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Kosse NJ, Galetin T, Schwarz SB, Mathes T, Koryllos A, Lopez-Pastorini A, Beckers F, Stoelben E. Results of the Diaphragmatic Plication Database: 10 Years' Experience. Thorac Cardiovasc Surg 2023; 71:483-489. [PMID: 34655069 DOI: 10.1055/s-0041-1735496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Unilateral diaphragmatic paralysis or paresis (UDP) in adults is an often overlooked disease which relevantly impairs the patient's lung function and quality of life. Particularly in idiopathic UDP, there is no evidence for conservative therapy and only little evidence for surgical therapy. METHODS The method involves retrospective single-center analysis of patients with UDP persistent for at least 1 year who were operated by diaphragmatic resection, plication, and augmentation with a polypropylene mesh. The patients were tested for lung and diaphragmatic function, six-minute walk test (6MWT), and blood gas analysis before, 3 and 12 months after surgery. RESULTS In total, 85 patients received surgery for UDP. The most frequent reasons for UDP were idiopathic (67%), iatrogenic (mainly cardiac and cervical spine surgery; 24%), and trauma (9%). The mean operation time was 84 ± 24 minutes, the length of hospital stay 8.4 ± 3.9 days, chest tubes were removed after 11.7 ± 4.1 days. Overall morbidity was 42%, mortality 0%. Forced expiratory volume in one second (FEV1) in supine position improved by 12.4% absolute, vital capacity by 11.8% absolute, and sniff nasal inspiratory pressure by 1.4 kPa 12 months after surgery (p <0.001 each). Total lung capacity increased by 6.8% absolute at 12 months (p = 0.001) The 6MWT distance improved by 45.9 m at 3 months and 50.9 m at 12 months (p = 0.001, each). CONCLUSION Surgical therapy for UDP is highly effective in the long term. The superiority over conservative treatments needs to be evaluated prospectively with standardized physiotherapeutic protocols. FEV1 in supine position and 6MWT are easy to perform tests and represent statistically and patient-relevant outcomes.
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Affiliation(s)
- Nils Jurriaan Kosse
- Department of Thoracic Surgery, University Witten Herdecke Faculty of Health, Witten, Germany
- Lung Clinic Merheim/Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Koln, Germany
| | - Thomas Galetin
- Department of Thoracic Surgery, University Witten Herdecke Faculty of Health, Witten, Germany
- Lung Clinic Merheim/Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Koln, Germany
| | - Sarah Bettina Schwarz
- Department of Pneumology, University Witten Herdecke Faculty of Health, Witten, Germany
- Lungclinic Merheim/Pneumology, Kliniken der Stadt Köln gGmbH, Koeln, Germany
| | - Tim Mathes
- Institut für Forschung in der operativen Medizin (IFOM), Universität Witten/Herdecke Fakultät für Gesundheit, Witten, Nordrhein-Westfalen, Germany
| | - Aris Koryllos
- Department of Thoracic Surgery, University Witten Herdecke Faculty of Health, Witten, Germany
- Lung Clinic Merheim/Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Koln, Germany
| | - Alberto Lopez-Pastorini
- Department of Thoracic Surgery, University Witten Herdecke Faculty of Health, Witten, Germany
- Lung Clinic Merheim/Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Koln, Germany
| | - Frank Beckers
- Department of Thoracic Surgery, St Vinzenz Hospital, Koeln, Germany
| | - Erich Stoelben
- Department of Thoracic Surgery, University Witten Herdecke Faculty of Health, Witten, Germany
- Lung Clinic Merheim/Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Koln, Germany
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Kron A, Scheffler M, Heydt C, Ruge L, Schaepers C, Eisert AK, Merkelbach-Bruse S, Riedel R, Nogova L, Fischer RN, Michels S, Abdulla DSY, Koleczko S, Fassunke J, Schultheis AM, Kron F, Ueckeroth F, Wessling G, Sueptitz J, Beckers F, Braess J, Panse J, Grohé C, Hamm M, Kabitz HJ, Kambartel K, Kaminsky B, Krueger S, Schulte C, Lorenz J, Lorenzen J, Meister W, Meyer A, Kappes J, Reinmuth N, Schaaf B, Schulte W, Serke M, Buettner R, Wolf J. Genetic Heterogeneity of MET-Aberrant NSCLC and Its Impact on the Outcome of Immunotherapy. J Thorac Oncol 2020; 16:572-582. [PMID: 33309988 DOI: 10.1016/j.jtho.2020.11.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Robust data on the outcome of MET-aberrant NSCLC with nontargeted therapies are limited, especially in consideration of the heterogeneity of MET-amplified tumors (METamp). METHODS A total of 337 tumor specimens of patients with MET-altered Union for International Cancer Control stage IIIB/IV NSCLC were analyzed using next-generation sequencing, fluorescence in situ hybridization, and immunohistochemistry. The evaluation focused on the type of MET aberration, co-occurring mutations, programmed death-ligand 1 expression, and overall survival (OS). RESULTS METamp tumors (n = 278) had a high frequency of co-occurring mutations (>80% for all amplification levels), whereas 57.6% of the 59 patients with MET gene and exon 14 (METex14) tumors had no additional mutations. In the METamp tumors, with increasing gene copy number (GCN), the frequency of inactivating TP53 mutations increased (GCN < 4: 58.2%; GCN ≥ 10: 76.5%), whereas the frequency of KRAS mutations decreased (GCN < 4: 43.2%; GCN ≥ 10: 11.8%). A total of 10.1% of all the METamp tumors with a GCN ≥ 10 had a significant worse OS (4.0 mo; 95% CI: 1.9-6.0) compared with the tumors with GCN < 10 (12.0 mo; 95% confidence interval [CI]: 9.4-14.6). In the METamp NSCLC, OS with immune checkpoint inhibitor (ICI) therapy was significantly better compared with chemotherapy with 19.0 months (95% CI: 15.8-22.2) versus 8.0 months (95% CI: 5.8-10.2, p < 0.0001). No significant difference in median OS was found between ICI therapy and chemotherapy in the patients with METex14 (p = 0.147). CONCLUSIONS METex14, METamp GCN ≥ 10, and METamp GCN < 10 represent the subgroups of MET-dysregulated NSCLC with distinct molecular and clinical features. The patients with METex14 do not seem to benefit from immunotherapy in contrast to the patients with METamp, which is of particular relevance for the prognostically poor METamp GCN ≥ 10 subgroup.
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Affiliation(s)
- Anna Kron
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Matthias Scheffler
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Carina Heydt
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Lea Ruge
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Carsten Schaepers
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Anna-Kristina Eisert
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Sabine Merkelbach-Bruse
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Richard Riedel
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Lucia Nogova
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Rieke Nila Fischer
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Sebastian Michels
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Diana S Y Abdulla
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Sophia Koleczko
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Jana Fassunke
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Anne M Schultheis
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Florian Kron
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany; FOM University of Applied Sciences, Essen, Germany
| | - Frank Ueckeroth
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Gabriele Wessling
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Juliane Sueptitz
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Frank Beckers
- Network Genomic Medicine, Cologne, Germany; Department of Thoracic Surgery, St. Vinzenz-Hospital Cologne, Cologne, Germany
| | - Jan Braess
- Network Genomic Medicine, Cologne, Germany; Department of Hematology and Oncology, Hospital Barmherzige Brueder Regensburg, Regensburg, Germany
| | - Jens Panse
- Network Genomic Medicine, Cologne, Germany; Department of Internal Medicine IV, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital RWTH Aachen, Aachen, Germany
| | - Christian Grohé
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Evangelische Lungenklinik Berlin, Berlin, Germany
| | - Michael Hamm
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology and Respiratory Medicine, Helios Medical Center of Hildesheim, Hildesheim, Germany
| | - Hans-Joachim Kabitz
- Network Genomic Medicine, Cologne, Germany; Department of Internal Medicine II, Clinic of Konstanz, Konstanz, Germany
| | - Kato Kambartel
- Network Genomic Medicine, Cologne, Germany; Department of Thoracic Oncology and Interventional Bronchology, Hospital Bethanien Moers, Moers, Germany
| | - Britta Kaminsky
- Network Genomic Medicine, Cologne, Germany; Department of Pneumonology and Allergology, Hospital Bethanien Solingen, Solingen, Germany
| | - Stefan Krueger
- Network Genomic Medicine, Cologne, Germany; Department of Pneumonology, Florence-Nightingale Hospital Düsseldorf, Düsseldorf, Germany
| | - Clemens Schulte
- Network Genomic Medicine, Cologne, Germany; Joint Private Practice for Hematology/Oncology, Dortmund, Germany
| | - Joachim Lorenz
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Hospital Luedenscheid, Luedenscheid, Germany
| | - Johann Lorenzen
- Network Genomic Medicine, Cologne, Germany; Department of Pathology, Hospital Dortmund, Dortmund, Germany
| | - Wolfram Meister
- Network Genomic Medicine, Cologne, Germany; Department of Thoracic Oncology and Interventional Bronchology, Helios Medical Center of Hildesheim, Hildesheim, Germany
| | - Andreas Meyer
- Network Genomic Medicine, Cologne, Germany; Department of Pulmonary Medicine, Maria Hilf Hospital GmbH, Moenchengladbach, Germany
| | - Jutta Kappes
- Network Genomic Medicine, Cologne, Germany; Department of Internal Medicine and Pneumology, Catholic Hospital Koblenz, Koblenz, Germany
| | - Niels Reinmuth
- Network Genomic Medicine, Cologne, Germany; Department of Oncology, Asklepios Clinic Munich-Gauting, Munich-Gauting, Germany
| | - Bernhard Schaaf
- Network Genomic Medicine, Cologne, Germany; Department of Respiratory Medicine and Infectious Diseases, Medical Center North of Dortmund, Dortmund, Germany
| | - Wolfgang Schulte
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology and Allergology, GFO Clinic Bonn, Bonn, Germany
| | - Monika Serke
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology and Oncology, Evangelic Hospital Hamm, Hamm, Germany
| | - Reinhard Buettner
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Jürgen Wolf
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany.
