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Mao X, Staiger JF. Multimodal cortical neuronal cell type classification. Pflugers Arch 2024; 476:721-733. [PMID: 38376567 PMCID: PMC11033238 DOI: 10.1007/s00424-024-02923-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
Since more than a century, neuroscientists have distinguished excitatory (glutamatergic) neurons with long-distance projections from inhibitory (GABAergic) neurons with local projections and established layer-dependent schemes for the ~ 80% excitatory (principal) cells as well as the ~ 20% inhibitory neurons. Whereas, in the early days, mainly morphological criteria were used to define cell types, later supplemented by electrophysiological and neurochemical properties, nowadays. single-cell transcriptomics is the method of choice for cell type classification. Bringing recent insight together, we conclude that despite all established layer- and area-dependent differences, there is a set of reliably identifiable cortical cell types that were named (among others) intratelencephalic (IT), extratelencephalic (ET), and corticothalamic (CT) for the excitatory cells, which altogether comprise ~ 56 transcriptomic cell types (t-types). By the same means, inhibitory neurons were subdivided into parvalbumin (PV), somatostatin (SST), vasoactive intestinal polypeptide (VIP), and "other (i.e. Lamp5/Sncg)" subpopulations, which altogether comprise ~ 60 t-types. The coming years will show which t-types actually translate into "real" cell types that show a common set of multimodal features, including not only transcriptome but also physiology and morphology as well as connectivity and ultimately function. Only with the better knowledge of clear-cut cell types and experimental access to them, we will be able to reveal their specific functions, a task which turned out to be difficult in a part of the brain being so much specialized for cognition as the cerebral cortex.
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Affiliation(s)
- Xiaoyi Mao
- Institute for Neuroanatomy, University Medical Center Göttingen, Georg-August-University, Kreuzbergring 36, 37075, Göttingen, Germany
| | - Jochen F Staiger
- Institute for Neuroanatomy, University Medical Center Göttingen, Georg-August-University, Kreuzbergring 36, 37075, Göttingen, Germany.
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Schlögl S, Schlögl KS, Bengel P, Haarmann H, Bergau L, Rasenack E, Hasenfuss G, Zabel M. Contact force sensing manual catheter versus remote magnetic navigation ablation of atrial fibrillation: a single-center comparison. Heart Vessels 2024; 39:427-437. [PMID: 38189924 PMCID: PMC11006819 DOI: 10.1007/s00380-023-02344-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Data comparing remote magnetic catheter navigation (RMN) with manual catheter navigation in combination with contact force sensing (MCN-CF) ablation of atrial fibrillation (AF) is lacking. The primary aim of the present retrospective comparative study was to compare the outcome of RMN versus (vs.) MCN-CF ablation of AF with regards to AF recurrence. Secondary aim was to analyze periprocedural risk, ablation characteristics and repeat procedures. METHODS We retrospectively analyzed 452 patients undergoing a total of 605 ablations of AF: 180 patients were ablated using RMN, 272 using MCN-CF. RESULTS Except body mass index there was no significant difference between groups at baseline. After a mean 1.6 ± 1.6 years of follow-up and 1.3 ± 0.4 procedures, 81% of the patients in the MCN-CF group remained free of AF recurrence compared to 53% in the RMN group (P < 0.001). After analysis of 153 repeat ablations (83 MCN-RF vs. 70 RMN; P = 0.18), there was a significantly higher reconnection rate of pulmonary veins after RMN ablation (P < 0.001). In multivariable Cox-regression analysis, RMN ablation (P < 0.001) and left atrial diameter (P = 0.013) was an independent risk factor for AF recurrence. Procedure time, radiofrequency application time and total fluoroscopy time and fluoroscopy dose were higher in the RMN group without difference in total number of ablation points. Complication rates did not differ significantly between groups (P = 0.722). CONCLUSIONS In our retrospective comparative study, the AF recurrence rate and pulmonary vein reconnection rate is significantly lower with more favorable procedural characteristics and similar complication rate utilizing MCN-CF compared to RMN.
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Affiliation(s)
- Simon Schlögl
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany.
| | - Klaudia Stella Schlögl
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Philipp Bengel
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Helge Haarmann
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Leonard Bergau
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Eva Rasenack
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Markus Zabel
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
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Waeschle RM, Epperlein T, Demmer I, Hummers E, Quintel Q. Intersectoral cooperation between university hospitals and physicians in private practice in Germany- where the potential for optimization lies. BMC Health Serv Res 2024; 24:497. [PMID: 38649877 PMCID: PMC11034040 DOI: 10.1186/s12913-024-10963-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Intersectoral cooperation between physicians in private practice and hospitals is highly relevant for ensuring the quality of medical care. However, the experiences and potential for optimization at this interface from the perspective of physicians in private practice have not yet been systematically investigated. The aim of this questionnaire survey was to record participants' experiences with regard to cooperation with university hospitals and to identify the potential for optimizing intersectoral cooperation. METHODS We performed a prospective cross-sectional study using an online survey among practising physicians of all disciplines offering ambulatory care in Germany. The link to a 41-item questionnaire was sent via mail using a commercial mail distributor in which 1095 practising physicians participated. Baseline statistics were performed with SurveyMonkey and Excel. RESULTS A total of 70.6%/722 of the responding physicians in private practice rated cooperation with university hospitals as satisfactory. Satisfaction with the quality of treatment was confirmed by 87.2%/956 of the physicians. The subjectively perceived complication rate in patient care was assessed as rare (80.9%/886). However, the median waiting time for patients in the inpatient discharge letter was 4 weeks. The accessibility of medical contact persons was rated as rather difficult by 52.6%/577 of the physicians. A total of 48.6%/629 of the participants considered better communication as an equal partner to be an important potential for optimization. Likewise, 65.2%/714 participants wished for closer cooperation in pre- and/or post inpatient care. CONCLUSION The following optimization potentials were identified: timely discharge letters, clear online presentations of clinical contacts, improved accessibility by telephone, introduction or further development of a referral portal, regular intersectoral training and/or "get-togethers", regular surveys of general practitioners and implementation of resulting measures, further development of cross-sectoral communication channels and strengthening of hospital IT.
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Affiliation(s)
- R M Waeschle
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
| | - T Epperlein
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - I Demmer
- Department of General Practice, University Medical Centre Göttingen, Göttingen, Germany
| | - E Hummers
- Department of General Practice, University Medical Centre Göttingen, Göttingen, Germany
| | - Q Quintel
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
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Dreyer A, Lenz C, Groß U, Bohne W, Zautner AE. Comparative analysis of proteomic adaptations in Enterococcus faecalis and Enterococcus faecium after long term bile acid exposure. BMC Microbiol 2024; 24:110. [PMID: 38570789 PMCID: PMC10988882 DOI: 10.1186/s12866-024-03253-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 03/07/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND All gastrointestinal pathogens, including Enterococcus faecalis and Enterococcus faecium, undergo adaptation processes during colonization and infection. In this study, we investigated by data-independent acquisition mass spectrometry (DIA-MS) two crucial adaptations of these two Enterococcus species at the proteome level. Firstly, we examined the adjustments to cope with bile acid concentrations at 0.05% that the pathogens encounter during a potential gallbladder infection. Therefore, we chose the primary bile acids cholic acid (CA) and chenodeoxycholic acid (CDCA) as well as the secondary bile acid deoxycholic acid (DCA), as these are the most prominent bile acids. Secondly, we investigated the adaptations from an aerobic to a microaerophilic environment, as encountered after oral-fecal infection, in the absence and presence of deoxycholic acid (DCA). RESULTS Our findings showed similarities, but also species-specific variations in the response to the different bile acids. Both Enterococcus species showed an IC50 in the range of 0.01- 0.023% for DCA and CDCA in growth experiments and both species were resistant towards 0.05% CA. DCA and CDCA had a strong effect on down-expression of proteins involved in translation, transcription and replication in E. faecalis (424 down-expressed proteins with DCA, 376 down-expressed proteins with CDCA) and in E. faecium (362 down-expressed proteins with DCA, 391 down-expressed proteins with CDCA). Proteins commonly significantly altered in their expression in all bile acid treated samples were identified for both species and represent a "general bile acid response". Among these, various subunits of a V-type ATPase, different ABC-transporters, multi-drug transporters and proteins related to cell wall biogenesis were up-expressed in both species and thus seem to play an essential role in bile acid resistance. Most of the differentially expressed proteins were also identified when E. faecalis was incubated with low levels of DCA at microaerophilic conditions instead of aerobic conditions, indicating that adaptations to bile acids and to a microaerophilic atmosphere can occur simultaneously. CONCLUSIONS Overall, these findings provide a detailed insight into the proteomic stress response of two Enterococcus species and help to understand the resistance potential and the stress-coping mechanisms of these important gastrointestinal bacteria.
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Affiliation(s)
- Annika Dreyer
- Institute for Medical Microbiology and Virology, University Medical Center Göttingen, Göttingen, Germany
| | - Christof Lenz
- Bioanalytical Mass Spectrometry Group, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Department of Clinical Chemistry, University Medical Center Göttingen, Göttingen, Germany
| | - Uwe Groß
- Institute for Medical Microbiology and Virology, University Medical Center Göttingen, Göttingen, Germany
| | - Wolfgang Bohne
- Institute for Medical Microbiology and Virology, University Medical Center Göttingen, Göttingen, Germany
| | - Andreas Erich Zautner
- Institute for Medical Microbiology and Virology, University Medical Center Göttingen, Göttingen, Germany.
- Institute of Medical Microbiology and Hospital Hygiene, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
- Center for Health and Medical Prevention (CHaMP), Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
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Schmachtenberg T, Königs G, Roder S, Müller F, Müllenmeister C, Schröder D, El-Sayed I. How do people with long COVID utilize COVID-19 vaccination and rehabilitation services and what are their experiences with these services? results of a qualitative study with 48 participants from Germany. BMC Public Health 2024; 24:915. [PMID: 38549052 PMCID: PMC10976759 DOI: 10.1186/s12889-024-18380-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/18/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Studies estimate that at least 7.5% of adults are affected by long-term symptoms such as fatigue or cognitive impairment after the acute phase of COVID-19. COVID-19 vaccination may reduce the risk of long COVID. Rehabilitation can have a positive impact on recovery. This study aims to present the experiences of people with long COVID with COVID-19 vaccination and rehabilitation. Such research is important because perceptions of these measures can impact healthcare utilization and health status. METHODS 48 adults with long COVID participated in this qualitative study, 25 of them in one-on-one interviews and 23 in focus groups. Participants were recruited via calls for participation on the websites and social media channels of two university hospitals and with the help of respondents' networks. The conversations were audio-recorded, transcribed, and analyzed using qualitative content analysis. Subsequently, the results were compared, interpreted, and discussed by scientific literature. RESULTS 35 study participants reported that they had received a COVID-19 vaccination and 16 of them stated that they had utilized a rehabilitation service. These participants had varying experiences with COVID-19 vaccination and rehabilitation. Nine of them stated that they developed long COVID despite vaccination before COVID-19. Ten participants reported vaccine reactions, and two participants reported severe side effects. Two participants reported persistent deterioration of their long COVID symptoms after vaccination. This led to uncertainty about the safety, benefits, and handling of COVID-19 vaccination. However, most participants perceived the vaccine as effective regarding milder COVID-19 sequelae. Four participants felt their rehabilitation was helpful and four participants felt it was unhelpful. Two persons found the combination of inpatient rehabilitation and rehabilitation sport helpful. CONCLUSIONS Several implications can be derived from this study: (1) researchers should explore the effects of COVID-19 vaccination on long COVID symptoms; (2) vaccination campaigns should be more responsive to the perspectives of people with long COVID on vaccination; (3) care planners should build rehabilitation facilities specialized in long COVID; (4) rehabilitation providers should train their professionals regarding long COVID and develop rehabilitation programs tailored to different clinical pictures. TRIAL REGISTRATION German register for clinical trials DRKS00026007, 09 September 2021.
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Affiliation(s)
- Tim Schmachtenberg
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
- Department of Rheumatology and Immunology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Gloria Königs
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Sascha Roder
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
- Department of Social Work, University of Applied Sciences and Arts Bielefeld, Interaktion 1, 33619, Bielefeld, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
- Department of Family Medicine, College of Human Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, 49503, East Lansing, MI, USA
| | - Christina Müllenmeister
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Dominik Schröder
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Iman El-Sayed
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
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Gattarello S, Lombardo F, Romitti F, D'Albo R, Velati M, Fratti I, Pozzi T, Nicolardi R, Fioccola A, Busana M, Collino F, Herrmann P, Camporota L, Quintel M, Moerer O, Saager L, Meissner K, Gattinoni L. Determinants of acute kidney injury during high-power mechanical ventilation: secondary analysis from experimental data. Intensive Care Med Exp 2024; 12:31. [PMID: 38512544 PMCID: PMC10957825 DOI: 10.1186/s40635-024-00610-1] [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: 08/15/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The individual components of mechanical ventilation may have distinct effects on kidney perfusion and on the risk of developing acute kidney injury; we aimed to explore ventilatory predictors of acute kidney failure and the hemodynamic changes consequent to experimental high-power mechanical ventilation. METHODS Secondary analysis of two animal studies focused on the outcomes of different mechanical power settings, including 78 pigs mechanically ventilated with high mechanical power for 48 h. The animals were categorized in four groups in accordance with the RIFLE criteria for acute kidney injury (AKI), using the end-experimental creatinine: (1) NO AKI: no increase in creatinine; (2) RIFLE 1-Risk: increase of creatinine of > 50%; (3) RIFLE 2-Injury: two-fold increase of creatinine; (4) RIFLE 3-Failure: three-fold increase of creatinine; RESULTS: The main ventilatory parameter associated with AKI was the positive end-expiratory pressure (PEEP) component of mechanical power. At 30 min from the initiation of high mechanical power ventilation, the heart rate and the pulmonary artery pressure progressively increased from group NO AKI to group RIFLE 3. At 48 h, the hemodynamic variables associated with AKI were the heart rate, cardiac output, mean perfusion pressure (the difference between mean arterial and central venous pressures) and central venous pressure. Linear regression and receiving operator characteristic analyses showed that PEEP-induced changes in mean perfusion pressure (mainly due to an increase in CVP) had the strongest association with AKI. CONCLUSIONS In an experimental setting of ventilation with high mechanical power, higher PEEP had the strongest association with AKI. The most likely physiological determinant of AKI was an increase of pleural pressure and CVP with reduced mean perfusion pressure. These changes resulted from PEEP per se and from increase in fluid administration to compensate for hemodynamic impairment consequent to high PEEP.
