.A., U.F.), University Hospital Bern and University of Bern, Inselspital, Bern, Switzerland
| | - U Fischer
- Department of Neurology (J.K., M.R.H., M.A., U.F.), University Hospital Bern and University of Bern, Inselspital, Bern, Switzerland
| | - P Mordasini
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G., P.J. Mosimann, F.Z., E.P., T.D., P. Mordasini)
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Uhlig J, Uhlig A, Biggemann L, Fischer U, Lotz J, Wienbeck S. Diagnostic accuracy of cone-beam breast computed tomography: a systematic review and diagnostic meta-analysis. Eur Radiol 2018; 29:1194-1202. [PMID: 30255249 DOI: 10.1007/s00330-018-5711-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/17/2018] [Accepted: 08/08/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To review the published evidence on cone-beam breast computed tomography (CBBCT) and summarize its diagnostic accuracy for breast lesion assessment. MATERIALS AND METHODS A systematic literature search was conducted using the EMBASE, MEDLINE and CENTRAL libraries. Studies were included if reporting sensitivity and specificity for discrimination of benign and malignant breast lesions via breast CT. Sensitivity and specificity were jointly modeled using a bivariate approach calculating summary areas under the receiver-operating characteristics curve (AUC). All analyses were separately performed for non-contrast and contrast-enhanced CBBCT (NC-CBBCT, CE-CBBCT). RESULTS A total of 362 studies were screened, of which 6 with 559 patients were included. All studies were conducted between 2015 and 2018 and evaluated female participants. Four of six studies included dense and very dense breasts with a high proportion of microcalcifications. For NC-CBBCT, pooled sensitivity was 0.789 (95% CI: 0.66-0.89) and pooled specificity was 0.697 (95% CI: 0.471-0.851), both showing considerable significant between-study heterogeneity (I2 = 89.4%, I2 = 94.7%, both p < 0.001). Partial AUC for NC-CBBCT was 0.817. For CE-CBBCT, pooled sensitivity was 0.899 (95% CI: 0.785-0.956) and pooled specificity was 0.788 (95% CI: 0.709-0.85), both exhibiting non-significant moderate between-study heterogeneity (I2 = 57.3%, p = 0.0527; I2 = 53.1%, p = 0.0738). Partial AUC for CE-CBBCT was 0.869. CONCLUSION The evidence available for CBBCT tends to show superior diagnostic performance for CE-CBBCT over NC-CBBCT regarding sensitivity, specificity and partial AUC. Diagnostic accuracy of CE-CBBCT was numerically comparable to that of breast MRI with meta-analyses reporting sensitivity of 0.9 and specificity of 0.72. KEY POINTS • CE-CBBCT rather than NC-CBBCT should be used for assessment of breast lesions for its higher diagnostic accuracy. • CE-CBBCT diagnostic performance was comparable to published results on breast MRI, thus qualifying CE-CBBCT as a potential imaging alternative for patients with MRI contraindications.
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Affiliation(s)
- Johannes Uhlig
- Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany. .,Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
| | - Annemarie Uhlig
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Lorenz Biggemann
- Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Uwe Fischer
- Diagnostic Breast Imaging Center, Goettingen, Germany
| | - Joachim Lotz
- Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.,German Centre for Cardiovascular Research, Partnersite Goettingen, Goettingen, Germany
| | - Susanne Wienbeck
- Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
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