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D'Hooghe T, Vermey B, Chua S, Zafarmand H, Wang R, Longobardi S, Cottell E, Beckers F, Mol B, Venetis C. Is the number of oocytes aspirated after ovarian stimulation for IVF/ICSI associated with the number of top/good quality embryos? A systematic review and meta-analysis. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Beckers M, Berardis S, Gohy S, Beckers F, Goubau C, Lebecque P. 313 Serum 25-hydroxyvitamin D does not correlate with pancreatic status, FEV1, BMI, IgG nor prescribed doses of oral supplementation in patients with cystic fibrosis. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30652-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kosse N, Koryllos A, Beckers F, Stoelben E. Funktionelle Evaluation prä- und postoperativ nach Zwerchfellraffung bei einseitiger Zwerchfellparalyse. Pneumologie 2017. [DOI: 10.1055/s-0037-1598264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- N Kosse
- Lungenklinik Köln Merheim, Lehrstuhl für Thoraxchirurgie der Universität Witten Herdecke, Kliniken der Stadt Köln-Merheim
| | - A Koryllos
- Lungenklinik Köln Merheim, Lehrstuhl für Thoraxchirurgie der Universität Witten Herdecke, Kliniken der Stadt Köln-Merheim
| | - F Beckers
- Klinik für Thoraxchirurgie, Lungenklinik Köln-Nord, St. Vinzenz-Hospital Köln
| | - E Stoelben
- Lungenklinik Köln Merheim, Lehrstuhl für Thoraxchirurgie der Universität Witten Herdecke, Kliniken der Stadt Köln-Merheim
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Koriller N, Angenendt S, Schäfer S, Beckers F. Ungewöhnlicher Fall eines malignen Triton Tumors der Brustwand in Kombination mit einem synchronen Lungenkarzinom. Zentralbl Chir 2016. [DOI: 10.1055/s-0036-1587486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lopez-Pastorini A, Plönes T, Brockmann M, Ludwig C, Beckers F, Stoelben E. Spontaneous regression of non-small cell lung cancer after biopsy of a mediastinal lymph node metastasis: a case report. J Med Case Rep 2015; 9:217. [PMID: 26377170 PMCID: PMC4573999 DOI: 10.1186/s13256-015-0702-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 08/31/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Spontaneous regression of cancer is defined as a complete or partial, temporary or permanent disappearance of tumor in the absence of specific therapy. With only a few cases reported, spontaneous regression is extremely rare in primary lung cancer. Regarding spontaneous regression in lung cancer, recent investigations revealed the role of immunological mechanisms, thus indicating potential treatment options by specific immunotherapy in the future. CASE PRESENTATION A 76-year-old Caucasian man with progressive dyspnea presented to our hospital. A computed tomography scan revealed a tumor mass in the upper lobe of his right lung and enlarged mediastinal lymph nodes. A biopsy of a paratracheal lymph node by mediastinoscopy disclosed metastatic lung cancer. By immunohistochemical findings the tumor was classified as large cell carcinoma. Diagnosed with clinical stage IIIA non-small cell lung cancer, a neoadjuvant therapy concept was indicated. However, before starting chemoradiation, a computed tomography scan showed a regression of both the tumor mass in the upper lobe of his right lung and the mediastinal lymphadenopathy. As a repeated computed tomography scan showed further regression, we agreed with our patient to perform routine follow-up instead of starting therapy. To date, no relapse has been reported. CONCLUSIONS Given the circumstances that regression started after the biopsy and involved both the tumor in the upper lobe of his right lung and the mediastinal lymph node metastases, an immune response is a reasonable explanation for the observed spontaneous regression in this case.
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Affiliation(s)
- Alberto Lopez-Pastorini
- Department of Thoracic Surgery, University Medical Center Witten/Herdecke, Lung Clinic Merheim, Campus Cologne, Ostmerheimerstr. 200, 51109, Cologne, Germany.
| | - Till Plönes
- Department of Thoracic Surgery, University Medical Center Witten/Herdecke, Lung Clinic Merheim, Campus Cologne, Ostmerheimerstr. 200, 51109, Cologne, Germany.
| | - Michael Brockmann
- Department of Pathology, University Medical Center Witten/Herdecke, Clinic Merheim, Campus Cologne, Ostmerheimerstr. 200, 51109, Cologne, Germany.
| | - Corinna Ludwig
- Department of Thoracic Surgery, University Medical Center Witten/Herdecke, Lung Clinic Merheim, Campus Cologne, Ostmerheimerstr. 200, 51109, Cologne, Germany.
| | - Frank Beckers
- Department of Thoracic Surgery, University Medical Center Witten/Herdecke, Lung Clinic Merheim, Campus Cologne, Ostmerheimerstr. 200, 51109, Cologne, Germany.
| | - Erich Stoelben
- Department of Thoracic Surgery, University Medical Center Witten/Herdecke, Lung Clinic Merheim, Campus Cologne, Ostmerheimerstr. 200, 51109, Cologne, Germany.
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Choe WC, Passman RS, Brachmann J, Morillo CA, Sanna T, Bernstein RA, Di Lazzaro V, Diener HC, Rymer MM, Beckers F, Koehler J, Ziegler PD. A Comparison of Atrial Fibrillation Monitoring Strategies After Cryptogenic Stroke (from the Cryptogenic Stroke and Underlying AF Trial). Am J Cardiol 2015; 116:889-93. [PMID: 26183793 DOI: 10.1016/j.amjcard.2015.06.012] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/14/2015] [Accepted: 06/14/2015] [Indexed: 11/24/2022]
Abstract
Ischemic stroke cause remains undetermined in 30% of cases, leading to a diagnosis of cryptogenic stroke. Paroxysmal atrial fibrillation (AF) is a major cause of ischemic stroke but may go undetected with short periods of ECG monitoring. The Cryptogenic Stroke and Underlying Atrial Fibrillation trial (CRYSTAL AF) demonstrated that long-term electrocardiographic monitoring with insertable cardiac monitors (ICM) is superior to conventional follow-up in detecting AF in the population with cryptogenic stroke. We evaluated the sensitivity and negative predictive value (NPV) of various external monitoring techniques within a cryptogenic stroke cohort. Simulated intermittent monitoring strategies were compared to continuous rhythm monitoring in 168 ICM patients of the CRYSTAL AF trial. Short-term monitoring included a single 24-hour, 48-hour, and 7-day Holter and 21-day and 30-day event recorders. Periodic monitoring consisted of quarterly monitoring through 24-hour, 48-hour, and 7-day Holters and monthly 24-hour Holters. For a single monitoring period, the sensitivity for AF diagnosis was lowest with a 24-hour Holter (1.3%) and highest with a 30-day event recorder (22.8%). The NPV ranged from 82.3% to 85.6% for all single external monitoring strategies. Quarterly monitoring with 24-hour Holters had a sensitivity of 3.1%, whereas quarterly 7-day monitors increased the sensitivity to 20.8%. The NPVs for repetitive periodic monitoring strategies were similar at 82.6% to 85.3%. Long-term continuous monitoring was superior in detecting AF compared to all intermittent monitoring strategies evaluated (p <0.001). Long-term continuous electrocardiographic monitoring with ICMs is significantly more effective than any of the simulated intermittent monitoring strategies for identifying AF in patients with previous cryptogenic stroke.