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Affiliation(s)
- Simone Gattarello
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany.
| | - Fabio Lombardo
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Federica Romitti
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Rosanna D'Albo
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Mara Velati
- Department of Anesthesia and Intensive Care Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Isabella Fratti
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Tommaso Pozzi
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Rosmery Nicolardi
- Department of Anesthesia and Intensive Care Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Antonio Fioccola
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Mattia Busana
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Francesca Collino
- Department of Anesthesia, Intensive Care and Emergency, "Città Della Salute E Della Scienza" Hospital, Turin, Italy
| | - Peter Herrmann
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Michael Quintel
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
- Department of Anesthesiology, Intensive Care and Emergency Medicine Donau-Isar-Klinikum Deggendorf, Deggendorf, Germany
| | - Onnen Moerer
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Leif Saager
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Konrad Meissner
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Luciano Gattinoni
- Department of Anesthesiology, University Medical Centre Göttingen, Göttingen, Germany
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Ivanov V, Manenti GL, Plewe SS, Kagan I, Schwiedrzik CM. Decision-making processes in perceptual learning depend on effectors. Sci Rep 2024; 14:5644. [PMID: 38453977 PMCID: PMC10920771 DOI: 10.1038/s41598-024-55508-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/24/2024] [Indexed: 03/09/2024] Open
Abstract
Visual perceptual learning is traditionally thought to arise in visual cortex. However, typical perceptual learning tasks also involve systematic mapping of visual information onto motor actions. Because the motor system contains both effector-specific and effector-unspecific representations, the question arises whether visual perceptual learning is effector-specific itself, or not. Here, we study this question in an orientation discrimination task. Subjects learn to indicate their choices either with joystick movements or with manual reaches. After training, we challenge them to perform the same task with eye movements. We dissect the decision-making process using the drift diffusion model. We find that learning effects on the rate of evidence accumulation depend on effectors, albeit not fully. This suggests that during perceptual learning, visual information is mapped onto effector-specific integrators. Overlap of the populations of neurons encoding motor plans for these effectors may explain partial generalization. Taken together, visual perceptual learning is not limited to visual cortex, but also affects sensorimotor mapping at the interface of visual processing and decision making.
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Affiliation(s)
- Vladyslav Ivanov
- Neural Circuits and Cognition Lab, European Neuroscience Institute Göttingen - A Joint Initiative of the University Medical Center Göttingen and the Max Planck Society, Grisebachstraße 5, 37077, Göttingen, Germany
- Sensorimotor Group, German Primate Center - Leibniz Institute for Primate Research, Kellnerweg 4, 37077, Göttingen, Germany
| | - Giorgio L Manenti
- Neural Circuits and Cognition Lab, European Neuroscience Institute Göttingen - A Joint Initiative of the University Medical Center Göttingen and the Max Planck Society, Grisebachstraße 5, 37077, Göttingen, Germany
- Perception and Plasticity Group, German Primate Center - Leibniz Institute for Primate Research, Kellnerweg 4, 37077, Göttingen, Germany
- Leibniz ScienceCampus Primate Cognition, Göttingen, Germany
- Systems Neuroscience Program, Graduate School for Neurosciences, Biophysics and Molecular Biosciences (GGNB), 37077, Göttingen, Germany
| | - Sandrin S Plewe
- Neural Circuits and Cognition Lab, European Neuroscience Institute Göttingen - A Joint Initiative of the University Medical Center Göttingen and the Max Planck Society, Grisebachstraße 5, 37077, Göttingen, Germany
- Perception and Plasticity Group, German Primate Center - Leibniz Institute for Primate Research, Kellnerweg 4, 37077, Göttingen, Germany
- Leibniz ScienceCampus Primate Cognition, Göttingen, Germany
| | - Igor Kagan
- Leibniz ScienceCampus Primate Cognition, Göttingen, Germany
- Decision and Awareness Group, German Primate Center - Leibniz Institute for Primate Research, Kellnerweg 4, 37077, Göttingen, Germany
| | - Caspar M Schwiedrzik
- Neural Circuits and Cognition Lab, European Neuroscience Institute Göttingen - A Joint Initiative of the University Medical Center Göttingen and the Max Planck Society, Grisebachstraße 5, 37077, Göttingen, Germany.
- Perception and Plasticity Group, German Primate Center - Leibniz Institute for Primate Research, Kellnerweg 4, 37077, Göttingen, Germany.
- Leibniz ScienceCampus Primate Cognition, Göttingen, Germany.
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Sekanina U, Tetzlaff B, Mazur A, Huckle T, Kühn A, Dano R, Höckelmann C, Scherer M, Balzer K, Köpke S, Hummers E, Müller C. Interprofessional collaboration in the home care setting: perspectives of people receiving home care, relatives, nurses, general practitioners, and therapists-results of a qualitative analysis. BMC Prim Care 2024; 25:79. [PMID: 38438843 PMCID: PMC10910757 DOI: 10.1186/s12875-024-02313-8] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/16/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND About one million people in need of home care in Germany are assisted by 15,400 home care services. Home healthcare is mostly a complex endeavour because interprofessional collaboration is often challenging. This might negatively impact patient safety. The project interprof HOME aims to develop an interprofessional person-centred care concept for people receiving home care in a multistep approach. In one of the work packages we explored how people receiving home care, relatives, nurses, general practitioners, and therapists (physiotherapists, occupational therapists, and speech therapists) perceive collaboration in this setting. METHODS Semi-structured interviews were conducted with 20 people receiving home care and with 21 relatives. Additionally, we worked with nine monoprofessional focus groups involving nurses of home care services (n = 17), general practitioners (n = 14), and therapists (n = 21). The data were analysed by content analysis. RESULTS Three main categories evolved: "perception of interprofessional collaboration", "means of communication", and "barriers and facilitators". People receiving home care and relatives often perceive little to no interprofessional collaboration and take over a significant part of the organisational coordination and information exchange. Interprofessional collaboration in steady care situations does exist at times and mostly occurs in coordination tasks. Contact and information exchange are rare, however, interprofessional personal encounters are sporadic, and fixed agreements and permanent contact persons are not standard. These trends increase with the complexity of the healthcare situation. Joint collaborations are often perceived as highly beneficial. Means of communications such as telephone, fax, or e-mail are used differently and are often considered tedious and time-consuming. No interprofessional formal written or electronic documentation system exists. Personal acquaintance and mutual trust are perceived as being beneficial, while a lack of mutual availability, limited time, and inadequate compensation hinder interprofessional collaboration. CONCLUSIONS Interprofessional collaboration in home care occurs irregularly, and coordination often remains with people receiving home care or relatives. While this individual care set-up may work sufficiently well in low complex care situations, it becomes vulnerable to disruptions with increasing complexity. Close interactions, joint collaboration, and fixed means of communication might improve healthcare at home. The findings were integrated into the development of the person-centred interprofessional care concept interprof HOME. TRIAL REGISTRATION This study is registered on the International Clinical Trails registry platform ClinicalTrials.gov as NCT05149937 on 03/11/2021.
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Affiliation(s)
- Uta Sekanina
- Department of General Practice, University Medical Center Goettingen, Humboldtallee 38, 37073, Göttingen, Germany.
| | - Britta Tetzlaff
- Department of General Practice and Primary Care, University Medical Center Hamburg- Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ana Mazur
- Department of General Practice, University Medical Center Goettingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Tilman Huckle
- Nursing Research Unit, Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Anja Kühn
- Nursing Research Unit, Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Richard Dano
- Institute of Nursing Science, Medical Faculty, University of Cologne, University Hospital Cologne, Gleueler Str. 176-178, 50935, Köln, Germany
| | - Carolin Höckelmann
- Institute of Nursing Science, Medical Faculty, University of Cologne, University Hospital Cologne, Gleueler Str. 176-178, 50935, Köln, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg- Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Katrin Balzer
- Nursing Research Unit, Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Medical Faculty, University of Cologne, University Hospital Cologne, Gleueler Str. 176-178, 50935, Köln, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Goettingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Christiane Müller
- Department of General Practice, University Medical Center Goettingen, Humboldtallee 38, 37073, Göttingen, Germany
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9
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Dombrowski T, Pursche N, Beutner C, Beutner D. [High interaction potential of online-only courses with breakout sessions-results of a pilot study]. HNO 2024; 72:173-181. [PMID: 38260983 PMCID: PMC10879270 DOI: 10.1007/s00106-023-01407-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The flipped classroom (FC) is nowadays a popular principle of blended student-centered learning. Students first prepare basic knowledge at home and subsequently meet for consolidation and a more in-depth look at a certain topic. During the COVID-19 pandemic, several groups developed approaches to also transform the characteristic FC second session into an online-only format. OBJECTIVE Herein, we present a pilot study on establishing an online-only FC format with elements of collaborative learning and its evaluation by medical students. MATERIALS AND METHODS The FC design related to diseases of the salivary glands was transformed into an online-only event. After studying the basic information online, supported by self-made interactive videos and/or lecture recordings, students met in a video conference enriched by breakout sessions, interactive demonstration of the related clinical examination including ultrasound, and a formative assessment. A questionnaire with 27 items was answered by participants to evaluate the concept and the event. RESULTS Use of common hard- and software systems led to a technically stable video conference. A total of 55 students completed the questionnaire and were included into data analysis. During the breakout sessions, lively interaction between participants was observed. The evaluation of both the event itself and the related learning progress showed good results despite the lack of preparation beforehand in 27% of participants. CONCLUSION Online-only FC designs can result in high satisfaction. High quality of online preparation, a solid technical platform, accurate time management, and a reasonable selection of topics are the main parameters contributing to successful course design. Nowadays, embedding medical imaging can be realized in appropriate quality for educational purposes. The implementation of breakout sessions and voting tools enables collaborative online learning with high levels of interaction and satisfaction for both teachers and students.
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Affiliation(s)
- Tobias Dombrowski
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - Nils Pursche
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Caroline Beutner
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Dirk Beutner
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
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10
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Guhlich M, Rieken S. [Prophylactic Radiation Therapy Versus Standard of Care for Patients With High-Risk Asymptomatic Bone Metastases]. Strahlenther Onkol 2024; 200:253-254. [PMID: 38180495 PMCID: PMC10876712 DOI: 10.1007/s00066-023-02195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Manuel Guhlich
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - Stefan Rieken
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
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11
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Redfield SE, De-la-Torre P, Zamani M, Wang H, Khan H, Morris T, Shariati G, Karimi M, Kenna MA, Seo GH, Xu H, Lu W, Naz S, Galehdari H, Indzhykulian AA, Shearer AE, Vona B. PKHD1L1, a gene involved in the stereocilia coat, causes autosomal recessive nonsyndromic hearing loss. Hum Genet 2024; 143:311-329. [PMID: 38459354 PMCID: PMC11043200 DOI: 10.1007/s00439-024-02649-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/21/2024] [Indexed: 03/10/2024]
Abstract
Identification of genes associated with nonsyndromic hearing loss is a crucial endeavor given the substantial number of individuals who remain without a diagnosis after even the most advanced genetic testing. PKHD1L1 was established as necessary for the formation of the cochlear hair-cell stereociliary coat and causes hearing loss in mice and zebrafish when mutated. We sought to determine if biallelic variants in PKHD1L1 also cause hearing loss in humans. Exome sequencing was performed on DNA of four families segregating autosomal recessive nonsyndromic sensorineural hearing loss. Compound heterozygous p.[(Gly129Ser)];p.[(Gly1314Val)] and p.[(Gly605Arg)];p[(Leu2818TyrfsTer5)], homozygous missense p.(His2479Gln) and nonsense p.(Arg3381Ter) variants were identified in PKHD1L1 that were predicted to be damaging using in silico pathogenicity prediction methods. In vitro functional analysis of two missense variants was performed using purified recombinant PKHD1L1 protein fragments. We then evaluated protein thermodynamic stability with and without the missense variants found in one of the families and performed a minigene splicing assay for another variant. In silico molecular modeling using AlphaFold2 and protein sequence alignment analysis were carried out to further explore potential variant effects on structure. In vitro functional assessment indicated that both engineered PKHD1L1 p.(Gly129Ser) and p.(Gly1314Val) mutant constructs significantly reduced the folding and structural stabilities of the expressed protein fragments, providing further evidence to support pathogenicity of these variants. Minigene assay of the c.1813G>A p.(Gly605Arg) variant, located at the boundary of exon 17, revealed exon skipping leading to an in-frame deletion of 48 amino acids. In silico molecular modeling exposed key structural features that might suggest PKHD1L1 protein destabilization. Multiple lines of evidence collectively associate PKHD1L1 with nonsyndromic mild-moderate to severe sensorineural hearing loss. PKHD1L1 testing in individuals with mild-moderate hearing loss may identify further affected families.
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Affiliation(s)
- Shelby E Redfield
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, BCH-3129, Boston, MA, 02115, USA
| | - Pedro De-la-Torre
- Mass Eye and Ear, Eaton Peabody Laboratories, Boston, MA, USA
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Mina Zamani
- Department of Biology, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran
- Narges Medical Genetics and Prenatal Diagnosis Laboratory, Kianpars, Ahvaz, Iran
| | - Hanjun Wang
- Precision Medicine Center, Academy of Medical Science, Zhengzhou University, No. 40 Daxuebei Road, Zhengzhou, 450052, China
| | - Hina Khan
- School of Biological Sciences, University of the Punjab, Quaid-e-Azam Campus, Lahore, 54590, Pakistan
| | - Tyler Morris
- Mass Eye and Ear, Eaton Peabody Laboratories, Boston, MA, USA
| | - Gholamreza Shariati
- Narges Medical Genetics and Prenatal Diagnosis Laboratory, Kianpars, Ahvaz, Iran
- Department of Medical Genetics, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Karimi
- Khuzestan Cochlear Implantation Center (Tabassom), Ahvaz, Iran
| | - Margaret A Kenna
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, BCH-3129, Boston, MA, 02115, USA
- Mass Eye and Ear, Eaton Peabody Laboratories, Boston, MA, USA
| | | | - Hongen Xu
- Precision Medicine Center, Academy of Medical Science, Zhengzhou University, No. 40 Daxuebei Road, Zhengzhou, 450052, China
| | - Wei Lu
- Department of Otorhinolaryngology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jian-She Road, Zhengzhou, 450052, China
| | - Sadaf Naz
- School of Biological Sciences, University of the Punjab, Quaid-e-Azam Campus, Lahore, 54590, Pakistan
| | - Hamid Galehdari
- Department of Biology, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Artur A Indzhykulian
- Mass Eye and Ear, Eaton Peabody Laboratories, Boston, MA, USA.
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - A Eliot Shearer
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, BCH-3129, Boston, MA, 02115, USA.
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Barbara Vona
- Institute of Human Genetics, University Medical Center Göttingen, 37073, Göttingen, Germany.
- Institute for Auditory Neuroscience and InnerEarLab, University Medical Center Göttingen, 37075, Göttingen, Germany.
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12
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Diedrich L, Kolhoff HI, Chakalov I, Vékony T, Németh D, Antal A. Prefrontal theta-gamma transcranial alternating current stimulation improves non-declarative visuomotor learning in older adults. Sci Rep 2024; 14:4955. [PMID: 38418511 PMCID: PMC10901881 DOI: 10.1038/s41598-024-55125-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/20/2024] [Indexed: 03/01/2024] Open
Abstract
The rise in the global population of older adults underscores the significance to investigate age-related cognitive disorders and develop early treatment modalities. Previous research suggests that non-invasive transcranial Alternating Current Stimulation (tACS) can moderately improve cognitive decline in older adults. However, non-declarative cognition has received relatively less attention. This study investigates whether repeated (16-day) bilateral theta-gamma cross-frequency tACS targeting the Dorsolateral Prefrontal Cortex (DLPFC) enhances non-declarative memory. Computerized cognitive training was applied alongside stimulation to control for the state-of-the-brain. The Alternating Serial Reaction Time (ASRT) task was employed to assess non-declarative functions such as visuomotor skill and probabilistic sequence learning. Results from 35 participants aged 55-82 indicated that active tACS led to more substantial improvements in visuomotor skills immediately after treatment, which persisted 3 months later, compared to sham tACS. Treatment benefit was more pronounced in older adults of younger age and those with pre-existing cognitive decline. However, neither intervention group exhibited modulation of probabilistic sequence learning. These results suggest that repeated theta-gamma tACS can selectively improve distinct non-declarative cognitive aspects when targeting the DLPFC. Our findings highlight the therapeutic potential of tACS in addressing deficits in learning and retaining general skills, which could have a positive impact on the quality of life for cognitively impaired older individuals by preserving independence in daily activities.
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Affiliation(s)
- Lukas Diedrich
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.
| | - Hannah I Kolhoff
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Ivan Chakalov
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Teodóra Vékony
- Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, INSERM, CNRS, Université Claude Bernard Lyon 1, Bron, France
- Department of Education and Psychology, Faculty of Social Sciences, University of Atlántico Medio, Las Palmas de Gran Canaria, Spain
| | - Dezső Németh
- Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, INSERM, CNRS, Université Claude Bernard Lyon 1, Bron, France
- BML-NAP Research Group, Institute of Psychology, Eötvös Loránd University and Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Budapest, Hungary
- Department of Education and Psychology, Faculty of Social Sciences, University of Atlántico Medio, Las Palmas de Gran Canaria, Spain
| | - Andrea Antal
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
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13
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Tatenhorst L, Maass F, Paul H, Dambeck V, Bähr M, Dono R, Lingor P. Glypican-4 serum levels are associated with cognitive dysfunction and vascular risk factors in Parkinson's disease. Sci Rep 2024; 14:5005. [PMID: 38424123 PMCID: PMC10904781 DOI: 10.1038/s41598-024-54800-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/16/2024] [Indexed: 03/02/2024] Open
Abstract
Glypicans are biomarkers for various pathologies, including cardiovascular disease, cancer and diabetes. Increasing evidence suggests that glypicans also play a role in the context of neurodegenerative disorders. Initially described as supporting functionality of synapses via glutamate receptors during CNS development, Glypican 4 (GPC-4) also plays a role in the context of dementia via tau hyperphosphorylation in Alzheimer's disease, which is also a co-pathology in Parkinson's disease dementia. However, clinical evidence of circulating GPC-4 in Parkinson's disease (PD) is missing so far. We therefore investigated GPC-4 in biofluids of PD patients. We analyzed GPC-4 levels in cerebrospinal fluid (CSF, n = 140), serum (n = 80), and tear fluid samples (n = 70) of PD patients and control subjects in a similar age range by ELISA (serum, CSF) and western blot (tear fluid). Expression of circulating GPC-4 was confirmed in all three biofluids, with highest levels in serum. Interestingly, GPC-4 levels were age-dependent, and multiple regression analysis revealed a significant association between GPC-4 serum levels and MoCA score, suggesting an involvement of GPC-4 in PD-associated cognitive decline. Furthermore, stratification of PD patients for vascular risk factors revealed a significant increase of GPC-4 serum levels in PD patients with vascular risk factors. Our results suggest GPC-4 as a clinical biomarker for vascular risk stratification in order to identify PD patients with increased risk of developing dementia.
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Affiliation(s)
- Lars Tatenhorst
- Department of Neurology, University Medical Center Göttingen, 37099, Göttingen, Germany
- Center for Biostructural Imaging of Neurodegeneration (BIN), University Medical Center Göttingen, 37099, Göttingen, Germany
| | - Fabian Maass
- Department of Neurology, University Medical Center Göttingen, 37099, Göttingen, Germany
| | - Hannah Paul
- Department of Neurology, University Medical Center Göttingen, 37099, Göttingen, Germany
- Center for Biostructural Imaging of Neurodegeneration (BIN), University Medical Center Göttingen, 37099, Göttingen, Germany
| | - Vivian Dambeck
- Department of Neurology, University Medical Center Göttingen, 37099, Göttingen, Germany
- Center for Biostructural Imaging of Neurodegeneration (BIN), University Medical Center Göttingen, 37099, Göttingen, Germany
| | - Mathias Bähr
- Department of Neurology, University Medical Center Göttingen, 37099, Göttingen, Germany
- Center for Biostructural Imaging of Neurodegeneration (BIN), University Medical Center Göttingen, 37099, Göttingen, Germany
| | - Rosanna Dono
- Aix Marseille Univ, CNRS, IBDM, Turing Center for Living Systems, NeuroMarseille, 13288, Marseille, France
| | - Paul Lingor
- Department of Neurology, University Medical Center Göttingen, 37099, Göttingen, Germany.
- Center for Biostructural Imaging of Neurodegeneration (BIN), University Medical Center Göttingen, 37099, Göttingen, Germany.
- Clinical Department of Neurology, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81679, Munich, Germany.
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14
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Garg P, Würtz F, Hobbie F, Buttgereit K, Aich A, Leite K, Rehling P, Kügler S, Bähr M. Human serum-derived α-synuclein auto-antibodies mediate NMDA receptor-dependent degeneration of CNS neurons. J Neuroinflammation 2024; 21:62. [PMID: 38419079 PMCID: PMC10902935 DOI: 10.1186/s12974-024-03050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/18/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Presence of autoantibodies against α-synuclein (α-syn AAb) in serum of the general population has been widely reported. That such peripheral factors may be involved in central nervous system pathophysiology was demonstrated by detection of immunoglobulins (IgGs) in cerebrospinal fluid and brain of Parkinson's disease (PD) patients. Thus, blood-borne IgGs may reach the brain parenchyma through an impaired blood-brain barrier (BBB). FINDINGS The present study aims to evaluate the patho-physiological impact of α-syn AAbs on primary brain cells, i.e., on spontaneously active neurons and on astrocytes. Exposure of neuron-astrocyte co-cultures to human serum containing α-syn AAbs mediated a dose-dependent reduction of spontaneous neuronal activity, and subsequent neurodegeneration. Removal specifically of α-syn AAbs from the serum prevented neurotoxicity, while purified, commercial antibodies against α-syn mimicked the neurodegenerative effect. Mechanistically, we found a strong calcium flux into neurons preceding α-syn AAbs-induced cell death, specifically through NMDA receptors. NMDA receptor antagonists prevented neurodegeneration upon treatment with α-syn (auto)antibodies. α-syn (auto)antibodies did not affect astrocyte survival. However, in presence of α-syn, astrocytes reacted to α-syn antibodies by secretion of the chemokine RANTES. CONCLUSION These findings provide a novel basis to explain how a combination of BBB impairment and infiltration of IgGs targeting synuclein may contribute to neurodegeneration in PD and argue for caution with α-syn immunization therapies for treatment of PD.
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Affiliation(s)
- Pretty Garg
- Department of Neurology, University Medical Center Göttingen, Waldweg 33, 37073, Göttingen, Germany
- Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, 37073, Göttingen, Germany
| | - Franziska Würtz
- Department of Neurology, University Medical Center Göttingen, Waldweg 33, 37073, Göttingen, Germany
| | - Fabian Hobbie
- Department of Neurology, University Medical Center Göttingen, Waldweg 33, 37073, Göttingen, Germany
| | - Klemens Buttgereit
- Department of Neurology, University Medical Center Göttingen, Waldweg 33, 37073, Göttingen, Germany
| | - Abhishek Aich
- Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, 37073, Göttingen, Germany
- Department of Cellular Biochemistry, University Medical Center Göttingen, Göttingen, Germany
| | - Kristian Leite
- Department of Neurology, University Medical Center Göttingen, Waldweg 33, 37073, Göttingen, Germany
| | - Peter Rehling
- Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, 37073, Göttingen, Germany
- Department of Cellular Biochemistry, University Medical Center Göttingen, Göttingen, Germany
| | - Sebastian Kügler
- Department of Neurology, University Medical Center Göttingen, Waldweg 33, 37073, Göttingen, Germany.
| | - Mathias Bähr
- Department of Neurology, University Medical Center Göttingen, Waldweg 33, 37073, Göttingen, Germany
- Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, 37073, Göttingen, Germany
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15
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Mouchoux J, Meyer-Marcotty P, Sojka F, Dechent P, Klenke D, Wiechens B, Quast A. Reliability of landmark identification for analysis of the temporomandibular joint in real-time MRI. Head Face Med 2024; 20:10. [PMID: 38365709 PMCID: PMC10874088 DOI: 10.1186/s13005-024-00411-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/22/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Real-time magnetic resonance imaging (rtMRI) is essential for diagnosing and comprehending temporomandibular joint (TMJ) movements. Current methods for tracking and analysis require manual landmark placement on each acquisition frame. Therefore, our study aimed to assess the inter- and intra-rater reliability of placing cephalometric landmarks in frames from a dynamic real-time TMJ MRI. MATERIAL AND METHODS Four real-time MRIs of the right TMJ were taken during mandibular movement at ten frames per second. Seven dentists identified ten landmarks on two frames (intercuspal position-ICP-and maximum mouth opening-MMO) twice at a two-week interval, yielding 112 tracings. Six typical cephalometric measurements (angles and distances) were derived from these landmarks. The reliabilities of landmarks and measurements were evaluated using distance-based (dbICC), linear mixed effect model intraclass correlation (lmeICC), and standard ICC. RESULTS The average inter-rater reliability for the landmarks stood at 0.92 (dbICC) and 0.93 (lmeICC). The intra-rater reliability scores were 0.97 and 0.98. Over 80% of the landmarks showed an ICC greater than 0.98 (inter-rater) and over 0.99 (intra-rater). The lowest landmark ICC was observed for the orbitale and the oblique ridge of the mandibular ramus. However, the cephalometric angle and distance measurements derived from these landmarks showed only moderate to good reliability, whereas the reliability in the frames with ICP was better than those with MMO. Measurements performed in the ICP frame were more reliable than measurements in the MMO frame. CONCLUSION While dentists reliably localize isolated landmarks in real-time MRIs, the cephalometric measurements derived from them remain inconsistent. The better results in ICP than MMO are probably due to a more familiar jaw position. The higher error rate of the TMJ measurements in MMO could be associated with a lack of training in real-time MRI analysis in dentistry.
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Affiliation(s)
- Jérémy Mouchoux
- Poliklinik Für Kieferorthopädie, Universitätmedizin Göttingen (UMG), Göttingen, Germany.
| | | | - Florian Sojka
- Poliklinik Für Kieferorthopädie, Universitätmedizin Göttingen (UMG), Göttingen, Germany
| | - Peter Dechent
- Institut Für Kognitive Neurologie, Universitätmedizin Göttingen (UMG), Göttingen, Germany
| | - Daniela Klenke
- Poliklinik Für Kieferorthopädie, Universitätmedizin Göttingen (UMG), Göttingen, Germany
| | - Bernhard Wiechens
- Poliklinik Für Kieferorthopädie, Universitätmedizin Göttingen (UMG), Göttingen, Germany
| | - Anja Quast
- Poliklinik Für Kieferorthopädie, Universitätmedizin Göttingen (UMG), Göttingen, Germany
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16
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Schilling M, Unterberg-Buchwald C, Lotz J, Uecker M. Assessment of deep learning segmentation for real-time free-breathing cardiac magnetic resonance imaging at rest and under exercise stress. Sci Rep 2024; 14:3754. [PMID: 38355969 PMCID: PMC10866998 DOI: 10.1038/s41598-024-54164-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/09/2024] [Indexed: 02/16/2024] Open
Abstract
In recent years, a variety of deep learning networks for cardiac MRI (CMR) segmentation have been developed and analyzed. However, nearly all of them are focused on cine CMR under breathold. In this work, accuracy of deep learning methods is assessed for volumetric analysis (via segmentation) of the left ventricle in real-time free-breathing CMR at rest and under exercise stress. Data from healthy volunteers (n = 15) for cine and real-time free-breathing CMR at rest and under exercise stress were analyzed retrospectively. Exercise stress was performed using an ergometer in the supine position. Segmentations of two deep learning methods, a commercially available technique (comDL) and an openly available network (nnU-Net), were compared to a reference model created via the manual correction of segmentations obtained with comDL. Segmentations of left ventricular endocardium (LV), left ventricular myocardium (MYO), and right ventricle (RV) are compared for both end-systolic and end-diastolic phases and analyzed with Dice's coefficient. The volumetric analysis includes the cardiac function parameters LV end-diastolic volume (EDV), LV end-systolic volume (ESV), and LV ejection fraction (EF), evaluated with respect to both absolute and relative differences. For cine CMR, nnU-Net and comDL achieve Dice's coefficients above 0.95 for LV and 0.9 for MYO, and RV. For real-time CMR, the accuracy of nnU-Net exceeds that of comDL overall. For real-time CMR at rest, nnU-Net achieves Dice's coefficients of 0.94 for LV, 0.89 for MYO, and 0.90 for RV and the mean absolute differences between nnU-Net and the reference are 2.9 mL for EDV, 3.5 mL for ESV, and 2.6% for EF. For real-time CMR under exercise stress, nnU-Net achieves Dice's coefficients of 0.92 for LV, 0.85 for MYO, and 0.83 for RV and the mean absolute differences between nnU-Net and reference are 11.4 mL for EDV, 2.9 mL for ESV, and 3.6% for EF. Deep learning methods designed or trained for cine CMR segmentation can perform well on real-time CMR. For real-time free-breathing CMR at rest, the performance of deep learning methods is comparable to inter-observer variability in cine CMR and is usable for fully automatic segmentation. For real-time CMR under exercise stress, the performance of nnU-Net could promise a higher degree of automation in the future.
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Affiliation(s)
- Martin Schilling
- Institute for Diagnostic and Interventional Radiology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Christina Unterberg-Buchwald
- Institute for Diagnostic and Interventional Radiology, Universitätsmedizin Göttingen, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Clinic of Cardiology and Pneumology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Martin Uecker
- Institute for Diagnostic and Interventional Radiology, Universitätsmedizin Göttingen, Göttingen, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
- Institute of Biomedical Imaging, Graz University of Technology, Graz, Austria.
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17
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Prokakis E, Bamahmoud H, Jansari S, Fritsche L, Dietz A, Boshnakovska A, Rehling P, Johnsen SA, Gallwas J, Wegwitz F. USP22 supports the aggressive behavior of basal-like breast cancer by stimulating cellular respiration. Cell Commun Signal 2024; 22:120. [PMID: 38347585 PMCID: PMC10863169 DOI: 10.1186/s12964-023-01441-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/12/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Breast cancer (BC) is the most frequent tumor entity in women worldwide with a high chance of therapeutic response in early- and non-metastatic disease stages. Among all BC subtypes, triple-negative BC (TNBC) is the most challenging cancer subtype lacking effective molecular targets due to the particular enrichment of cancer stem cells (CSCs), frequently leading to a chemoresistant phenotype and metastasis. The Ubiquitin Specific Peptidase 22 (USP22) is a deubiquitinase that has been frequently associated with a CSC-promoting function and intimately implicated in resistance to conventional therapies, tumor relapse, metastasis and overall poor survival in a broad range of cancer entities, including BC. To date, though, the role of USP22 in TNBC has been only superficially addressed. METHODS The current study utilized the MMTV-cre, Usp22fl/fl transgenic mouse model to study the involvement of USP22 in the stem cell-like properties of the growing mammary tissue. Additionally, we combined high-throughput transcriptomic analyses with publicly available patient transcriptomic data and utilized TNBC culture models to decipher the functional role of USP22 in the CSC characteristics of this disease. RESULTS Interestingly, we identified that USP22 promotes CSC properties and drug tolerance by supporting the oxidative phosphorylation program, known to be largely responsible for the poor response to conventional therapies in this particularly aggressive BC subtype. CONCLUSIONS This study suggests a novel tumor-supportive role of USP22 in sustaining cellular respiration to facilitate the drug-tolerant behavior of HER2+-BC and TNBC cells. Therefore, we posit USP22 as a promising therapeutic target to optimize standard therapies and combat the aggressiveness of these malignancies. Video Abstract.