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Beckers F, Werner I, Stoelben E. Die chirurgische Therapie des Lungenkarzinom im Stadium I – Segmentresektion vs. Lobektomie. Pneumologie 2015. [DOI: 10.1055/s-0035-1544766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Beckers F, Lange N, Koryllos A, Picchioni F, Windisch W, Stoelben E. Unilateral Lobe Resection by Video-Assisted Thoracoscopy Leads to the Most Optimal Functional Improvement in Severe Emphysema. Thorac Cardiovasc Surg 2014; 64:336-42. [PMID: 25535772 DOI: 10.1055/s-0034-1395989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background Lung volume reduction surgery (LVRS) is a well-established treatment option for pulmonary emphysema, but the most advantageous technical approach remains debatable. Methods Short- and long-term outcomes were comparably assessed in pulmonary emphysema patients who underwent unilateral LVRS with either lobe or sublobe (segment or wedge) resection. Patients were consecutively enrolled in the study after careful conventional and computer-based definition of the target region. Results A total of 36 patients with a mean age of 62.1 ± 8.9 years (range, 41-79 years) were recruited. Video-assisted thoracoscopy (VATS) was performed in 33 patients, while 3 patients with additional early-stage lung cancer received anterolateral thoracotomy. Surgery duration was longer for lobectomy (median 93 minutes, range 44-168 minutes) as compared with sublobe resection (median 52 minutes, range 25-131 minutes; p = 0.0007), but complication rates were similar. After 90 days postsurgery, mortality was zero and lung function improved to a similar degree in both the groups. After 1 year, total lung capacity (TLC) was still reduced by 17.2 ± 20.6% predicted as compared with the baseline values for lobe resection, while TLC was increased by 12.1 ± 14.5% predicted for sublobe resection. In addition, the 6-minute walking distance improved following LVRS, with slightly better results in lobe resection patients. Conclusions By careful definition of the target region, unilateral VATS-LVRS with lobe resection in severely affected pulmonary emphysema patients is a safe procedure that is superior to unilateral sublobe VATS resection in terms of improving long-term 1-year lung hyperinflation. Therefore, unilateral VATS lobe resection is a promising treatment approach that should be further evaluated by randomized controlled trials.
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Affiliation(s)
- Frank Beckers
- Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Thoraxchrirugie der Privaten Universität Witten/Herdecke, Köln, Germany
| | - Nadine Lange
- Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Thoraxchrirugie der Privaten Universität Witten/Herdecke, Köln, Germany
| | - Aris Koryllos
- Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Thoraxchrirugie der Privaten Universität Witten/Herdecke, Köln, Germany
| | - Fabrizio Picchioni
- Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Pneumologie und Beatmungsmedizin der Privaten Universität Witten/Herdecke, Köln, Germany
| | - Wolfram Windisch
- Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Pneumologie und Beatmungsmedizin der Privaten Universität Witten/Herdecke, Köln, Germany
| | - Erich Stoelben
- Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Thoraxchrirugie der Privaten Universität Witten/Herdecke, Köln, Germany
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Beckers F, Werner I, Stoelben E. Die Resektion des Lungenkarzinoms im Stadium I – Segmentresektion vs. Lobektomie: Parenchymsparend und onkologisch gleichwertig? Zentralbl Chir 2014. [DOI: 10.1055/s-0034-1389306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Stöcker C, Welter S, Witte B, Beckers F, Klemm W, Kraß S. Computerunterstützung in der Lungenchirurgie für VATS und Segmentresektionen. Zentralbl Chir 2014. [DOI: 10.1055/s-0034-1389313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Plönes T, Beckers F, Engel-Riedel W, Stoelben E, Brockmann M, Schildgen V, Schildgen O. Absence of amplification of the FGFR1-gene in human malignant mesothelioma of the pleura: a pilot study. BMC Res Notes 2014; 7:549. [PMID: 25138167 PMCID: PMC4148949 DOI: 10.1186/1756-0500-7-549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 08/14/2014] [Indexed: 11/22/2022] Open
Abstract
Background Mesothelioma (MPM) is a rare malignant disease with a worse outcome. Fibroblast growth factor 1 (FGFR1) may be an interesting target for selective tyrosine kinases inhibitors (TKI) in MPM. The aim of this study was to evaluate the amplification of the FGFR1 gene in patients suffering from MPM. Findings We identified nineteen male patients treated in our department between August 2008 and July 2010 matching the inclusion criteria. Mean age was 68 years. Histopathological examination confirmed thirteen patients with epitheloid subtype, five with biphasic and one patient with sarcomatoid. Fluorescence in situ hybridization analysis revealed no polysomy nor an amplification of the FGFR gene copy number in any case. Conclusion Regarding that also EGFR amplifications in MPM are absolute rarities, our findings may be a hint that TKI’s will not satisfy the hope for a new era in the treatment of MPM.
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Affiliation(s)
- Till Plönes
- Department of Thoracic Surgery, University Medical Center Witten/Herdecke, Lung Clinic Merheim, Campus Cologne, Ostmerheimerstrasse 200, 51109 Köln, Germany.
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Sanna T, Diener HC, Passman RS, Di Lazzaro V, Bernstein RA, Morillo CA, Rymer MM, Thijs V, Rogers T, Beckers F, Lindborg K, Brachmann J. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med 2014; 370:2478-2486. [PMID: 24963567 DOI: 10.1056/nejmoa1313600.a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND Current guidelines recommend at least 24 hours of electrocardiographic (ECG) monitoring after an ischemic stroke to rule out atrial fibrillation. However, the most effective duration and type of monitoring have not been established, and the cause of ischemic stroke remains uncertain despite a complete diagnostic evaluation in 20 to 40% of cases (cryptogenic stroke). Detection of atrial fibrillation after cryptogenic stroke has therapeutic implications. METHODS We conducted a randomized, controlled study of 441 patients to assess whether long-term monitoring with an insertable cardiac monitor (ICM) is more effective than conventional follow-up (control) for detecting atrial fibrillation in patients with cryptogenic stroke. Patients 40 years of age or older with no evidence of atrial fibrillation during at least 24 hours of ECG monitoring underwent randomization within 90 days after the index event. The primary end point was the time to first detection of atrial fibrillation (lasting >30 seconds) within 6 months. Among the secondary end points was the time to first detection of atrial fibrillation within 12 months. Data were analyzed according to the intention-to-treat principle. RESULTS By 6 months, atrial fibrillation had been detected in 8.9% of patients in the ICM group (19 patients) versus 1.4% of patients in the control group (3 patients) (hazard ratio, 6.4; 95% confidence interval [CI], 1.9 to 21.7; P<0.001). By 12 months, atrial fibrillation had been detected in 12.4% of patients in the ICM group (29 patients) versus 2.0% of patients in the control group (4 patients) (hazard ratio, 7.3; 95% CI, 2.6 to 20.8; P<0.001). CONCLUSIONS ECG monitoring with an ICM was superior to conventional follow-up for detecting atrial fibrillation after cryptogenic stroke. (Funded by Medtronic; CRYSTAL AF ClinicalTrials.gov number, NCT00924638.).