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Affiliation(s)
- Evangelos Prokakis
- Department of Gynecology and Obstetrics, University Medical Center Göttingen, Göttingen, Germany.
- Department of General, Visceral & Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany.
| | - Husam Bamahmoud
- Department of Gynecology and Obstetrics, University Medical Center Göttingen, Göttingen, Germany
| | - Shaishavi Jansari
- Department of Gynecology and Obstetrics, University Medical Center Göttingen, Göttingen, Germany
| | - Lena Fritsche
- Department of Gynecology and Obstetrics, University Medical Center Göttingen, Göttingen, Germany
| | - Alexander Dietz
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Angela Boshnakovska
- Department of Cellular Biochemistry, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Rehling
- Department of Cellular Biochemistry, University Medical Center Göttingen, Göttingen, Germany
| | - Steven A Johnsen
- Department of General, Visceral & Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
- The Robert Bosch Center for Tumor Diseases, Stuttgart, Germany
| | - Julia Gallwas
- Department of Gynecology and Obstetrics, University Medical Center Göttingen, Göttingen, Germany
| | - Florian Wegwitz
- Department of Gynecology and Obstetrics, University Medical Center Göttingen, Göttingen, Germany.
- Department of General, Visceral & Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany.
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AboJabel H, Welsch J, Schicktanz S. Cross-cultural perspectives on intelligent assistive technology in dementia care: comparing Israeli and German experts' attitudes. BMC Med Ethics 2024; 25:15. [PMID: 38326778 PMCID: PMC10848426 DOI: 10.1186/s12910-024-01010-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Despite the great benefits of intelligent assistive technology (IAT) for dementia care - for example, the enhanced safety and increased independence of people with dementia and their caregivers - its practical adoption is still limited. The social and ethical issues pertaining to IAT in dementia care, shaped by factors such as culture, may explain these limitations. However, most studies have focused on understanding these issues within one cultural setting only. Therefore, the aim of this study was to explore and compare the attitudes of Israeli and German dementia experts toward IAT in dementia care, to contribute to a more cultural-comparative perspective. METHODS Semi-structured interviews were conducted with 35 experts (15 Israelis and 20 Germans) in key roles in health and community services for people with dementia as well as in the fields of dementia and IAT (e.g., computer science, electrical/biomedical engineering, ethics, nursing, and gerontology). Thematic content analysis was used to analyze the data. FINDINGS Israeli and German experts identified the same social accelerators in the development and implementation of IAT in dementia care (i.e., changes in family structure and social digitization) and benefits of adopting IAT (e.g., enhancing the safety of people with dementia and increasing their independence). However, there were differences in inhibitor/risk assessments between the two groups. Namely, economic considerations and the cognitive capacity of people with dementia were identified by both groups as inhibitors, while Israeli experts additionally reported stigma and ageism. Whereas both groups agreed that IAT might reduce human connection, and that the technology is not yet reliable enough, German experts highlighted concerns regarding privacy; in contrast, Israeli experts prioritized safety over privacy. CONCLUSIONS Our research findings allow for the identification of relevant similarities but also important differences between German and Israeli experts' perspectives. As such, an important basis has been provided for a more in-depth discussion regarding where, why, and how culturally-sensitive technology development is needed.
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Affiliation(s)
- Hanan AboJabel
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany.
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Johannes Welsch
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
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Abboud T, Malinova V, Rohde V, Mielke D. Radiofrequency thermocoagulation under neuromonitoring guidance and general anesthesia for treatment of refractory trigeminal neuralgia. Acta Neurochir (Wien) 2024; 166:56. [PMID: 38302773 PMCID: PMC10834569 DOI: 10.1007/s00701-024-05964-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/06/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Radiofrequency thermocoagulation (RFT) for refractory trigeminal neuralgia is usually performed in awake patients to localize the involved trigeminal branches. It is often a painful experience. Here, we present RFT under neuromonitoring guidance and general anesthesia. METHOD Stimulation of trigeminal branches at the foramen ovale with the tip of the RFT cannula is performed under short general anesthesia. Antidromic sensory-evoked potentials (aSEP) are recorded from the 3 trigeminal branches. The cannula is repositioned until the desired branch can be stimulated and lesioned. CONCLUSION aSEP enable accurate localization of involved trigeminal branches during RFT and allow performing the procedure under general anesthesia.
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Affiliation(s)
- Tammam Abboud
- Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Vesna Malinova
- Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Dorothee Mielke
- Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
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Gattinoni L, Collino F, Camporota L. Ventilator induced lung injury: a case for a larger umbrella? Intensive Care Med 2024; 50:275-278. [PMID: 38172299 PMCID: PMC10907410 DOI: 10.1007/s00134-023-07296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/25/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Luciano Gattinoni
- Department of Anesthesiology, University Medical Center Göttingen, Robert Koch Straße 40, 37075, Göttingen, Germany.
| | - Francesca Collino
- Department of Anesthesia, Intensive Care and Emergency, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Piemonte, Turin, Italy
| | - Luigi Camporota
- Department of Adult Critical Care, Centre for Human and Applied Physiological Sciences, Guy's and St. Thomas' NHS Foundation Trust, King's College London, London, UK
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Torsello GF, Stavroulakis K, Bisdas T, Cardona Y, Wichmann K, Torsello GB. Treatment of Femoropopliteal Artery Disease with Polymer-Coated Drug-Eluting Stent: 5-Year Results of a Prospective, Non-Randomized Study Including the Halo Phenomenon. Cardiovasc Intervent Radiol 2024; 47:177-185. [PMID: 38228879 PMCID: PMC10844144 DOI: 10.1007/s00270-023-03652-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE To investigate the long-term results of the Eluvia drug-eluting stent (DES) implantation for femoropopliteal arterial disease, including the 'halo' phenomenon. Long-term data of DES is scarce. A focal reaction ('halo') following Eluvia DES deployment has been described. However, the long-term clinical impact of this phenomenon remains unclear. METHODS This prospective, non-randomized, single-arm study included 130 consecutive patients treated with an Eluvia DES for symptomatic femoropopliteal disease between March 2016 and December 2018. Clinical outcomes and imaging were assessed after 6 months and annually thereafter for up to 5 years. The primary outcome measure was primary patency. Secondary outcomes were freedom from clinically driven target lesion revascularization (CD-TLR), freedom from major amputation, overall survival and amputation-free survival rates. RESULTS The primary patency was 65% at 5 years. The freedom from CD-TLR and from major amputation at 5 years was 79 and 96%, respectively. The overall survival and amputation-free survival rates were 88 and 83% at 60 months, respectively. Out of the 27 patients with a halo sign, two showed an increased (7.4%) and 6 (22.2%) a decreased diameter. In 19 cases (70.4%), the diameter remained unchanged at the latest follow-up. The presence of the 'halo' sign was associated with increased primary patency (87% versus 59%, HR: 2.48, 95%CI 1.19-5.16, P = .015). CONCLUSIONS The presented patient cohort treated with the Eluvia DES for femoropopliteal artery lesions indicates durable efficacy and a good safety profile regardless of the halo phenomenon. The results need to be confirmed in a larger patient cohort. LEVEL OF EVIDENCE III Non-randomized controlled cohort/follow-up study.
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Affiliation(s)
- Giovanni Federico Torsello
- Department of Diagnostic and Interventional Radiology, Institute of Diagnostic and Interventional Radiology, Göttingen Medical Center, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
| | | | - Theodosios Bisdas
- Department of Vascular Surgery, Athens Medical Center, Athens, Greece
| | - Yamel Cardona
- Institute for Vascular Research, St. Franziskus Hospital, Münster, Germany
| | - Katrin Wichmann
- Institute for Vascular Research, St. Franziskus Hospital, Münster, Germany
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Fioccola A, Nicolardi RV, Pozzi T, Fratti I, Romitti F, Collino F, Reupke V, Bassi GL, Protti A, Santini A, Cressoni M, Busana M, Moerer O, Camporota L, Gattinoni L. Estimation of normal lung weight index in healthy female domestic pigs. Intensive Care Med Exp 2024; 12:6. [PMID: 38273120 PMCID: PMC10811311 DOI: 10.1186/s40635-023-00591-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Lung weight is an important study endpoint to assess lung edema in porcine experiments on acute respiratory distress syndrome and ventilatory induced lung injury. Evidence on the relationship between lung-body weight relationship is lacking in the literature. The aim of this work is to provide a reference equation between normal lung and body weight in female domestic piglets. MATERIALS AND METHODS 177 healthy female domestic piglets from previous studies were included in the analysis. Lung weight was assessed either via a CT-scan before any experimental injury or with a scale after autopsy. The animals were randomly divided in a training (n = 141) and a validation population (n = 36). The relation between body weight and lung weight index (lung weight/body weight, g/kg) was described by an exponential function on the training population. The equation was tested on the validation population. A Bland-Altman analysis was performed to compare the lung weight index in the validation population and its theoretical value calculated with the reference equation. RESULTS A good fit was found between the validation population and the exponential equation extracted from the training population (RMSE = 0.060). The equation to determine lung weight index from body weight was: [Formula: see text] At the Bland and Altman analyses, the mean bias between the real and the expected lung weight index was - 0.26 g/kg (95% CI - 0.96-0.43), upper LOA 3.80 g/kg [95% CI 2.59-5.01], lower LOA - 4.33 g/kg [95% CI = - 5.54-(- 3.12)]. CONCLUSIONS This exponential function might be a valuable tool to assess lung edema in experiments involving 16-50 kg female domestic piglets. The error that can be made due to the 95% confidence intervals of the formula is smaller than the one made considering the lung to body weight as a linear relationship.
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Affiliation(s)
- Antonio Fioccola
- Department of Health Sciences, University of Florence, Florence, Italy
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Rosmery Valentina Nicolardi
- IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Tommaso Pozzi
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Isabella Fratti
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Federica Romitti
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Verena Reupke
- Department of Experimental Animal Medicine, University of Göttingen, Göttingen, Germany
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Uniting Care Hospitals, Intensive Care Units St Andrew's War Memorial Hospital and The Wesley Hospital, Brisbane, QLD, Australia
- Wesley Medical Research, Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane, QLD, Australia
| | - Alessandro Protti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alessandro Santini
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Massimo Cressoni
- Unit of Radiology, IRCCS, Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Mattia Busana
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Onnen Moerer
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Luigi Camporota
- Department of Adult Critical Care Guy's & St Thomas' NHS Foundation Trust, London, UK
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, King's College London, London, UK
| | - Luciano Gattinoni
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany.
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Steinmetz C, Krause L, Sulejmanovic S, Kaumkötter S, Mengden T, Grefe C, Knoglinger E, Reiss N, Brixius K, Bjarnason-Wehrens B, Schmidt T, von Haehling S, Sadlonova M, von Arnim CAF, Heinemann S. The prevalence and impact of sarcopenia in older cardiac patients undergoing inpatient cardiac rehabilitation - results from a prospective, observational cohort pre-study. BMC Geriatr 2024; 24:94. [PMID: 38267843 PMCID: PMC10809534 DOI: 10.1186/s12877-024-04694-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND The prevalence of sarcopenia and its impact in older patients undergoing inpatient cardiac rehabilitation (iCR) after cardiac procedure has been insufficiently studied. The main aim of this study was to evaluate the prevalence of sarcopenia and quantify the functional capacity of older sarcopenic and non-sarcopenic patients participating in iCR. METHODS Prospective, observational cohort study within the framework of the ongoing multicenter prehabilitation study "PRECOVERY". A sample of 122 patients ≥75 years undergoing iCR after cardiac procedure were recruited in four German iCR facilities and followed up 3 months later by telephone. At iCR (baseline), the Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls (SARC-F) questionnaire was used to identify sarcopenic patients. In addition, Katz-Index, Clinical Frailty Scale (CFS), handgrip strength (HGS), Short Physical Performance Battery (SPPB) and 6-minute walk distance (6MWD) measured functional capacity and frailty at baseline. Outcomes were prevalence of sarcopenia and the correlation of sarcopenia to functional capacity and frailty at baseline as well as the SARC-F score at follow-up. The Wilcoxon test was applied for pre-post-test analysis. Correlation between sarcopenia and 6MWD, SPPB score and HGS was tested with the eta coefficient with one-way ANOVA. RESULTS Complete assessments were collected from 101 patients (79.9 ± 4.0 years; 63% male). At baseline, the mean SARC-F score was 2.7 ± 2.1; 35% with sarcopenia. Other baseline results were Katz-Index 5.7 ± 0.9, CFS 3.2 ± 1.4, HGS 24.9 ± 9.9 kg, SPPB score 7.5 ± 3.3 and 6MWD 288.8 ± 136.5 m. Compared to baseline, fewer patients were sarcopenic (23% versus 35%) at follow-up. In the subgroup of sarcopenic patients at baseline (n = 35), pre-post comparison resulted in a significant SARC-F improvement (p = 0.017). There was a significant correlation between sarcopenia measured by SARC-F and poor results in the assessments of functional capacity (p < 0.001; r > 0.546). CONCLUSIONS The prevalence of sarcopenia in older patients at iCR after cardiac procedure is high (35%) and remains high at follow-up (23%). Sarcopenia screening is important since the diagnosis of sarcopenia in these patients correlates significantly with poor functional capacity. The results indicate that these patients may benefit from prehabilitation aimed at improving perioperative outcomes, increasing functional capacity and mitigating adverse effects. TRIAL REGISTRATION German Clinical Trials Register (DRKS; http://www.drks.de ; DRKS00032256). Retrospectively registered on 13 July 2023.
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Affiliation(s)
- Carolin Steinmetz
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
| | - Laura Krause
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Samra Sulejmanovic
- Institute for Sports Science University of Hildesheim, Universitätsplatz 1, 31141, Hildesheim, Germany
| | - Sabrina Kaumkötter
- Schüchtermann-Schiller'sche Clinic, Ulmenallee 11, 49214, Bad Rothenfelde, Germany
| | - Thomas Mengden
- Department of Rehabilitation, Kerckhoff Heart Center, Ludwigstr. 41, 61231, Bad Nauheim, Germany
| | - Clemens Grefe
- Clinic and Rehabilitation Center Lippoldsberg, Birkenallee 1, 34399, Wesertal, Germany
| | - Ernst Knoglinger
- Kirchberg Clinic, Bad Lauterberg, Kirchberg 7-11, 37431, Bad Lauterberg, Germany
| | - Nils Reiss
- Schüchtermann-Schiller'sche Clinic, Ulmenallee 11, 49214, Bad Rothenfelde, Germany
| | - Klara Brixius
- Institute of Cardiology and Sports Medicine, Department of Molecular and Cellular Sports Medicine, German Sport University, Am Müngersdorfer Sportpark 6, 50933, Cologne, Germany
| | - Birna Bjarnason-Wehrens
- Institute of Cardiology and Sports Medicine, Department Preventive and Rehabilitative Sport and Exercise Medicine, German Sport University, Am Müngersdorfer Sportpark 6, 50933, Cologne, Germany
| | - Thomas Schmidt
- Schüchtermann-Schiller'sche Clinic, Ulmenallee 11, 49214, Bad Rothenfelde, Germany
- Institute of Cardiology and Sports Medicine, Department Preventive and Rehabilitative Sport and Exercise Medicine, German Sport University, Am Müngersdorfer Sportpark 6, 50933, Cologne, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Robert-Koch-Str. 42a, 37075, Goettingen, Germany
| | - Monika Sadlonova
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Goettingen Medical Center, Robert-Koch-Str. 40, 37075, Goettingen, Germany
- Department of Cardiovascular and Thoracic Surgery, University of Goettingen Medical Center, Robert-Koch-Str. 40, 37075, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Robert-Koch-Str. 42a, 37075, Goettingen, Germany
| | - Christine A F von Arnim
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Robert-Koch-Str. 42a, 37075, Goettingen, Germany
| | - Stephanie Heinemann
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
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Lange T, Backhaus SJ, Schulz A, Evertz R, Schneider P, Kowallick JT, Hasenfuß G, Kelle S, Schuster A. Inter-study reproducibility of cardiovascular magnetic resonance-derived hemodynamic force assessments. Sci Rep 2024; 14:634. [PMID: 38182625 PMCID: PMC10770352 DOI: 10.1038/s41598-023-50405-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR)-derived hemodynamic force (HDF) analyses have been introduced recently enabling more in-depth cardiac function evaluation. Inter-study reproducibility is important for a widespread clinical use but has not been quantified for this novel CMR post-processing tool yet. Serial CMR imaging was performed in 11 healthy participants in a median interval of 63 days (range 49-87). HDF assessment included left ventricular (LV) longitudinal, systolic peak and impulse, systolic/diastolic transition, diastolic deceleration as well as atrial thrust acceleration forces. Inter-study reproducibility and study sample sizes required to demonstrate 10%, 15% or 20% relative changes of HDF measurements were calculated. In addition, intra- and inter-observer analyses were performed. Intra- and inter-observer reproducibility was excellent for all HDF parameters according to intraclass correlation coefficient (ICC) values (> 0.80 for all). Inter-study reproducibility of all HDF parameters was excellent (ICC ≥ 0.80 for all) with systolic parameters showing lower coeffients of variation (CoV) than diastolic measurements (CoV 15.2% for systolic impulse vs. CoV 30.9% for atrial thrust). Calculated sample sizes to detect relative changes ranged from n = 12 for the detection of a 20% relative change in systolic impulse to n = 200 for the detection of 10% relative change in atrial thrust. Overall inter-study reproducibility of CMR-derived HDF assessments was sufficient with systolic HDF measurements showing lower inter-study variation than diastolic HDF analyses.
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Affiliation(s)
- Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Patrick Schneider
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, Georg-August University, University Medical Center Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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25
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Müller F, Ngo J, Arnetz JE, Holman HT. Development and validation of the provider assessed quality of consultations with language interpretation scale (PQC-LI). BMC Res Notes 2024; 17:15. [PMID: 38178154 PMCID: PMC10768141 DOI: 10.1186/s13104-023-06675-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/16/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVE With the growing immigrant communities in the western world, there is an urgent need to address language barriers to care, and health disparities as a whole. Studies on limited English proficiency patients (LEP) have focused on patient perspectives of office visits, however little is known about health care provider perspectives of medical visits using interpretive services. We aimed to develop a pragmatic brief questionnaire for assessing providers' views of the quality of communication in outpatient visits with patients with LEP. The questionnaire was validated in a cross-sectional study (n = 99) using principal component analyses (PCA) with oblimin rotation. Internal consistency was analyzed using Cronbach's alpha. RESULTS Based on theory and literature, a seven-item scale was developed that captures two relevant concepts: (1) Provider - patient interaction during the consultation and (2) perceived quality of translation. The questionnaire was used to assess 99 LEP consultations and demonstrated good feasibility in a clinical setting. PCA revealed the two theory-based components with good factor loadings and internal consistency of α = 0.77. These preliminary results indicate that the questionnaire provides medical professionals with a validated tool to evaluate LEP patient encounters. Further confirmatory validation of the Provider-assessed Quality of Consultations with Language Interpretation (PQC-LI) in larger samples is warranted.
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Affiliation(s)
- Frank Müller
- Department of Family Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, MI, 49503, USA.
- Spectrum Health Family Medicine Residency Center, 25 Michigan St NE Suite 5100, Grand Rapids, MI, 49503, USA.
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
| | - Julie Ngo
- Department of Family Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Judith E Arnetz
- Department of Family Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Harland T Holman
- Department of Family Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, MI, 49503, USA
- Spectrum Health Family Medicine Residency Center, 25 Michigan St NE Suite 5100, Grand Rapids, MI, 49503, USA
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Müller SJ, Khadhraoui E, Ernst M, Rohde V, Schatlo B, Malinova V. Differentiation of multiple brain metastases and glioblastoma with multiple foci using MRI criteria. BMC Med Imaging 2024; 24:3. [PMID: 38166651 PMCID: PMC10759655 DOI: 10.1186/s12880-023-01183-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Glioblastoma with multiple foci (mGBM) and multiple brain metastases share several common features on magnetic resonance imaging (MRI). A reliable preoperative diagnosis would be of clinical relevance. The aim of this study was to explore the differences and similarities between mGBM and multiple brain metastases on MRI. METHODS We performed a retrospective analysis of 50 patients with mGBM and compared them with a cohort of 50 patients with multiple brain metastases (2-10 lesions) histologically confirmed and treated at our department between 2015 and 2020. The following imaging characteristics were analyzed: lesion location, distribution, morphology, (T2-/FLAIR-weighted) connections between the lesions, patterns of contrast agent uptake, apparent diffusion coefficient (ADC)-values within the lesion, the surrounding T2-hyperintensity, and edema distribution. RESULTS A total of 210 brain metastases and 181 mGBM lesions were analyzed. An infratentorial localization was found significantly more often in patients with multiple brain metastases compared to mGBM patients (28 vs. 1.5%, p < 0.001). A T2-connection between the lesions was detected in 63% of mGBM lesions compared to 1% of brain metastases. Cortical edema was only present in mGBM. Perifocal edema with larger areas of diffusion restriction was detected in 31% of mGBM patients, but not in patients with metastases. CONCLUSION We identified a set of imaging features which improve preoperative diagnosis. The presence of T2-weighted imaging hyperintensity connection between the lesions and cortical edema with varying ADC-values was typical for mGBM.
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Affiliation(s)
- Sebastian Johannes Müller
- Department of Neuroradiology, University Medical Center, Göttingen, Germany
- Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Germany
| | - Eya Khadhraoui
- Department of Neuroradiology, University Medical Center, Göttingen, Germany
- Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Germany
| | - Marielle Ernst
- Department of Neuroradiology, University Medical Center, Göttingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center, Göttingen, Germany
| | - Bawarjan Schatlo
- Department of Neurosurgery, University Medical Center, Göttingen, Germany
| | - Vesna Malinova
- Department of Neurosurgery, University Medical Center, Göttingen, Germany.
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Zeidler R, Dudeck M, Frank U, Gerlinger G, Hesse D, Muysers J, Pollmächer T, Riedemann C, Sander J, Völlm B, Müller JL. [The situation in the German forensic commitment-Results of a survey by the DGPPN]. Nervenarzt 2024; 95:1-8. [PMID: 37943326 PMCID: PMC10810040 DOI: 10.1007/s00115-023-01564-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND AND OBJECTIVE In German forensic psychiatry detention under Sections 63 and 64 of the German Penal Code have been repeatedly reformed over the past years; however, despite the most recent amendments to the law on detention, clinics and state authorities warn of insufficient capacities and worrying conditions. Media reports paint a defiant picture. At the same time, there is a lack of valid data that would allow an objective description of the situation in forensic psychiatry. Against this background the management of institutions in Germany has been surveyed. MATERIAL AND METHODS The survey was conducted as an online survey and sent to all 78 forensic hospitals in Germany. The survey covered topics such as structural data of the facilities, the occupancy and staffing situation, incidents, support from supervisory authorities and funding agencies, and patient characteristics. The results are presented descriptively. RESULTS Of the 78 facilities contacted, 45 (approximately 60%) participated at least partially in the survey. Many of the clinics (68.5%) complained of significant overcrowding. A clear lack of staff and rooms was reported, at the same time it was stated that patients do not receive adequate treatment. Approximately 1 in 5 patients have a length of stay for more than 10 years and one third of the clinics reported an increasing number of physical assaults by patients. CONCLUSION This overview shows that the forensic psychiatric hospitals are in very different but generally strained situations. A significant number of clinics are under great pressure. Financial, structural, spatial and personnel resources were described as insufficient to properly and professionally fulfill the legal mandate. The treatment standards presented by the DGPPN in 2017 are not met in many clinics.
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Affiliation(s)
- Robert Zeidler
- Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e. V., Berlin, Deutschland
| | - Manuela Dudeck
- Klinik für Forensische Psychiatrie und Psychotherapie der Universität Ulm am BKH Günzburg, Ulm, Deutschland
| | - Udo Frank
- ZfP Südwürttemberg, Ravensburg-Weissenau, Deutschland
| | - Gabriel Gerlinger
- Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e. V., Berlin, Deutschland
| | - Dirk Hesse
- Maßregelvollzugszentrum Niedersachsen, Moringen, Deutschland
| | | | - Thomas Pollmächer
- Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e. V., Berlin, Deutschland
- Zentrum für psychische Gesundheit, Klinikum Ingolstadt, Ingolstadt, Deutschland
| | | | - Julia Sander
- Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e. V., Berlin, Deutschland
| | - Birgit Völlm
- Klinik für Forensische Psychiatrie, Zentrum für Nervenheilkunde, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Jürgen L Müller
- Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e. V., Berlin, Deutschland.
- Klinik für Forensische Psychiatrie und Psychotherapie, Asklepios Fachklinikum Göttingen, Universitätsmedizin Göttingen, Rosdorfer Weg 70, 37081, Göttingen, Deutschland.
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Biggemann L, Uhlig J, Streit U, Al-Bourini O, Wedi E, Amanzada A, Ellenrieder V, Rühlmann F, Ghadimi M, Frahm J, Uecker M, Seif Amir Hosseini A. Visualization of deglutition and gastroesophageal reflux using real-time MRI: a standardized approach to image acquisition and assessment. Sci Rep 2023; 13:22854. [PMID: 38129469 PMCID: PMC10739804 DOI: 10.1038/s41598-023-49776-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
This study aims to develop a standardized algorithm for gastroesophageal image acquisition and diagnostic assessment using real-time MRI. Patients with GERD symptoms undergoing real-time MRI of the esophagus and esophagogastric junction between 2015 and 2018 were included. A 10 ml bolus of pineapple juice served as an oral contrast agent. Patients performed Valsalva maneuver to provoke reflux and hiatal hernia. Systematic MRI assessment included visual presence of achalasia, fundoplication failure in patients with previous surgical fundoplication, gastroesophageal reflux, and hiatal hernia. A total of 184 patients (n = 92 female [50%], mean age 52.7 ± 15.8 years) completed MRI studies without adverse events at a mean examination time of 15 min. Gastroesophageal reflux was evident in n = 117 (63.6%), hiatal hernia in n = 95 (52.5%), and achalasia in 4 patients (2.2%). Hiatal hernia was observed more frequently in patients with reflux at rest (n = 67 vs. n = 6, p < 0.01) and during Valsalva maneuver (n = 87 vs. n = 8, p < 0.01). Real-time MRI visualized a morphologic correlate for recurring GERD symptoms in 20/22 patients (90%) after fundoplication procedure. In a large-scale single-center cohort of patients with GERD symptoms undergoing real-time MRI, visual correlates for clinical symptoms were evident in most cases. The proposed assessment algorithm could aid in wider-spread utilization of real-time MRI and provides a comprehensive approach to this novel imaging modality.
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Affiliation(s)
- Lorenz Biggemann
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany.
| | - Johannes Uhlig
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Ulrike Streit
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
- Department of Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, München, Germany
| | - Omar Al-Bourini
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Edris Wedi
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Göttingen, Göttingen, Germany
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
| | - Ahmad Amanzada
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Volker Ellenrieder
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Felix Rühlmann
- Department of General, Visceral, and Paediatric Surgery, University Medical Center, Göttingen, Germany
| | - Michael Ghadimi
- Department of General, Visceral, and Paediatric Surgery, University Medical Center, Göttingen, Germany
| | - Jens Frahm
- Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Martin Uecker
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
- Institute of Biomedical Imaging, Graz University of Technology, Graz, Austria
- Cluster of Excellence "Multiscale Bioimaging: From Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Göttingen, Germany
| | - Ali Seif Amir Hosseini
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
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Guhlich M, Maag TE, Dröge LH, Hille A, Donath S, Bendrich S, Schirmer MA, Nauck F, Leu M, Riggert J, Gallwas J, Rieken S. Hemostatic radiotherapy in clinically significant tumor-related bleeding: excellent palliative results in a retrospective analysis of 77 patients. Radiat Oncol 2023; 18:203. [PMID: 38124078 PMCID: PMC10734078 DOI: 10.1186/s13014-023-02391-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Significant bleeding of tumor sites is a dreaded complication in oncological diseases and often results in clinical emergencies. Besides basic local and interventional procedures, an urgent radiotherapeutic approach can either achieve a bleeding reduction or a bleeding stop in a vast majority of patients. In spite of being used regularly in clinical practice, data reporting results to this therapy approach is still scarce. METHODS We retrospectively analyzed 77 patients treated for significant tumor-related bleeding at our clinic between 2000 and 2021, evaluating treatment response rate, hemoglobin levels, hemoglobin transfusion necessity, administered radiotherapy dose and overall survival. RESULTS Response rate in terms of bleeding stop was 88.3% (68/77) in all patients and 95.2% (60/63) in the subgroup, wherein radiotherapy (RT) was completed as intended. Hemoglobin transfusions decreased during treatment in a further subgroup analysis. Median overall survival (OS) was 3.3 months. Patients with primary tumors (PT) of the cervix (carcinoma of the cervix, CC) or endometrium (endometrioid carcinoma, EDC) and patients receiving the full intended RT dose showed statistically significant better OS in a multivariable cox regression model. Median administered dose was 39 Gy, treatment related acute toxicity was considerably low. CONCLUSIONS Our data show an excellent response rate with a low toxicity profile when administering urgent radiotherapy for tumor related clinically significant bleeding complications. Nonetheless, treatment decisions should be highly individual due to the low median overall survival of this patient group.
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Affiliation(s)
- Manuel Guhlich
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany.
| | - Teresa Esther Maag
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Leif Hendrik Dröge
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Andrea Hille
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Sandra Donath
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Stephanie Bendrich
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Markus Anton Schirmer
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Friedemann Nauck
- Department of Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Leu
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Joachim Riggert
- Department of Transfusion Medicine, University Medical Center Gottingen, Göttingen, Germany
| | - Julia Gallwas
- Clinic of Gynecology and Obstetrics, University Medical Center Göttingen, Göttingen, Germany
| | - Stefan Rieken
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
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Vonderschmitt J, Wöhlke S, Schicktanz S. Scarce resources, public health and professional care: the COVID-19 pandemic exacerbating bioethical conflicts - findings from global qualitative expert interviews. BMC Public Health 2023; 23:2492. [PMID: 38093218 PMCID: PMC10717036 DOI: 10.1186/s12889-023-17249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Since spring 2020, the SARS-CoV-2 virus has spread worldwide, causing dramatic global consequences in terms of medical, care, economic, cultural and bioethical dimensions. Although the resulting conflicts initially appeared to be quite similar in most countries, a closer look reveals a country-specific intensification and differentiation of issues. Our study focused on understanding and highlighting bioethical conflicts that were triggered, exposed or intensified by the COVID-19 pandemic in low and middle-income countries (LMICs) and high-income countries (HICs). METHODS We conducted qualitative interviews with 39 ethics experts from 34 countries (Argentina, Australia, Austria, Brazil, Canada, Colombia, Denmark, Ecuador, Ethiopia, France, Germany, India, Italy, Israel, Japan, Kyrgyzstan, Mexico, Nigeria, Oman, Pakistan, Paraguay, Poland, Romania, Russia, Singapore, South Korea, Spain, Sweden, South Africa, Tunisia, Türkiye, United-Kingdom, United States of America, Zambia) from November 2020 to March 2021. We analysed the interviews using qualitative content analysis. RESULTS The scale of the bioethical challenges between countries differed, as did coping strategies for meeting these challenges. Data analysis focused on: a) Resource scarcity in clinical contexts: Scarcity of medical resources led to the need to prioritize the care of some COVID-19 patients in clinical settings globally. Because this entails the postponement of treatment for other patients, the possibility of serious present or future harm to deprioritized patients was identified as a relevant issue. b) Health literacy: The pandemic demonstrated the significance of health literacy and its influence on the effective implementation of health measures. c) Inequality and vulnerable groups: The pandemic highlighted the context-sensitivity and intersectionality of the vulnerabilities of women and children in LMICs and the aged in HICs. d) Conflicts surrounding healthcare professionals: The COVID-19 outbreak underscored the tough working conditions for nurses and other health professionals, raising awareness of the need for reform. CONCLUSION The pandemic exposed pre-existing structural problems in LMICs and HICs. Without neglecting individual contextual factors in the observed countries, we created a mosaic of different voices of experts in bioethics across the globe, drawing attention to the need for international solidarity in the context of a global crisis.