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Affiliation(s)
- Tommaso Sanna
- From the Catholic University of the Sacred Heart, Institute of Cardiology (T.S.), and Institute of Neurology, Campus Bio-Medico University (V.D.L.) - both in Rome; the Department of Neurology and Stroke Center, University Hospital Essen, Essen (H.-C.D.), and Hospital Klinikum Coburg, Teaching Hospital of the University of Würzburg, Coburg (J.B.) - both in Germany; Bluhm Cardiovascular Institute (R.S.P.) and Davee Department of Neurology (R.A.B.), Northwestern University Feinberg School of Medicine, Chicago; Population Health Research Institute, McMaster University, Hamilton, ON, Canada (C.A.M.); University of Kansas Medical Center, Kansas City (M.M.R.); the KU Leuven Department of Neurosciences, the VIB-Vesalius Research Center, and the Department of Neurology, University Hospitals Leuven - all in Leuven, Belgium (V.T.); Medtronic, Mounds View, MN (T.R., K.L.); and Medtronic, Maastricht, the Netherlands (F.B.)
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Sanna T, Diener HC, Passman RS, Di Lazzaro V, Bernstein RA, Morillo CA, Rymer MM, Thijs V, Rogers T, Beckers F, Lindborg K, Brachmann J. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med 2014; 370:2478-86. [PMID: 24963567 DOI: 10.1056/nejmoa1313600] [Citation(s) in RCA: 1389] [Impact Index Per Article: 138.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Current guidelines recommend at least 24 hours of electrocardiographic (ECG) monitoring after an ischemic stroke to rule out atrial fibrillation. However, the most effective duration and type of monitoring have not been established, and the cause of ischemic stroke remains uncertain despite a complete diagnostic evaluation in 20 to 40% of cases (cryptogenic stroke). Detection of atrial fibrillation after cryptogenic stroke has therapeutic implications. METHODS We conducted a randomized, controlled study of 441 patients to assess whether long-term monitoring with an insertable cardiac monitor (ICM) is more effective than conventional follow-up (control) for detecting atrial fibrillation in patients with cryptogenic stroke. Patients 40 years of age or older with no evidence of atrial fibrillation during at least 24 hours of ECG monitoring underwent randomization within 90 days after the index event. The primary end point was the time to first detection of atrial fibrillation (lasting >30 seconds) within 6 months. Among the secondary end points was the time to first detection of atrial fibrillation within 12 months. Data were analyzed according to the intention-to-treat principle. RESULTS By 6 months, atrial fibrillation had been detected in 8.9% of patients in the ICM group (19 patients) versus 1.4% of patients in the control group (3 patients) (hazard ratio, 6.4; 95% confidence interval [CI], 1.9 to 21.7; P<0.001). By 12 months, atrial fibrillation had been detected in 12.4% of patients in the ICM group (29 patients) versus 2.0% of patients in the control group (4 patients) (hazard ratio, 7.3; 95% CI, 2.6 to 20.8; P<0.001). CONCLUSIONS ECG monitoring with an ICM was superior to conventional follow-up for detecting atrial fibrillation after cryptogenic stroke. (Funded by Medtronic; CRYSTAL AF ClinicalTrials.gov number, NCT00924638.).
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Affiliation(s)
- Tommaso Sanna
- From the Catholic University of the Sacred Heart, Institute of Cardiology (T.S.), and Institute of Neurology, Campus Bio-Medico University (V.D.L.) - both in Rome; the Department of Neurology and Stroke Center, University Hospital Essen, Essen (H.-C.D.), and Hospital Klinikum Coburg, Teaching Hospital of the University of Würzburg, Coburg (J.B.) - both in Germany; Bluhm Cardiovascular Institute (R.S.P.) and Davee Department of Neurology (R.A.B.), Northwestern University Feinberg School of Medicine, Chicago; Population Health Research Institute, McMaster University, Hamilton, ON, Canada (C.A.M.); University of Kansas Medical Center, Kansas City (M.M.R.); the KU Leuven Department of Neurosciences, the VIB-Vesalius Research Center, and the Department of Neurology, University Hospitals Leuven - all in Leuven, Belgium (V.T.); Medtronic, Mounds View, MN (T.R., K.L.); and Medtronic, Maastricht, the Netherlands (F.B.)
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Volokhina EB, Grijpstra J, Beckers F, Lindh E, Robert V, Tommassen J, Bos MP. Species-specificity of the BamA component of the bacterial outer membrane protein-assembly machinery. PLoS One 2013; 8:e85799. [PMID: 24376896 PMCID: PMC3869937 DOI: 10.1371/journal.pone.0085799] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 12/02/2013] [Indexed: 11/29/2022] Open
Abstract
The BamA protein is the key component of the Bam complex, the assembly machinery for outer membrane proteins (OMP) in gram-negative bacteria. We previously demonstrated that BamA recognizes its OMP substrates in a species-specific manner in vitro. In this work, we further studied species specificity in vivo by testing the functioning of BamA homologs of the proteobacteria Neisseria meningitidis, Neisseria gonorrhoeae, Bordetella pertussis, Burkholderia mallei, and Escherichia coli in E. coli and in N. meningitidis. We found that no BamA functioned in another species than the authentic one, except for N. gonorrhoeae BamA, which fully complemented a N. meningitidis bamA mutant. E. coli BamA was not assembled into the N. meningitidis outer membrane. In contrast, the N. meningitidis BamA protein was assembled into the outer membrane of E. coli to a significant extent and also associated with BamD, an essential accessory lipoprotein of the Bam complex.Various chimeras comprising swapped N-terminal periplasmic and C-terminal membrane-embedded domains of N. meningitidis and E. coli BamA proteins were also not functional in either host, although some of them were inserted in the OM suggesting that the two domains of BamA need to be compatible in order to function. Furthermore, conformational analysis of chimeric proteins provided evidence for a 16-stranded β-barrel conformation of the membrane-embedded domain of BamA.
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Affiliation(s)
- Elena B. Volokhina
- Department of Molecular Microbiology and Institute of Biomembranes, Utrecht University, Utrecht, The Netherlands
| | - Jan Grijpstra
- Department of Molecular Microbiology and Institute of Biomembranes, Utrecht University, Utrecht, The Netherlands
| | - Frank Beckers
- Department of Molecular Microbiology and Institute of Biomembranes, Utrecht University, Utrecht, The Netherlands
| | - Erika Lindh
- Department of Molecular Microbiology and Institute of Biomembranes, Utrecht University, Utrecht, The Netherlands
| | - Viviane Robert
- Department of Molecular Microbiology and Institute of Biomembranes, Utrecht University, Utrecht, The Netherlands
| | - Jan Tommassen
- Department of Molecular Microbiology and Institute of Biomembranes, Utrecht University, Utrecht, The Netherlands
| | - Martine P. Bos
- Department of Molecular Microbiology and Institute of Biomembranes, Utrecht University, Utrecht, The Netherlands
- * E-mail:
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Plones T, Koryllos A, Beckers F, Stoelben E. Fatal migration of an endobronchial stent into the pulmonary artery. Case Reports 2013; 2013:bcr-2013-009650. [DOI: 10.1136/bcr-2013-009650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Schaefer F, Beckers F, Windisch W, Stoelben E. Die Sarkoidose - die seltene Ursache einer einseitigen Zwerchfellparese. Pneumologie 2013. [DOI: 10.1055/s-0033-1334541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Beckers F, Schäfer F, Stoelben E. Spontanremission eines histologisch nachgewiesenen Bronchialkarzinoms mit mediastinaler Lymphknotenmetastasierung. Pneumologie 2013. [DOI: 10.1055/s-0033-1334577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- A. Koryllos
- Kliniken der Stadt Köln Merheim, Thoraxchirurgie, Köln, Deutschland
| | - C. Ludwig
- Kliniken der Stadt Köln Merheim, Thoraxchirurgie, Köln, Deutschland
| | - F. Beckers
- Kliniken der Stadt Köln Merheim, Thoraxchirurgie, Köln, Deutschland
| | - E. Stoelben
- Kliniken der Stadt Köln Merheim, Thoraxchirurgie, Köln, Deutschland
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Morand P, Beckers F, Stoelben E. Die thorakoskopische Resektion des Lungenkarzinoms im Stadium I – Segmentresektion vs. Lobektomie. Pneumologie 2012. [DOI: 10.1055/s-0032-1302737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Angenendt S, Beckers F, Ludwig C, Stoelben E. Operationspflichtige Mediastinitis nach EUS-FNA, eine schwerwiegende Komplikation. Pneumologie 2012. [DOI: 10.1055/s-0032-1302804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
BACKGROUND Complications located at the tracheostoma often occur in combination with nosocomial infections. We posed the question: how is the surgical result in tracheal resections influenced by bacterial contamination with multiresistant germs? PATIENTS AND METHODS Between 2005 and 2009 we performed a primary end-to-end-resection of the trachea after tracheotomy in 30 patients. The demographic basic data, the diagnostic data on tracheal stenosis after decanullation and type of tracheotomy were documented. Preoperatively all patients underwent a flexible bronchoscopy with bronchial lavage. All patients received an antibiotic inhalation therapy postoperatively. RESULTS 16 patients presented a status post-permanent tracheotomy (PT), in 14 cases after percutaneous dilatative tracheotomy (PDT). In 64 % of all cases the preoperative bronchial lavage was positive for bacterial contamination. The major pathogen was with 23 % a multiresistant Pseudomonas aeruginosa (MR). In three cases long-term-complications occurred, all of which were bacterially contaminated. CONCLUSION After long-term intubation a bacterial contamination is very common and presents a negative predictor for the outcome of primary tracheal end-to-end resections. A prophylactic postoperative antibiotic therapy can improve the short- and long-term results.