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Affiliation(s)
- Jane Vonderschmitt
- Department of Medical Ethics and History of Medicine, University Medical Center Goettingen, Humboldtallee 36 / 37073, Goettingen, Germany.
| | - Sabine Wöhlke
- Department of Health Sciences, Hamburg University of Applied Sciences, Ulmenliet 20 / 21033, Hamburg, Germany
| | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Goettingen, Humboldtallee 36 / 37073, Goettingen, Germany
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Younas N, Saleem T, Younas A, Zerr I. Nuclear face of Tau: an inside player in neurodegeneration. Acta Neuropathol Commun 2023; 11:196. [PMID: 38087392 PMCID: PMC10714511 DOI: 10.1186/s40478-023-01702-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
Tau (Tubulin associated unit) protein is a major hallmark of Alzheimer's disease (AD) and tauopathies. Tau is predominantly an axonal protein with a crucial role in the stabilization and dynamics of the microtubules. Since the discovery of Tau protein in 1975, research efforts were concentrated on the pathophysiological role of Tau protein in the context of the microtubules. Although, for more than three decades, different localizations of Tau protein have been discovered e.g., in the nuclear compartments. Discovery of the role of Tau protein in various cellular compartments especially in the nucleus opens up a new fold of complexity in tauopathies. Data from cellular models, animal models, and the human brain indicate that nuclear Tau is crucial for genome stability and to cope with cellular distress. Moreover, it's nature of nuclear translocation, its interactions with the nuclear DNA/RNA and proteins suggest it could play multiple roles in the nucleus. To comprehend Tau pathophysiology and efficient Tau-based therapies, there is an urgent need to understand whole repertoire of Tau species (nuclear and cytoplasmic) and their functional relevance. To complete the map of Tau repertoire, understanding of various species of Tau in the nucleus and cytoplasm, identification if specific transcripts of Tau, isoforms and post-translational modifications could foretell Tau's localizations and functions, and how they are modified in neurodegenerative diseases like AD, is urgently required. In this review, we explore the nuclear face of Tau protein, its nuclear localizations and functions and its linkage with Alzheimer's disease.
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Affiliation(s)
- Neelam Younas
- University Medical Center Göttingen, National Reference Center for Surveillance of TSE, Department of Neurology, Robert-Koch strasse 40, 37075, Göttingen, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, 37075, Germany.
| | - Tayyaba Saleem
- University Medical Center Göttingen, National Reference Center for Surveillance of TSE, Department of Neurology, Robert-Koch strasse 40, 37075, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, 37075, Germany
| | - Abrar Younas
- University Medical Center Göttingen, National Reference Center for Surveillance of TSE, Department of Neurology, Robert-Koch strasse 40, 37075, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, 37075, Germany
| | - Inga Zerr
- University Medical Center Göttingen, National Reference Center for Surveillance of TSE, Department of Neurology, Robert-Koch strasse 40, 37075, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, 37075, Germany
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Svetlove A, Ritter CO, Dullin C, Schmid M, Schauer S, Uihlein J, Uecker M, Mietsch M, Stadelmann C, Lotz J, Unterberg-Buchwald C. Evaluation of MR-safe bioptomes for MR-guided endomyocardial biopsy in minipigs: a potential radiation-free clinical approach. Eur Radiol Exp 2023; 7:76. [PMID: 38049615 PMCID: PMC10695907 DOI: 10.1186/s41747-023-00391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/21/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Diagnostic accuracy of endomyocardial biopsy could improve if clinically safe magnetic resonance (MR)-compatible bioptomes were available. We explored two novel MR-compatible cardiac bioptomes for performance, safety, and clinical viability, employing in vivo minipig trials and phase-contrast synchrotron radiation computed microtomography (SRµCT). METHODS Analysis of ex vivo obtained pig endomyocardial biopsies was performed using phase-contrast SRµCT and conventional two-dimensional histology. The technical performance was evaluated by measuring volume, inner and outer integrities, compression, and histological diagnostic value in 3 sets (6 per set) of biopsies for each experimental bioptome. The bioptomes were tested in vivo in 3 healthy minipigs per bioptome. The clinical feasibility was evaluated by procedural and cutting success as well as histological diagnostic value. RESULTS The bioptome with the 'grind-grind' design achieved similar values to control in compression (p = 0.822), inner (p = 0.628), and outer (p = 0.507), integrities ex vivo. It showed a better performance in the in vivo real-time MRI setting demonstrating a higher cutting success (91.7%) than the 'grind-anvil' (86.2%) design. In both ex vivo and in vivo evaluations, the 'grind-grind' design displayed sufficient diagnostic value (83% and 95%). The 'grind-anvil' design showed adequate diagnostic value both ex vivo and in vivo (78% and 87.5%) but was not comparable to control according to the three-dimensional (3D) analysis. CONCLUSION A novel MR-compatible bioptome was identified as plausible in a clinical setting. Additionally, SRµCT and subsequent 3D structural analysis could be valuable in the label-free investigation of myocardial tissue at a micrometer level. RELEVANCE STATEMENT Implementation of MR-guided biopsy can improve animal studies on structural myocardial changes at any point in an experimental setup. With further improvements in guiding catheters, MR-guided biopsy, using the new bioptome, has a potential to increase quality and diagnostic accuracy in patients both with structural and inflammatory cardiomyopathies. KEY POINTS • Novel MR-compatible bioptomes show promise for a clinical application. • SRµCT enabled detailed analysis of endomyocardial biopsies. • The bioptomes showed adequate in vivo performance without major complications.
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Affiliation(s)
- Angelika Svetlove
- Translational Molecular Imaging, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Cluster of Excellence "Multiscale Bioimaging: From Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre, Göttingen, Germany
| | - Christian O Ritter
- Institute for Diagnostic and Interventional Radiology, University Medical Centre, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, Klinikum St. Marien Amberg, Amberg, Germany
| | - Christian Dullin
- Translational Molecular Imaging, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre, Göttingen, Germany
- Department for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- TLRC (Translational Lung Research Center), University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Schmid
- EPflex Feinwerktechnik GmbH, Dettingen an der Erms, Germany
| | - Senta Schauer
- EPflex Feinwerktechnik GmbH, Dettingen an der Erms, Germany
| | | | - Martin Uecker
- Institute for Diagnostic and Interventional Radiology, University Medical Centre, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Institute of Biomedical Imaging, Graz University of Technology, Graz, Austria
| | - Matthias Mietsch
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Laboratory Animal Science Unit, Leibniz-Institut Für Primatenforschung, Deutsches Primatenzentrum GmbH, Göttingen, Germany
| | | | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, University Medical Centre, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Christina Unterberg-Buchwald
- Institute for Diagnostic and Interventional Radiology, University Medical Centre, Göttingen, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany.
- Department of Cardiology and Pneumology, University Medical Centre, Göttingen, Germany.
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Bettag C, Schatlo B, Abboud T, Behme D, Bock C, von der Brelie C, Rohde V, Mielke D. Endoscope-enhanced fluorescence-guided microsurgery increases survival in patients with glioblastoma. Acta Neurochir (Wien) 2023; 165:4221-4226. [PMID: 37950066 PMCID: PMC10739506 DOI: 10.1007/s00701-023-05862-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Extent of resection (EOR) predicts progression-free survival (PFS) and may impact overall survival (OS) in patients with glioblastoma. We recently demonstrated that 5-aminolevulinic acid-(5-ALA)-fluorescence-enhanced endoscopic surgery increase the rate of gross total resection. However, it is hitherto unknown whether fluorescence-enhanced endoscopic resection affects survival. METHODS We conducted a retrospective single-center analysis of a consecutive series of patients who underwent surgery for non-eloquently located glioblastoma between 2011 and 2018. All patients underwent fluorescence-guided microscopic or fluorescence-guided combined microscopic and endoscopic resection. PFS, OS, EOR as well as clinical and demographic parameters, adjuvant treatment modalities, and molecular characteristics were compared between microscopy-only vs. endoscopy-assisted microsurgical resection. RESULTS Out of 114 patients, 73 (65%) were male, and 57 (50%) were older than 65 years. Twenty patients (18%) were operated on using additional endoscopic assistance. Both cohorts were equally distributed in terms of age, performance status, lesion location, adjuvant treatment modalities, and molecular status. Gross total resection was achieved in all endoscopy-assisted patients compared to about three-quarters of microscope-only patients (100% vs. 75.9%, p=0.003). The PFS in the endoscope-assisted cohort was 19.3 months (CI95% 10.8-27.7) vs. 10.8 months (CI95% 8.2-13.4; p=0.012) in the microscope-only cohort. OS in the endoscope-assisted group was 28.9 months (CI95% 20.4-34.1) compared to 16.8 months (CI95% 14.0-20.9), in the microscope-only group (p=0.001). CONCLUSION Endoscope-assisted fluorescence-guided resection of glioblastoma appears to substantially enhance gross total resection and OS. The strong effect size observed herein is contrasted by the limitations in study design. Therefore, prospective validation is required before we can generalize our findings.
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Affiliation(s)
- Christoph Bettag
- Department of Neurosurgery, University Hospital Goettingen, Goettingen, Germany.
| | - Bawarjan Schatlo
- Department of Neurosurgery, University Hospital Goettingen, Goettingen, Germany
| | - Tammam Abboud
- Department of Neurosurgery, University Hospital Goettingen, Goettingen, Germany
| | - Daniel Behme
- Department of Neuroradiology, University Hospital Goettingen, Goettingen, Germany
- Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Christoph Bock
- Department of Neurosurgery, University Hospital Goettingen, Goettingen, Germany
| | - Christian von der Brelie
- Department of Neurosurgery, University Hospital Goettingen, Goettingen, Germany
- Department of Neurosurgery, Johanniter Hospital Bonn, Bonn, Germany
| | - Veit Rohde
- Department of Neurosurgery, University Hospital Goettingen, Goettingen, Germany
| | - Dorothee Mielke
- Department of Neurosurgery, University Hospital Goettingen, Goettingen, Germany
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Younas N, Zafar S, Saleem T, Fernandez Flores LC, Younas A, Schmitz M, Zerr I. Differential interactome mapping of aggregation prone/prion-like proteins under stress: novel links to stress granule biology. Cell Biosci 2023; 13:221. [PMID: 38041189 PMCID: PMC10693047 DOI: 10.1186/s13578-023-01164-7] [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: 05/30/2023] [Accepted: 11/02/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Aberrant stress granules (SGs) are emerging as prime suspects in the nucleation of toxic protein aggregates. Understanding the molecular networks linked with aggregation-prone proteins (prion protein, synuclein, and tau) under stressful environments is crucial to understand pathophysiological cascades associated with these proteins. METHODS We characterized and validated oxidative stress-induced molecular network changes of endogenous aggregation-prone proteins (prion protein, synuclein, and tau) by employing immunoprecipitation coupled with mass spectrometry analysis under basal and oxidative stress conditions. We used two different cell models (SH-SY5Y: human neuroblastoma and HeLa cell line) to induce oxidative stress using a well-known inducer (sodium arsenite) of oxidative stress. RESULTS Overall, we identified 597 proteins as potential interaction partners. Our comparative interactome mapping provides comprehensive network reorganizations of three aggregation-prone hallmark proteins, establish novel interacting partners and their dysregulation, and validates that prion protein and synuclein localize in cytoplasmic SGs. Localization of prion protein and synuclein in TIA1-positive SGs provides an important link between SG pathobiology and aggregation-prone proteins. In addition, dysregulation (downregulation) of prion protein and exportin-5 protein, and translocation of exportin-5 into the nucleus under oxidative stress shed light on nucleocytoplasmic transport defects during the stress response. CONCLUSIONS The current study contributes to our understanding of stress-mediated network rearrangements and posttranslational modifications of prion/prion-like proteins. Localization of prion protein and synuclein in the cytoplasmic SGs provides an important link between stress granule pathobiology and aggregation-prone proteins. In addition, our findings demonstrate nucleocytoplasmic transport defects after oxidative stress via dysregulation and nuclear accumulation of exportin-5.
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Affiliation(s)
- Neelam Younas
- Department of Neurology, University Medical Center, Georg-August-Universität, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Saima Zafar
- Department of Neurology, University Medical Center, Georg-August-Universität, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Robert-Koch-Straße 40, 37075, Göttingen, Germany
- Biomedical Engineering and Sciences Department, School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Tayyaba Saleem
- Department of Neurology, University Medical Center, Georg-August-Universität, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Leticia Camila Fernandez Flores
- Department of Neurology, University Medical Center, Georg-August-Universität, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Abrar Younas
- Department of Neurology, University Medical Center, Georg-August-Universität, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Matthias Schmitz
- Department of Neurology, University Medical Center, Georg-August-Universität, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Inga Zerr
- Department of Neurology, University Medical Center, Georg-August-Universität, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Robert-Koch-Straße 40, 37075, Göttingen, Germany
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Abstract
Surgical resection, when combined with chemotherapy, has been shown to significantly improve the survival rate of patients with pancreatic ductal adenocarcinoma (PDAC). However, this treatment option is only feasible for a fraction of patients, as more than 50% of cases are diagnosed with metastasis. The multifaceted process of metastasis is still not fully understood, but recent data suggest that transcriptional and epigenetic plasticity play significant roles. Interfering with epigenetic reprogramming can potentially control the adaptive processes responsible for metastatic progression and therapy resistance, thereby enhancing treatment responses and preventing recurrence. This review will focus on the relevance of histone-modifying enzymes in pancreatic cancer, specifically on their impact on the metastatic cascade. Additionally, it will also provide a brief update on the current clinical developments in epigenetic therapies.
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Affiliation(s)
- Lukas Krauß
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, 37075, Göttingen, Germany.
| | - Carolin Schneider
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Elisabeth Hessmann
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, 37075, Göttingen, Germany
- Clinical Research Unit 5002, KFO5002, University Medical Center Göttingen, 37075, Göttingen, Germany
- CCC-N (Comprehensive Cancer Center Lower Saxony), 37075, Göttingen, Germany
| | - Dieter Saur
- Institute for Translational Cancer Research and Experimental Cancer Therapy, Technical University Munich, 81675, Munich, Germany
- German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120, Heidelberg, Germany
| | - Günter Schneider
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, 37075, Göttingen, Germany.