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Affiliation(s)
- A Wolter
- Lungenklinik Merheim, Zentrum für Thoraxchirurgie, Pneumologie/Onkologie und Schlaf- und Beatmungsmedizin, Kliniken der Stadt Köln gGmbH.
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Liu J, Verheyden B, Beckers F, Aubert AE. Haemodynamic adaptation during sudden gravity transitions. Eur J Appl Physiol 2011; 112:79-89. [PMID: 21479958 DOI: 10.1007/s00421-011-1956-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 03/30/2011] [Indexed: 10/18/2022]
Abstract
Haemodynamic responses during parabolic flight were studied. The hypothesis that haemodynamic changes may be counteracted by a transient vagal reflex during acute gravity transitions was tested. ECG, arterial pressure and respiration were recorded continuously in seven male subjects during parabolic flight. Beat-to-beat haemodynamic parameters were estimated. In the supine position no significant differences were shown among the different gravity phases. In the upright position, significant within-group differences were observed across gravity phases for all parameters. Postural differences in haemodynamic data disappeared during the microgravity phase and were enlarged during hypergravity phases. Detailed temporal analysis of cardiac time series in standing subjects confirmed the hypothesized biphasic response of initial parasympathetic modulation: a sharp increase of RRI within 3-5 s followed by a 10% decrease in the remaining period of microgravity (p < 0.001); a sharp increase in SAP within 2-4 s followed by a slow decrease of 25%. Significant within-group differences were observed in the standing position for mean RRI (836 ± 170 ms, p = 0.003), DAP (66 ± 8 mmHg, p < 0.001), MAP (139 ± 12 mmHg, p = 0.001), RRI HF amplitude (17.6 ± 7.5 ms, p < 0.001), SV (146 ± 5%, p < 0.001) and SVR (73 ± 10%, p = 0.020). In standing subjects, the initial baroreflex-mediated vagal heart rate response is limited to a transition period at early microgravity lasting about 3-5 s, followed by a gradual heart rate recovery during the remaining 15-17 s due to a parasympathetic withdrawal. The resultant increase in cardiac output induces a baroreflex-mediated systemic vasodilatation, which may be the driving force for a decreased arterial pressure in weightlessness.
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Affiliation(s)
- Jiexin Liu
- Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
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Wolter A, Ludwig C, Beckers F, Stoelben E. Bedeutung nosokomialer Infektionen bei der Resektion trachealer Stenosen. Pneumologie 2011. [DOI: 10.1055/s-0031-1271987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Alberts C, Beckers F, Beier J, Ludwig C, Stoelben E. Interdisziplinäre Therapie der Ventilatorischen Insuffizienz bei fortgeschrittenem Emphysem, ein Fallbeispiel. Pneumologie 2011. [DOI: 10.1055/s-0031-1272269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Beckers F, Lange N, Stoecker C, Stoelben E. Ergebnisse der unilateralen anatomischen Lungenvolumenreduktionsoperation - auf die Zielregion und das Resektionsausmaß kommt es an. Pneumologie 2011. [DOI: 10.1055/s-0031-1272136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sinha AM, Brachmann J, Diener HC, Morillo CA, Sanna T, Bernstein RA, Di Lazzaro V, Passman R, Rymer M, Beckers F. Response from the authors to: Identification of paroxysmal atrial fibrillation also for primary prevention of embolic stroke. Am Heart J 2010. [DOI: 10.1016/j.ahj.2010.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sinha AM, Diener HC, Morillo CA, Sanna T, Bernstein RA, Di Lazzaro V, Passman R, Beckers F, Brachmann J. Cryptogenic Stroke and underlying Atrial Fibrillation (CRYSTAL AF): design and rationale. Am Heart J 2010; 160:36-41.e1. [PMID: 20598970 DOI: 10.1016/j.ahj.2010.03.032] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 03/18/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with atrial fibrillation (AF) are at increased risk for ischemic stroke. In patients who have suffered a stroke, screening for AF is routinely performed only for a short period after the stroke as part of the evaluation for possible causes. If AF is detected after an ischemic stroke, oral anticoagulation therapy is recommended for secondary stroke prevention. In 25% to 30% of stroke patients, the stroke mechanism cannot be determined (cryptogenic stroke). The incidence of paroxysmal AF undetected by short-term monitoring in patients with cryptogenic stroke is unknown, but has important therapeutic implications on patient care. The optimum monitoring duration and method of AF detection after stroke are unknown. The purpose of this study is to evaluate the incidence of AF and time to AF detection in patients with cryptogenic stroke using an insertable cardiac monitor. STUDY DESIGN The CRYSTAL AF trial is a randomized prospective study to evaluate a novel approach to long-term monitoring for AF detection in patients with cryptogenic stroke. Four hundred fifty cryptogenic stroke patients (by definition, without a history of AF) will be enrolled at approximately 50 sites in Europe, Canada, and the United States. Patients will be randomized in a 1:1 fashion to standard arrhythmia monitoring (control arm) or implantation of the subcutaneous cardiac monitor (Reveal XT; Medtronic, Inc, Minneapolis, MN) (continuous monitoring arm). OUTCOMES The primary end point is time to detection of AF within 6 months after stroke. The clinical follow-up period will be at least 12 months. Study completion is expected at the end of 2012.
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Verheyden B, Liu J, Beckers F, Aubert AE. Operational point of neural cardiovascular regulation in humans up to 6 months in space. J Appl Physiol (1985) 2010; 108:646-54. [DOI: 10.1152/japplphysiol.00883.2009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Entering weightlessness affects central circulation in humans by enhancing venous return and cardiac output. We tested whether the operational point of neural cardiovascular regulation in space sets accordingly to adopt a level close to that found in the ground-based horizontal position. Heart rate (HR), finger blood and brachial blood pressure (BP), and respiratory frequency were collected in 11 astronauts from nine space missions. Recordings were made in supine and standing positions at least 10 days before launch and during spaceflight ( days 5– 19, 45– 67, 77– 116, 146– 180). Cross-correlation analyses of HR and systolic BP were used to measure three complementary aspects of cardiac baroreflex modulation: 1) baroreflex sensitivity, 2) number of effective baroreflex estimates, and 3) baroreflex time delay. A fixed breathing protocol was performed to measure respiratory sinus arrhythmia and low-frequency power of systolic BP variability. We found that HR and mean arterial pressure did not differ from preflight supine values for up to 6 mo in space. Respiration frequency tended to decrease during prolonged spaceflight. Concerning neural markers of cardiovascular regulation, we observed in-flight adaptations toward homeostatic conditions similar to those found in the ground-based supine position. Surprisingly, this was not the case for baroreflex time delay distribution, which had somewhat longer latencies in space. Except for this finding, our results confirm that the operational point of neural cardiovascular regulation in space sets to a level close to that of an Earth-based supine position. This adaptation level suggests that circulation is chronically relaxed for at least 6 mo in space.