- CCC-N (Comprehensive Cancer Center Lower Saxony), 37075, Göttingen, Germany.
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Hussaini S, Majumder R, Krinski V, Luther S. In silico optical modulation of spiral wave trajectories in cardiac tissue. Pflugers Arch 2023; 475:1453-1461. [PMID: 38095694 PMCID: PMC10730633 DOI: 10.1007/s00424-023-02889-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023]
Abstract
Life-threatening cardiac arrhythmias such as ventricular tachycardia and fibrillation are common precursors to sudden cardiac death. They are associated with the occurrence of abnormal electrical spiral waves in the heart that rotate at a high frequency. In severe cases, arrhythmias are combated with a clinical method called defibrillation, which involves administering a single global high-voltage shock to the heart to reset all its activity and restore sinus rhythm. Despite its high efficiency in controlling arrhythmias, defibrillation is associated with several negative side effects that render the method suboptimal. The best approach to optimize this therapeutic technique is to deepen our understanding of the dynamics of spiral waves. Here, we use computational cardiac optogenetics to study and control the dynamics of a single spiral wave in a two-dimensional, electrophysiologically detailed, light-sensitive model of a mouse ventricle. First, we illuminate the domain globally by applying a sequence of periodic optical pulses with different frequencies in the sub-threshold regime where no excitation wave is induced. In doing so, we obtain epicycloidal, hypocycloidal, and resonant drift trajectories of the spiral wave core. Then, to effectively control the wave dynamics, we use a method called resonant feedback pacing. In this approach, each global optical pulse is applied when the measuring electrode positioned on the domain registers a predefined value of the membrane voltage. This enables us to steer the spiral wave in a desired direction determined by the position of the electrode. Our study thus provides valuable mechanistic insights into the success or failure of global optical stimulation in executing efficient arrhythmia control.
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Affiliation(s)
- Sayedeh Hussaini
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Niedersachsen, Germany.
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organization, Am Fassberg, 37077, Göttingen, Niedersachsen, Germany.
| | - Rupamanjari Majumder
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Niedersachsen, Germany
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organization, Am Fassberg, 37077, Göttingen, Niedersachsen, Germany
| | - Valentin Krinski
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organization, Am Fassberg, 37077, Göttingen, Niedersachsen, Germany
| | - Stefan Luther
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Niedersachsen, Germany.
- Research Group Biomedical Physics, Max Planck Institute for Dynamics and Self-Organization, Am Fassberg, 37077, Göttingen, Niedersachsen, Germany.
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Schmachtenberg T, Königs G, Dragaqina A, Roder S, Müller F, Müllenmeister C, Schröder D, Dopfer-Jablonka A, Vieth K, El-Sayed I. "There is no one who helps you with it": experiences of people with long COVID regarding medical care, therapeutic measures, and barriers in the German healthcare system: results of a qualitative study with four focus groups. BMC Health Serv Res 2023; 23:1160. [PMID: 37884993 PMCID: PMC10601213 DOI: 10.1186/s12913-023-10170-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Many people experience long-term symptoms such as fatigue, cognitive problems, or shortness of breath after an acute infection with COVID-19. This emerging syndrome, known as long COVID, is new and complex in many aspects. This study aims to collect the experiences of people with long COVID with ambulatory healthcare structures. METHODS Four focus groups were conducted with a total of 23 adults with long COVID in June and July 2022. These discussions were audio-recorded, subsequently transcribed, and analyzed using the qualitative content analysis of Mayring and Kuckartz. RESULTS Fourteen out of 19 participants who had a primary care encounter regarding their long COVID symptoms did not perceive it as helpful. Many respondents reported that their general practitioners did not take their long COVID symptoms seriously and did not refer them to specialists or made therapeutic recommendations. However, some participants reported that they were prescribed non-pharmaceutical therapies (e.g., group meetings supported by psychotherapists, occupational therapy, etc.) that improved their condition. 14 of 23 respondents perceived care barriers such as providers' lack of awareness of long COVID, poor access to specialists, a lack of specialized care (e.g., long COVID clinics), or high bureaucratic hurdles for specific healthcare services. To improve medical care, participants suggested campaigns to raise awareness of long COVID among healthcare providers and the general population, increase research and government investments regarding the development of treatment structures for long COVID, expanding existing therapeutic services, and establishing one-stop shops for integrated specialist healthcare for people with long COVID. CONCLUSIONS Several implications for healthcare professionals and policymakers can be derived from this study: (1) general practitioners should take the symptoms of long COVID seriously, assume a care coordinating role, make referrals, and establish contact with long COVID clinics; (2) care planners should focus on developing interprofessional evidence-based care and treatment approaches for long COVID; (3) existing care structures such as long COVID outpatient clinics should be expanded. The overarching goal must be to develop consistent guidelines for long COVID diagnosis, care, and treatment. TRIAL REGISTRATION The study is registered in the German register for clinical trials (DRKS00026007, first registration on 09/09/2021).
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Affiliation(s)
- Tim Schmachtenberg
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
- Department of Rheumatology and Immunology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Gloria Königs
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Anita Dragaqina
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Sascha Roder
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
- Department of Family Medicine, College of Human Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Christina Müllenmeister
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Dominik Schröder
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Alexandra Dopfer-Jablonka
- Department of Rheumatology and Immunology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- German Center for Infection Research, Partner Site Hannover-Braunschweig, Feodor-Lynen- Str. 26, 30625, Hannover, Germany
| | - Katharina Vieth
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Iman El-Sayed
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
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Kanwischer L, Xu X, Saifuddin AB, Maamari S, Tan X, Alnour F, Tampe B, Meyer T, Zeisberg M, Hasenfuss G, Puls M, Zeisberg EM. Low levels of circulating methylated IRX3 are related to worse outcome after transcatheter aortic valve implantation in patients with severe aortic stenosis. Clin Epigenetics 2023; 15:149. [PMID: 37697352 PMCID: PMC10496273 DOI: 10.1186/s13148-023-01561-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Aortic stenosis (AS) is one of the most common cardiac diseases and major cause of morbidity and mortality in the elderly. Transcatheter aortic valve implantation (TAVI) is performed in such patients with symptomatic severe AS and reduces mortality for the majority of these patients. However, a significant percentage dies within the first two years after TAVI, such that there is an interest to identify parameters, which predict outcome and could guide pre-TAVI patient selection. High levels of cardiac fibrosis have been identified as such independent predictor of cardiovascular mortality after TAVI. Promoter hypermethylation commonly leads to gene downregulation, and the Iroquois homeobox 3 (IRX3) gene was identified in a genome-wide transcriptome and methylome to be hypermethylated and downregulated in AS patients. In a well-described cohort of 100 TAVI patients in which cardiac fibrosis levels were quantified histologically in cardiac biopsies, and which had a follow-up of up to two years, we investigated if circulating methylated DNA of IRX3 in the peripheral blood is associated with cardiac fibrosis and/or mortality in AS patients undergoing TAVI and thus could serve as a biomarker to add information on outcome after TAVI. RESULTS Patients with high levels of methylation in circulating IRX3 show a significantly increased survival as compared to patients with low levels of IRX3 methylation indicating that high peripheral IRX3 methylation is associated with an improved outcome. In the multivariable setting, peripheral IRX3 methylation acts as an independent predictor of all-cause mortality. While there is no significant correlation of levels of IRX3 methylation with cardiac death, there is a significant but very weak inverse correlation between circulating IRX3 promoter methylation level and the amount of cardiac fibrosis. Higher levels of peripheral IRX3 methylation further correlated with decreased cardiac IRX3 expression and vice versa. CONCLUSIONS High levels of IRX3 methylation in the blood of AS patients at the time of TAVI are associated with better overall survival after TAVI and at least partially reflect myocardial IRX3 expression. Circulating methylated IRX3 might aid as a potential biomarker to help guide both pre-TAVI patient selection and post-TAVI monitoring.
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Affiliation(s)
- Leon Kanwischer
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- DZHK German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Xingbo Xu
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- DZHK German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Afifa Binta Saifuddin
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- DZHK German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Sabine Maamari
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- DZHK German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Xiaoying Tan
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
- DZHK German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Fouzi Alnour
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- DZHK German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
- DZHK German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Michael Zeisberg
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
- DZHK German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- DZHK German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Miriam Puls
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- DZHK German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Elisabeth M Zeisberg
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
- DZHK German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany.
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Fleischer JR, Schmitt AM, Haas G, Xu X, Zeisberg EM, Bohnenberger H, Küffer S, Teuwen LA, Karras PJ, Beißbarth T, Bleckmann A, Planque M, Fendt SM, Vermeulen P, Ghadimi M, Kalucka J, De Oliveira T, Conradi LC. Molecular differences of angiogenic versus vessel co-opting colorectal cancer liver metastases at single-cell resolution. Mol Cancer 2023; 22:17. [PMID: 36691028 PMCID: PMC9872436 DOI: 10.1186/s12943-023-01713-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/31/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Colorectal cancer liver metastases (CRCLM) are associated with a poor prognosis, reflected by a five-year survival rate of 14%. Anti-angiogenic therapy through anti-VEGF antibody administration is one of the limited therapies available. However, only a subgroup of metastases uses sprouting angiogenesis to secure their nutrients and oxygen supply, while others rely on vessel co-option (VCO). The distinct mode of vascularization is reflected by specific histopathological growth patterns (HGPs), which have proven prognostic and predictive significance. Nevertheless, their molecular mechanisms are poorly understood. METHODS We evaluated CRCLM from 225 patients regarding their HGP and clinical data. Moreover, we performed spatial (21,804 spots) and single-cell (22,419 cells) RNA sequencing analyses to explore molecular differences in detail, further validated in vitro through immunohistochemical analysis and patient-derived organoid cultures. RESULTS We detected specific metabolic alterations and a signature of WNT signalling activation in metastatic cancer cells related to the VCO phenotype. Importantly, in the corresponding healthy liver of CRCLM displaying sprouting angiogenesis, we identified a predominantly expressed capillary subtype of endothelial cells, which could be further explored as a possible predictor for HGP relying on sprouting angiogenesis. CONCLUSION These findings may prove to be novel therapeutic targets to the treatment of CRCLM, in special the ones relying on VCO.
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Affiliation(s)
- Johannes Robert Fleischer
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Robert-Koch-Straβe 40, 37075, Göttingen, Germany
| | - Alexandra Maria Schmitt
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Robert-Koch-Straβe 40, 37075, Göttingen, Germany
| | - Gwendolyn Haas
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Robert-Koch-Straβe 40, 37075, Göttingen, Germany
| | - Xingbo Xu
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straβe 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site, Göttingen, Germany
| | - Elisabeth Maria Zeisberg
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straβe 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site, Göttingen, Germany
| | - Hanibal Bohnenberger
- Institute of Pathology, University Medical Center Göttingen, Robert-Koch-Straβe40, 37075, Göttingen, Germany
| | - Stefan Küffer
- Institute of Pathology, University Medical Center Göttingen, Robert-Koch-Straβe40, 37075, Göttingen, Germany
| | - Laure-Anne Teuwen
- Department of Oncology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Philipp Johannes Karras
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Robert-Koch-Straβe 40, 37075, Göttingen, Germany
- Department of General- and Visceral Surgery, Raphaelsklinik Münster, Loerstraße 23, 48143, Münster, Germany
| | - Tim Beißbarth
- Department of Medical Bioinformatics, University Medical Center Göttingen, Goldschmidtstraße 1, 37077, Göttingen, Germany
| | - Annalen Bleckmann
- Department of Medicine A, Hematology, Oncology, and Pneumology, University Hospital Münster, 48149, Münster, Germany
| | - Mélanie Planque
- Laboratory of Cellular Metabolism and Metabolic Regulation, VIB-KU Leuven Center for Cancer Biology, VIB, Leuven, Belgium
- Laboratory of Cellular Metabolism and Metabolic Regulation, Department of Oncology, KU Leuven and Leuven Cancer Institute (LKI), Leuven, Belgium
| | - Sarah-Maria Fendt
- Laboratory of Cellular Metabolism and Metabolic Regulation, VIB-KU Leuven Center for Cancer Biology, VIB, Leuven, Belgium
- Laboratory of Cellular Metabolism and Metabolic Regulation, Department of Oncology, KU Leuven and Leuven Cancer Institute (LKI), Leuven, Belgium
| | - Peter Vermeulen
- Translational Cancer Research Unit, GZA Hospitals, Sint-Augustinus, University of Antwerp, Antwerp, Belgium
| | - Michael Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Robert-Koch-Straβe 40, 37075, Göttingen, Germany
| | - Joanna Kalucka
- Department of Biomedicine, Aarhus University, Høegh-Guldbergsgade 10, 8000, Aarhus C, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Tiago De Oliveira
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Robert-Koch-Straβe 40, 37075, Göttingen, Germany
| | - Lena-Christin Conradi
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Robert-Koch-Straβe 40, 37075, Göttingen, Germany.
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Rühlmann F, Hedicke MS, Engelhardt D, Mackert AF, Tichelbäcker T, Leha A, Bernhardt M, Ghadimi M, Perl T, Azizian A, Gaedcke J. Incidence and impact of new-onset postoperative arrhythmia after surgery of the lower gastrointestinal tract. Sci Rep 2023; 13:1284. [PMID: 36690652 PMCID: PMC9870894 DOI: 10.1038/s41598-023-27508-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
Postoperative arrhythmias (PAs) are common events and have been widely investigated in cardiothoracic surgery. Within visceral surgery, a recent study revealed a significant occurrence of PA in esophageal resections. In contrast, PA in lower gastrointestinal surgery is rarely investigated and has been rudimentary described in the medical literature. The present work is a retrospective cohort study of 1171 patients who underwent surgery of lower gastrointestinal tract between 2012 and 2018. All included patients were treated and monitored in the intensive care unit (ICU) or intermediate care unit (IMC) after surgery. Follow-up, performed between January and May 2021, was obtained for the patients with PA investigating the possible persistence of PA and complications such as permanent arrhythmia or thromboembolic events after discharge. In total, n = 1171 patients (559 female, 612 male) without any history of prior arrhythmia were analyzed. Overall, PA occurred in n = 56 (4.8%) patients after surgery of the lower GI. The highest incidence of PA was seen in patients undergoing bowel surgery after mesenteric ischaemia (26.92%), followed by cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC; 16.67%). PA was significantly associated with higher age (72 years (IQR 63-78 years) vs. 64 years (IQR 55-73.5 years), p < 0.001) and longer length of stay in the ICU (median 15 days (IQR 5-25 days) vs. median 2 days (IQR 1-5 days), p < 0.001). PA was independently associated with organ failure (OR = 4.62, 95% CI 2.11-10.11, p < 0.001) and higher in-house mortality (OR = 3.37, 95% CI 1.23-9.28, p < 0.001). In median, PA occurred 66.5 h after surgery. In follow-up, 31% of all the patients with PA showed development of permanent arrhythmia. The incidence of PA after lower GI surgery is comparatively low. Its occurrence, however, seems to have severe implications since it is significantly associated with higher rates of organ failure and in-house mortality. Also, compared to the general population, the development of permanent arrhythmia is significantly higher in patients who developed new-onset PA.