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Affiliation(s)
- B. Verheyden
- Laboratory Experimental Cardiology and Interdisciplinary Centre for Space Studies, University Hospital Gasthuisberg, Leuven, Belgium
| | - J. Liu
- Laboratory Experimental Cardiology and Interdisciplinary Centre for Space Studies, University Hospital Gasthuisberg, Leuven, Belgium
| | - F. Beckers
- Laboratory Experimental Cardiology and Interdisciplinary Centre for Space Studies, University Hospital Gasthuisberg, Leuven, Belgium
| | - A. E. Aubert
- Laboratory Experimental Cardiology and Interdisciplinary Centre for Space Studies, University Hospital Gasthuisberg, Leuven, Belgium
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Aubert AE, Verheyden B, d′Ydewalle C, Beckers F, Van den Bergh O. Effects of mental stress on autonomic cardiac modulation during weightlessness. Am J Physiol Heart Circ Physiol 2010; 298:H202-9. [DOI: 10.1152/ajpheart.00865.2009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sustained weightlessness affects all body functions, among these also cardiac autonomic control mechanisms. How this may influence neural response to central stimulation by a mental arithmetic task remains an open question. The hypothesis was tested that microgravity alters cardiovascular neural response to standardized cognitive load stimuli. Beat-to-beat heart rate, brachial blood pressure, and respiratory frequency were collected in five astronauts, taking part in three different short-duration (10 to 11 days) space missions to the International Space Station. Data recording was performed in supine position 1 mo before launch; at days 5 or 8 in space; and on days 1, 4, and 25 after landing. Heart rate variability (HRV) parameters were obtained in the frequency domain. Measurements were performed in the control condition for 10 min and during a 5-min mental arithmetic stress task, consisting of deducting 17 from a four-digit number, read by a colleague, and orally announcing the result. Our results show that over all sessions (pre-, in-, and postflight), mental stress induced an average increase in mean heart rate (Δ7 ± 1 beats/min; P = 0.03) and mean arterial pressure (Δ7 ± 1 mmHg; P = 0.006). A sympathetic excitation during mental stress was shown from HRV parameters: increase of low frequency expressed in normalized units (Δ8.3 ± 1.4; P = 0.004) and low frequency/high frequency (Δ1.6 ± 0.3; P = 0.001) and decrease of high frequency expressed in normalized units (Δ8.9 ± 1.4; P = 0.004). The total power was not influenced by mental stress. No effect of spaceflight was found on baseline heart rate, mean arterial pressure, and HRV parameters. No differences in response to mental stress were found between pre-, in-, and postflight. Our findings confirm that a mental arithmetic task in astronauts elicits sympathovagal shifts toward enhanced sympathetic modulation and reduced vagal modulation. However, these responses are not changed in space during microgravity or after spaceflight.
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Affiliation(s)
- André E. Aubert
- Laboratory of Experimental Cardiology, and Interdisciplinary Centre for Space Studies, University Hospital Gasthuisberg; and
| | - Bart Verheyden
- Laboratory of Experimental Cardiology, and Interdisciplinary Centre for Space Studies, University Hospital Gasthuisberg; and
| | | | - Frank Beckers
- Laboratory of Experimental Cardiology, and Interdisciplinary Centre for Space Studies, University Hospital Gasthuisberg; and
| | - Omer Van den Bergh
- Research Group on Health Psychology, Katholieke Universiteit Leuven, Leuven, Belgium
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Aubert AE, Verheyden B, Beckers F, Tack J, Vandenberghe J. Cardiac autonomic regulation under hypnosis assessed by heart rate variability: spectral analysis and fractal complexity. Neuropsychobiology 2009; 60:104-12. [PMID: 19776654 DOI: 10.1159/000239686] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 06/23/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study examined the effects of hypnosis on autonomic cardiac control. We hypothesized a modification of autonomic modulation of the heart rate with an enhanced vagal tone during hypnosis compared to baseline. METHODS In 12 healthy subjects (6 men and 6 women, 22.2 +/- 1.0 years of age) ECG was recorded at baseline and during hypnosis. Heart rate variability parameters were obtained in the frequency domain (LFnu: low frequency normalized units, and HFnu: high frequency normalized units) and from nonlinear analysis methods (detrended fluctuation analysis, DFA). RESULTS Compared to the control condition, hypnosis showed a significantly decreased LFnu, a significantly increased HFnu, and a significantly decreased LF/HF. DFA showed a significantly decreased short-range similarity. Heart rate remained unchanged. CONCLUSION Autonomic cardiac tone is significantly modified during hypnosis by shifting the balance of the sympathovagal interaction toward an enhanced parasympathetic modulation, accompanied by a reduction of the sympathetic tone and a decreased short-range similarity but without a concomitant change in heart rate. Central and secondary autonomous nervous system changes induced by hypnosis are a possible explanation for our results. Another highly probable explanation is given by a variation in the depth of respiration. Hypnosis appears to prevent the autonomic responses expected during neutral stimulation.
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Affiliation(s)
- André E Aubert
- Laboratory of Experimental Cardiology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium.
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Hausdorff W, Dagan R, Beckers F, Schuerman L. Estimating the direct impact of new conjugate vaccines against invasive pneumococcal disease. Vaccine 2009; 27:7257-69. [DOI: 10.1016/j.vaccine.2009.09.111] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2009] [Revised: 09/18/2009] [Accepted: 09/25/2009] [Indexed: 11/17/2022]
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Beckers F, Ludwig C, Cerinza J, Stoelben E. [Pulmonary nodules in underlying malignant diseases--not necessarily metastases of the primary tumour]. Pneumologie 2009; 63:693-6. [PMID: 19918721 DOI: 10.1055/s-0029-1215109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In this study the histological examination of pulmonary nodules and a comparison of the number of pre-, intra- and post-operative lung metastases in patients with a previous history of malignant disease were assessed. PATIENTS AND METHODS Between 1998 and 2003 we operated on 276 patients with suspected lung metastases. The histology of the primary tumour, the number of preoperatively diagnosed nodules, the number of lesions removed during surgery and the number of histologically confirmed metastases of 276 patients are presented. RESULTS In 276 patients a resection was performed. 161 of the patients were men (58.1%). The median age was 62 years (range: 21-86 years). In 110 cases a left-sided thoracotomy was performed (39.8%), in another 110 cases a right-sided thoracotomy was performed and in 56 cases we performed a bilateral thoracotomy (20.4%). In 15.2% the histology of the resected nodules was benign. In 8.6% of the cases the histological examination showed a primary lung cancer in stage I, in 74.4% of the cases the histology confirmed a metastasis of the primary cancer. CONCLUSIONS Solitary pulmonary nodules in patients with a previous history of malignant disease should always be resected for histological examination. Multiple pulmonary nodules should be histologically reappraised if there is any doubt about the entity.
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Affiliation(s)
- F Beckers
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln.
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Aubert AE, Verheyden B, Beckers F, Kesteloot H. Effect of 35 years beta-adrenergic blockade therapy on autonomic cardiovascular modulation. A case study. Acta Clin Belg 2009; 64:505-12. [PMID: 20101873 DOI: 10.1179/acb.2009.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The influence of long duration beta-blockade on autonomic and cardiovascular function remains not completely understood. The aim of this study was to evaluate the effect of long duration beta-adrenergic blockade treatment for hypertension control, on autonomic cardiovascular control in a 78-year-old male patient in relation to population findings. Heart rate variability was determined in the frequency domain (Total power, low frequency power and high frequency power), during baseline (supine and standing) and during 24 hour Holter recording. Results were compared with heart rate and heart rate variability data obtained from a normal healthy male population as a function of age. Circadian rhythm remained present. Heart rate during daytime was lower compared to the population group. None of the heart rate variability parameters were different from the normal population age group. Our results show that after 35 years of beta-blockade treatment, autonomic modulation of cardiac function remains within normal limits for that age group. Blood pressure remained at the higher limits (120-150/60-80 mmHg), but under control.
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Affiliation(s)
- A E Aubert
- Laboratory of Experimental Cardiology, University Hospital Gasthuisberg, KULeuven, Leuven, Belgium.
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Volokhina EB, Beckers F, Tommassen J, Bos MP. The beta-barrel outer membrane protein assembly complex of Neisseria meningitidis. J Bacteriol 2009; 191:7074-85. [PMID: 19767435 PMCID: PMC2772484 DOI: 10.1128/jb.00737-09] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Accepted: 09/09/2009] [Indexed: 11/20/2022] Open
Abstract
The evolutionarily conserved protein Omp85 is required for outer membrane protein (OMP) assembly in gram-negative bacteria and in mitochondria. Its Escherichia coli homolog, designated BamA, functions with four accessory lipoproteins, BamB, BamC, BamD, and BamE, together forming the beta-barrel assembly machinery (Bam). Here, we addressed the composition of this machinery and the function of its components in Neisseria meningitidis, a model organism for outer membrane biogenesis studies. Analysis of genome sequences revealed homologs of BamC, BamD (previously described as ComL), and BamE and a second BamE homolog, Mlp. No homolog of BamB was found. As in E. coli, ComL/BamD appeared essential for viability and for OMP assembly, and it could not be replaced by its E. coli homolog. BamE was not essential but was found to contribute to the efficiency of OMP assembly and to the maintenance of OM integrity. A bamC mutant showed only marginal OMP assembly defects, but the impossibility of creating a bamC bamE double mutant further indicated the function of BamC in OMP assembly. An mlp mutant was unaffected in OMP assembly. The results of copurification assays demonstrated the association of BamC, ComL, and BamE with Omp85. Semi-native gel electrophoresis identified the RmpM protein as an additional component of the Omp85 complex, which was confirmed in copurification assays. RmpM was not required for OMP folding but stabilized OMP complexes. Thus, the Bam complex in N. meningitidis consists of Omp85/BamA plus RmpM, BamC, ComL/BamD, and BamE, of which ComL/BamD and BamE appear to be the most important accessory components for OMP assembly.
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Affiliation(s)
- Elena B. Volokhina
- Department of Molecular Microbiology and Institute of Biomembranes, Utrecht University, 3584 CH Utrecht, The Netherlands
| | - Frank Beckers
- Department of Molecular Microbiology and Institute of Biomembranes, Utrecht University, 3584 CH Utrecht, The Netherlands
| | - Jan Tommassen
- Department of Molecular Microbiology and Institute of Biomembranes, Utrecht University, 3584 CH Utrecht, The Netherlands
| | - Martine P. Bos
- Department of Molecular Microbiology and Institute of Biomembranes, Utrecht University, 3584 CH Utrecht, The Netherlands
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Aubert AE, Vandeput S, Beckers F, Liu J, Verheyden B, Van Huffel S. Complexity of cardiovascular regulation in small animals. Philos Trans A Math Phys Eng Sci 2009; 367:1239-1250. [PMID: 19324706 DOI: 10.1098/rsta.2008.0276] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Oscillations of heart rate and blood pressure are related to the activity of the underlying control mechanism. They have been investigated mostly with linear methods in the time and frequency domains. Also, in recent years, many different nonlinear analysis methods have been applied for the evaluation of cardiovascular variability. This review presents the most commonly used nonlinear methods. Physiological understanding is obtained from various results from small animals.
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Affiliation(s)
- André E Aubert
- Laboratory Experimental Cardiology and Interdisciplinary Centre for Space Studies (ICSS), University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven 3000, Belgium.
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Beckers F, Ludwig C, Stoelben E. Analyse der Morbidität und Mortalität nach anatomischen Lungenresektionen stratifiziert nach der Lungenfunktion – welcher Patient ist inoperabel? Pneumologie 2009. [DOI: 10.1055/s-0029-1213824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Alberts CH, Beckers F, Lange N, Beier J, Stoelben E. Interventionelle Therapie bei beidseitiger idiopathischer Zwerchfellparese ein Fallbeispiel. Pneumologie 2009. [DOI: 10.1055/s-0029-1213975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Verheyden B, Beckers F, Couckuyt K, Liu J, Aubert AE. Respiratory modulation of cardiovascular rhythms before and after short-duration human spaceflight. Acta Physiol (Oxf) 2007; 191:297-308. [PMID: 17784903 DOI: 10.1111/j.1748-1716.2007.01744.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Astronauts commonly return from space with altered short-term cardiovascular dynamics and blunted baroreflex sensitivity. Although many studies have addressed this issue, post-flight effects on the dynamic circulatory control remain incompletely understood. It is not clear how long the cardiovascular system needs to recover from spaceflight as most post-flight investigations only extended between a few days and 2 weeks. METHODS In this study, we examined the effect of short-duration spaceflight (1-2 weeks) on respiratory-mediated cardiovascular rhythms in five cosmonauts. Two paced-breathing protocols at 6 and 12 breaths min(-1) were performed in the standing and supine positions before spaceflight, and after 1 and 25 days upon return. Dynamic baroreflex function was evaluated by transfer function analysis between systolic pressure and the RR intervals. RESULTS Post-flight orthostatic blood pressure control was preserved in all cosmonauts. In the standing position after spaceflight there was an increase in heart rate (HR) of approx. 20 beats min(-1) or more. Averaged for all five cosmonauts, respiratory sinus dysrhythmia and transfer gain reduced to 40% the day after landing, and had returned to pre-flight levels after 25 days. Low-frequency gain decreased from 6.6 (3.4) [mean (SD)] pre-flight to 3.9 (1.6) post-flight and returned to 5.7 (1.3) ms mmHg(-1) after 25 days upon return to Earth. Unlike alterations in the modulation of HR, blood pressure dynamics were not significantly different between pre- and post-flight sessions. CONCLUSION Our results indicate that short-duration spaceflight reduces respiratory modulation of HR and decreases cardiac baroreflex gain without affecting post-flight arterial blood pressure dynamics. Altered respiratory modulation of human autonomic rhythms does not persist until 25 days upon return to Earth.
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Affiliation(s)
- B Verheyden
- Laboratory of Experimental Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
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Verheyden B, Gisolf J, Beckers F, Karemaker JM, Wesseling KH, Aubert AE, Wieling W. Impact of age on the vasovagal response provoked by sublingual nitroglycerine in routine tilt testing. Clin Sci (Lond) 2007; 113:329-37. [PMID: 17504242 DOI: 10.1042/cs20070042] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
NTG (nitroglycerine) is used in routine tilt testing to elicit a vasovagal response. In the present study we hypothesized that with increasing age NTG triggers a more gradual BP (blood pressure) decline due to a diminished baroreflex-buffering capacity. The purpose of the present study was to examine the effect of NTG on baroreflex control of BP in patients with distinct age-related vasovagal collapse patterns. The study groups consisted of 29 patients (16-71 years old, 17 females) with clinically suspected VVS (vasovagal syncope) and a positive tilt test. Mean FAP (finger arterial pressure) was monitored continuously (Finapres). Left ventricular SV (stroke volume), CO (cardiac output) and SVR (systemic vascular resistance) were computed from the pressure pulsations (Modelflow). BRS (baroreflex sensitivity) was estimated in the time domain. In the first 3 min after NTG administration, BP was well-maintained in all patients. This implied an adequate arterial resistance response to compensate for steeper reductions in SV and CO with increasing age. HR (heart rate) increased and the BRS decreased after NTG administration. The rate of mean FAP fall leading to presyncope was inversely related to age (r=0.51, P=0.005). Accordingly, patients with a mean FAP fall >1.44 mmHg/s (median) were generally younger compared with patients with a slower mean FAP-fall (30+/-10 years compared with 51+/-17 years; P=0.001). The main determinant of the rate of BP fall on approach of presyncope was the rate of fall in HR (r=0.75, P<0.001). It was concluded that, in older patients, sublingual NTG provokes a more gradual BP decline compared with younger patients. This gradual decline cannot be ascribed to failure of the baroreflex-buffering capacity with increasing age. Age-related differences in the laboratory presentation of a vasovagal episode depend on the magnitude of the underlying bradycardic response.
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Affiliation(s)
- Bart Verheyden
- Laboratory of Experimental Cardiology, University Hospital Gasthuisberg, K.U. Leuven, Leuven, Belgium.