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Affiliation(s)
- Felix Rühlmann
- Department of General, Visceral, and Paediatric Surgery, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Mara Sophie Hedicke
- Department of General, Visceral, and Paediatric Surgery, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Deborah Engelhardt
- Department of General, Visceral, and Paediatric Surgery, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Alma Franziska Mackert
- Department of General, Visceral, and Paediatric Surgery, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Tobias Tichelbäcker
- Clinic III for Internal Medicine, Heart Centre of University Hospital of Cologne, Cologne, Germany
| | - Andreas Leha
- Institute of Medical Statistics Göttingen, University Medical Centre Göttingen, Göttingen, Germany
| | - Markus Bernhardt
- Department of General, Visceral, and Paediatric Surgery, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Michael Ghadimi
- Department of General, Visceral, and Paediatric Surgery, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Thorsten Perl
- Department of General, Visceral, and Paediatric Surgery, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Azadeh Azizian
- Department of General, Visceral, and Paediatric Surgery, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Jochen Gaedcke
- Department of General, Visceral, and Paediatric Surgery, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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Lier M, Euler M, Roessler M, Liman J, Goericke MB, Baubin M, Mueller SM, Kunze-Szikszay N. [Prehospital stroke treatment in German-speaking countries]. Notf Rett Med 2023:1-9. [PMID: 36711435 PMCID: PMC9854412 DOI: 10.1007/s10049-022-01112-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 01/22/2023]
Abstract
Background The prognosis of stroke patients can be improved by adherence to clinical guidelines. Objective To analyse the current state of organisation of prehospital stroke treatment in Germany, Austria and Switzerland with a focus on guideline adherence. Materials and methods All medical directors of emergency medical services (MDEMS) in Germany (n = 178), Austria (n = 9) and Switzerland (n = 32) were invited to complete an anonymous online survey (unipark.com, Tivian XI GmbH, Cologne, Germany) which was available for 10 weeks from April-June 2020. Participants were asked for information regarding structural organisation, clinical treatment and strategic/tactical aspects. Results The survey was completed 69 times and 65 datasets were analysed (4 participants without MDEMS status): 73.8% (n = 48) were MDEMS from Germany, 15.4% (n = 10) from Switzerland and 10.8% from Austria (n = 7). The survey results show relevant differences in the infrastructure of and the approach to prehospital stroke treatment. Standard operating procedures for stroke treatment were in place in 93.3% (n = 61) of the EMS areas. Furthermore, 37% (n = 24) of the EMS areas differentiated between stroke with mild and severe symptoms and 15.4% (n = 10) used specific scores for the prehospital prediction of large vessel occlusion strokes (LVOS). Conclusions Our data highlight the heterogeneity of prehospital stroke treatment in Germany, Austria and Switzerland. Consistent use of appropriate scores for LVOS prediction and a higher adherence to recent clinical guideline in general are measures that should be taken to optimise the prehospital treatment of stroke patients.
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Affiliation(s)
- Martin Lier
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Deutschland
| | - Maximilian Euler
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Deutschland
| | - Markus Roessler
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Deutschland
| | - Jan Liman
- Klinik für Neurologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Deutschland
- Klinik für Neurologie, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Breslauer Straße 201, Nürnberg, 90471 Deutschland
| | - Meike Bettina Goericke
- Klinik für Neurologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Deutschland
| | - Michael Baubin
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020 Innsbruck, Österreich
| | | | - Nils Kunze-Szikszay
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Deutschland
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Dieks JK, Jünemann L, Hensel KO, Bergmann C, Schmidt S, Quast A, Horn S, Sigler M, Meyer-Marcotty P, Santander P. Stereophotogrammetry can feasibly assess 'physiological' longitudinal three-dimensional head development of very preterm infants from birth to term. Sci Rep 2022; 12:8940. [PMID: 35624305 PMCID: PMC9136805 DOI: 10.1038/s41598-022-12887-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 05/03/2022] [Indexed: 11/09/2022] Open
Abstract
Head development is a surrogate for brain development in infants and is related to neurocognitive outcome. There is only limited knowledge on early extra-uterine head shape and size assessment in very preterm infants. Here, 26 very preterm infants with a mean gestational age of 29.1 ± 2.2 weeks and a mean birth weight of 1273.8 ± 427.7 g underwent serial stereophotogrammetric 3D head imaging in weekly intervals from birth to term-equivalent age. The main outcome was the longitudinal assessment of the 'physiological' preterm head development with cephalometric size (head circumference, cranial volume) and shape parameters (cranial index, cranial vault asymmetry index) according to chronological and postmenstrual age (PMA). Potential clinical risk factors for the development of an abnormal low cranial index (dolichocephaly) were analysed. In serial measurements of 26 infants, the estimated head volume (95% confidence interval) increased from 244 (226-263) cm3 at 28 weeks PMA to 705 (688-721) cm3 at 40 weeks PMA. Moderate or severe dolichocephaly occurred in 21/26 infants (80.8%). Cranial index decreased over time (72.4%; 70.7-74 95% confidence interval). Brachycephaly and plagiocephaly were uncommon. No risk factors for severe dolichocephaly were identified. Our study shows that early detection of head shape and size anomalies utilizing 3D stereophotogrammetry is feasible and safe even in very preterm infants < 1500 g and/or < 32 weeks. 3D stereophotogrammetry could be used for timely identification of infants at risk for head shape anomalies. No specific risk factors for head shape anomalies were identified, especially not mode and duration of respiratory support.
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Affiliation(s)
- Jana-K Dieks
- Department of Paediatric Cardiology, Neonatology and Intensive Care Medicine, University Medical Centre, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Laura Jünemann
- Department of Orthodontics, University Medical Centre, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Kai O Hensel
- Department of Paediatric Cardiology, Neonatology and Intensive Care Medicine, University Medical Centre, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- Department of Pediatrics, Faculty of Health, Helios University Medical Center Wuppertal, Witten/Herdecke University, Witten, Germany
| | - Charlotte Bergmann
- Department of Orthodontics, University Medical Centre, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Stefan Schmidt
- Department of Paediatric Cardiology, Neonatology and Intensive Care Medicine, University Medical Centre, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Anja Quast
- Department of Orthodontics, University Medical Centre, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Sebastian Horn
- Department of Paediatric Cardiology, Neonatology and Intensive Care Medicine, University Medical Centre, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- Department of Paediatrics, SRH Central Hospital Suhl, Albert-Schweitzer-Straße 2, 98527, Suhl, Germany
| | - Matthias Sigler
- Department of Paediatric Cardiology, Neonatology and Intensive Care Medicine, University Medical Centre, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Philipp Meyer-Marcotty
- Department of Orthodontics, University Medical Centre, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Petra Santander
- Department of Orthodontics, University Medical Centre, Robert-Koch-Straße 40, 37075, Göttingen, Germany
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Müller F, Heinemann S, Hummers E, Noack EM, Heesen G, Dopfer-Jablonka A, Mikuteit M, Niewolik J, Steffens S, Schröder D. [Immunosuppressed people's beliefs, expectations, and experiences with COVID-19 vaccinations : Results of a longitudinal study]. Z Rheumatol 2022; 82:342-354. [PMID: 35523964 PMCID: PMC9075708 DOI: 10.1007/s00393-022-01213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Immunocompromised people are less likely to be vaccinated, despite an increased benefit of many vaccinations in terms of benefit-risk assessment, including the vaccines against SARS CoV-2 (COVID-19). Attitudes, expectations, and experiences with previous vaccinations influence the decision to get vaccinated. OBJECTIVE To explore the attitudes of immunocompromised people towards vaccinations in general and COVID-19 vaccination in particular and their experiences with COVID-19 vaccinations. MATERIAL AND METHODS As part of the CoCo Immune study, immunocompromised participants were surveyed in the spring and summer of 2021 (1 November 2021-7 September 2021) using questionnaires. Initially, they were asked about their expectations concerning a COVID-19 vaccination and followed up about their experience after COVID-19 vaccination. In addition, sociodemographic data, general attitudes toward vaccinations and experiences with previous vaccinations were collected. Analysis was performed using descriptive and bivariate statistics. RESULTS The 243 participants mostly approved vaccinations and expected the COVID-19 vaccination to be effective and well-tolerated. Women were more concerned about the safety of vaccinations and were more often worried about side effects. Older persons felt better informed than younger persons. Participants who reported subjective side effects of previous vaccinations were more skeptical about vaccinations as well as the government institutions that recommend vaccinations. They less often agreed with the statement "in retrospect, the COVID-19 vaccination has been harmless for me so far". DISCUSSION The participants mostly expressed a positive attitude and anticipation towards COVID-19 vaccinations; however, the age and sex differences found suggest that there are different information needs which should be addressed when educating individuals about vaccinations or designing vaccination campaigns.
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Affiliation(s)
- Frank Müller
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland.
| | - Stephanie Heinemann
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland
| | - Eva Hummers
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland
| | - Eva Maria Noack
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland
| | - Gloria Heesen
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland
| | - Alexandra Dopfer-Jablonka
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Deutschland
- Deutsches Zentrum für Infektionsforschung, Hannover-Braunschweig, Deutschland
| | - Marie Mikuteit
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Jacqueline Niewolik
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Sandra Steffens
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Dominik Schröder
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland
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Hansen N, Luedecke D, Malchow B, Lipp M, Vogelgsang J, Timäus C, Zindler T, Gingele S, Kühn S, Gallinat J, Wiedemann K, Denk J, Moschny N, Fiehler J, Skripuletz T, Riedel C, Wattjes MP, Zerr I, Esselmann H, Poustka L, Karow A, Hartmann H, Frieling H, Bleich S, Wiltfang J, Neyazi A. Autoantibody-associated psychiatric syndromes in children: link to adult psychiatry. J Neural Transm (Vienna) 2021; 128:735-747. [PMID: 34057596 PMCID: PMC8205901 DOI: 10.1007/s00702-021-02354-8] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/13/2021] [Indexed: 01/18/2023]
Abstract
Studies show that psychiatric symptoms in adults and children are sometimes associated with serum neural autoantibodies. The significance of serum neural autoantibodies associated with psychiatric symptoms in children remains often unclear, but might be relevant for the extent and occurrence of psychiatric disease manifestation in later life, as well as therapy and outcome. For this narrative review, we sought articles listed in PubMed and published between 1988 and 2020 addressing the maternal-fetal transfer of neural autoantibodies and psychiatric disorders associated with serum neural autoantibodies. We identified six major subgroups of psychiatric disorders in children that are associated with serum neural autoantibodies: patients with attentional deficit hyperactivity disorder, autism spectrum disorder, obsessive compulsive disorder, Gilles de la Tourette syndrome, psychosis and catatonia. Furthermore, we summarized study findings from maternal-fetal transfer of Contactin-associated protein-like 2, N-methyl-D-aspartate receptor and fetal brain autoantibodies associated with behavioral effects in animals and humans. We hypothesize that the maternal transfer of serum neuronal autoantibodies during or after birth could result (1) in the ignition of an autoimmune-mediated inflammation having neurodevelopmental consequences for their children (autoimmune-priming-attack hypothesis) and (2) has a potential impact on the later manifestation of psychiatric disorders. Through this narrative review, we propose a diagnostic pathway for the clinical diagnosis of a potentially autoimmune origin of psychiatric symptoms in children while considering recent guidelines.
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Affiliation(s)
- Niels Hansen
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Von-Siebold-Str. 5, 37075, Göttingen, Germany.
| | - Daniel Luedecke
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Von-Siebold-Str. 5, 37075, Göttingen, Germany
| | - Michael Lipp
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
| | - Jonathan Vogelgsang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Von-Siebold-Str. 5, 37075, Göttingen, Germany
| | - Charles Timäus
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Von-Siebold-Str. 5, 37075, Göttingen, Germany
| | - Tristan Zindler
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Stefan Gingele
- Department of Neurology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
| | - Johannes Denk
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
| | - Nicole Moschny
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
| | - Thomas Skripuletz
- Department of Neurology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Christian Riedel
- Department of Neuroradiology, University Medical Center Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Mike P Wattjes
- Department of Neuroradiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Inga Zerr
- Department of Neurology, University Medical Center Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Hermann Esselmann
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Von-Siebold-Str. 5, 37075, Göttingen, Germany
| | - Luise Poustka
- Department of Childhood and Adolescence Psychiatry, University Medical Center Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
| | - Hans Hartmann
- Clinic for Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Von-Siebold-Str. 5, 37075, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Von-Siebold-Str. 3a, 37075, Göttingen, Germany
- Neurosciences and Signaling Group, Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Alexandra Neyazi
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
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Hansen N, Malchow B, Zerr I, Stöcker W, Wiltfang J, Timäus C. Neural cell-surface and intracellular autoantibodies in patients with cognitive impairment from a memory clinic cohort. J Neural Transm (Vienna) 2021; 128:357-369. [PMID: 33677623 PMCID: PMC7969694 DOI: 10.1007/s00702-021-02316-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/08/2021] [Indexed: 12/12/2022]
Abstract
Autoantibody-associated cognitive impairment is an expanding field in geriatric psychiatry. We aim to assess the association between the presence of specific neural autoantibodies and cognitive performance in a memory clinic cohort. 154 patients with cognitive impairment were included between 2019 and 2020 presenting initially in a memory clinic. We evaluated their patient files retrospectively applying epidemiologic parameters, psychopathology, neuropsychology, intracellular and membrane-surface autoantibodies in serum and cerebrospinal fluid (CSF) and markers of neurodegeneration in CSF. In 26 of 154 patients, we searched for neural autoantibodies due to indicators for autoimmunity. In 15/26 (58%) of patients we detected serum and/or CSF autoantibodies. We identified autoantibodies against intracellular or cell-surface antigens in 7 of all 26 (27%) patients with cognitive dysfunction, although we cannot exclude patients with potential specific autoantibodies lacking autoimmune indicators. There were no significant differences between psychopathological and neuropsychological profiles in groups of patients with cognitive impairment comprising patients with autoantibodies (ABS + COG), no autoantibodies (ABS - COG), and Alzheimer's disease (ADCOG). Concerning our CSF parameters, we detected intrathecal IgG synthesis in 14% of ABS + COG and in 13% of ABS - COG patients, whereas no intrathecal IgG synthesis was found in ADCOG patients. Furthermore, CSF Aß42 was significantly diminished in the ADCOG compared to the ABS + COG group (p < 0.05). In addition, the Aß42/40 ratio was lower in ADCOG patients than in the ABS + COG or ABS - COG group (p < 0.05). Our findings reveal the underestimated occurrence and autoantibodies' potential role in patients presenting cognitive impairment. Furthermore, the patients with possible Alzheimer's disease might be differentiated from autoantibody-positive patients via a reduced Aß42 and Aß42/40 ratio in the CSF. The antibody-type varies between patients to a relevant degree, thus demonstrating the need for more research to identify subgroup-specific phenotypes. These pilot study results open an avenue for improving diagnosis and treatment in a memory clinic.
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Affiliation(s)
- Niels Hansen
- Department of Psychiatry and Psychotherapy, University Medical Center of Göttingen, University of Goettingen, Von-Siebold-Str. 5, 37075, Goettingen, Germany.
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Medical Center of Göttingen, University of Goettingen, Von-Siebold-Str. 5, 37075, Goettingen, Germany
| | - Inga Zerr
- Department of Neurology, University of Goettingen, Robert-Koch Str. 40, 37075, Goettingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Von-Siebold-Str. 3a, 37075, Goettingen, Germany
| | - Winfried Stöcker
- Euroimmun Reference Laboratory, Seekamp 31, 23650, Luebeck, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center of Göttingen, University of Goettingen, Von-Siebold-Str. 5, 37075, Goettingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Von-Siebold-Str. 3a, 37075, Goettingen, Germany
- Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Charles Timäus
- Department of Psychiatry and Psychotherapy, University Medical Center of Göttingen, University of Goettingen, Von-Siebold-Str. 5, 37075, Goettingen, Germany
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