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Peeters E, Neyt A, Beckers F, De Smet S, Aubert AE, Geers R. Influence of supplemental magnesium, tryptophan, vitamin C, and vitamin E on stress responses of pigs to vibration. J Anim Sci 2007; 83:1568-80. [PMID: 15956466 DOI: 10.2527/2005.8371568x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Our objectives were to investigate and compare the effects of supplemental Mg, Trp, vitamin E (vit E), and vitamin C (vit C) on stress responses of pigs undergoing transport simulation. In this study, 126 pigs (25.1 +/- 4.4 kg BW) were allocated to one of the six following treatments: 1) negative control (no supplementation); 2) positive control (i.m. injection with 0.5 mg of carazolol/20 kg BW 12 h before vibration, beta-blocker); 3) Trp (additional amount of 6 g/kg of feed for 5 d, as-fed basis); 4) Mg (3 g/L drinking water for 2 d); 5) vit E (additional amount of 150 mg/kg of feed for 21 d, as-fed basis); 6) or vit C (additional amount of 300 mg/kg of feed for 21 d, as-fed basis). Pigs were treated in groups of three, and each treatment was replicated seven times. Feed and water intake were not different among treatments. Heart rate variables (mean, peak, and minimum heart rate, ventricular ectopic beats, and ST elevation of Channels A and B) and heart rate variability were registered from the night before vibration. Pigs were subjected to vibration in a transport simulator (8 Hz, 3 m/s) for 2 h and allowed to recover for 2 h. Generally, the positive control pigs had the lowest heart rate values (mean, peak, minimum heart rate, ST elevation of Channel A; P < 0.05), whereas Mg and Trp decreased ventricular ectopic beats and ST elevation of Channel B, respectively. The effect of vit C and E as vagal stimulators was clearly visible, whereas carazolol and Mg clearly blocked the sympathetic pathways of the autonomic nervous system. During vibration, the negative control pigs lay the least, and Mg pigs the most (P < 0.05). Salivary cortisol concentrations (taken before and after vibration and after recovery) showed that vit E pigs produced the least cortisol during stress periods. Intermediary metabolites (glucose, lactate, creatine kinase, and NEFA) were analyzed in plasma from blood taken before and after vibration. At the two sampling points, the vit E and Mg pigs had the lowest NEFA concentrations (P < 0.05), and the vit E pigs also had the lowest lactate concentrations before vibration. Urine samples were collected before and after vibration to determine catecholamine concentrations; only negative control pigs had an increase (P = 0.04) in epinephrine concentration, despite large individual variation. In general, these results indicate that the supplementation of Trp, Mg, vit E, or vit C improved coping ability of pigs during vibration comparison with the negative control treatment. A muscular injection of carazolol influenced only the heart rate variables.
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Affiliation(s)
- E Peeters
- Laboratory for Quality Care in Animal Production, Zootechnical Centre, K.U.Leuven, B-3360 Lovenjoel, Belgium.
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Anné W, Willems R, Holemans P, Beckers F, Roskams T, Lenaerts I, Ector H, Heidbüchel H. Self-terminating AF depends on electrical remodeling while persistent AF depends on additional structural changes in a rapid atrially paced sheep model. J Mol Cell Cardiol 2007; 43:148-58. [PMID: 17597147 DOI: 10.1016/j.yjmcc.2007.05.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 04/28/2007] [Accepted: 05/14/2007] [Indexed: 11/27/2022]
Abstract
The development of atrial fibrillation (AF) is associated with electrical and structural remodeling. The aim of this study was to assess the contribution of electrical and structural remodeling to the development of AF in a rapid atrially paced ovine model with and without His bundle ablation and to determine the role of the angiotensin pathway and matrix metalloproteinases in this process. Thirty-five sheep were rapidly paced in the atrium and were randomized to undergo His bundle ablation (HBA) (21 sheep; HBA sheep) or not (14 sheep; non-HBA sheep). After HBA the ventricles were paced at 80 bpm. Both groups were subdivided to receive active treatment (quinapril+losartan) or placebo. Sheep were followed for 15 weeks. Inducible AF was defined as a rapid irregular atrial rhythm lasting >1 min. Inducible AF was considered to be persistent if during further follow-up no sinus rhythm (SR) was documented anymore. The inducibility of AF with atrial tachypacing was not different between the 4 groups. On the other hand, non-HBA sheep developed persistent AF significantly earlier than HBA sheep (p=0.028). They had elevated ventricular rates, diminished atrial MMP-2, increased TIMP-2 expression, and more extensive atrial fibrosis. Active treatment in these sheep significantly lowered AT-II (p=0.018), prevented atrial fibrogenesis (p<0.001) and slowed the development of persistent AF (p=0.049). Electrical remodeling is sufficient to induce AF, while structural changes are needed for persistent AF. Fibrosis development in our model is the result of an increased expression of AT-II in combination with changes in MMP expression. Inhibition of the angiotensin pathway suppresses atrial fibrosis and the development of persistent AF.
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Affiliation(s)
- Wim Anné
- Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
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Verheyden B, Eijnde BO, Beckers F, Vanhees L, Aubert AE. Low-dose exercise training does not influence cardiac autonomic control in healthy sedentary men aged 55-75 years. J Sports Sci 2007; 24:1137-47. [PMID: 17175612 DOI: 10.1080/02640410500497634] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to evaluate the effects of a realistic, feasible, and commonly used fitness training programme on cardiac autonomic control in 14 sedentary men aged 62.0 +/- 6.1 years (mean +/- s). All participants performed a one-year fitness training programme in which training intensity and frequency were specifically chosen to be compliant for the majority of the participants (2-3 sessions per week at moderate intensity). At the same time, a reference group consisting of 15 sedentary age-matched men (age 64.2 +/- 6.5 years) did not change their habitual physical activity. Measurements were performed before and after the training intervention. Cardiac autonomic control was inferred from resting values (supine and standing) of heart rate variability (HRV) computed in the frequency domain over 10-min intervals. Endurance capacity was evaluated during a maximal incremental bicycle ergometer test. In spite of an increase in peak oxygen consumption (VO2peak) by 6.4% after training, heart rate in the training group remained unchanged at rest and at the same metabolic demand. No changes in resting parameters of HRV were shown for either groups or positions. Results from this study provide no evidence of a clinically meaningful increase in the vagal modulation to the sinus node at rest after one year of low-volume and moderate-intensity fitness training in men aged 55-75 years.
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Affiliation(s)
- Bart Verheyden
- Laboratory of Experimental Cardiology, Department of Cardiovascular Diseases, KU Leuven, Leuven, Belgium.
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Aubert AE, Beckers F, Cockuyt K, Liu J, Verheydenrst B. Cardiovascular function and gravity transitions during parabolic flight. Annu Int Conf IEEE Eng Med Biol Soc 2007; 2007:6673-6674. [PMID: 18003556 DOI: 10.1109/iembs.2007.4353890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Cardiovascular function and gravity transitions during parabolic flight.
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Affiliation(s)
- Andre E Aubert
- Laboratory Experimental Cardiology and Interdisciplinary Center for Space Studies (ICSS), Univ Hosp Gasthuisberg, K.U.Leuven, Leuven, Belgium
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Abstract
BACKGROUND An experimental setting and software were developed to evaluate cardiovascular autonomic function in conscious rats. A restrained approach was used, which, upon proper habituation, induced little or no stress in the rats and limited motion artifacts. METHODS The ECG and arterial blood pressure were recorded. Time- and frequency-domain indices of heart rate variability (HRV) and blood pressure variability (BPV) were calculated. The spontaneous baroreflex sensitivity (spBRS) was estimated using the method of statistical dependence. RESULTS The power spectra clearly concentrated in a frequency band with center frequency around 0.4 Hz, the low frequency (LF) component, and one at the respiratory frequency at 1.5 Hz, the high frequency (HF) component. In baseline conditions, a direct association existed between mean R-R and especially HRV parameters denoting vagal modulation such as rMSSD, pNN5, and HF power. Beta-adrenergic blockade by propranolol diminished basal heart rate. Vagal indices increased while there was an exclusive decrease in the low frequency band of HRV. Alpha-adrenergic blockade with phentolamine produced a depressor response with tachycardia, and a clear decrease in the LF component of BPV. Both the LF and HF component in the HRV spectrum were virtually absent. Cholinergic blockade with atropine did not significantly alter BP but induced a clear tachycardia with decreased vagal indices. The HF component of HRV was completely abolished and the LF band was reduced. CONCLUSIONS Both alpha- and beta-adrenergic blockade left spBRS virtually unaltered, while cholinergic blockade profoundly diminished spBRS. Spectral fluctuations of beta-sympathetic tone were restricted to the LF range of HRV, while the HF respiratory component represented vagal modulation. The alpha-sympathetic system played a dominant role in the LF oscillations of BPV. A role of the vagus in the HF oscillations of BPV in the rat is questioned. The baroreflex depended mainly on changes in vagal activity.
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Affiliation(s)
- Dirk Ramaekers
- Dept. of Cardiology, University Hospital Gasthuisberg O-N, Herestraat 49, B-3000 Leuven, Belgium
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Abstract
BACKGROUND Non-linear analysis of heart rate variability (HRV) can give additional information about autonomic control of the heart rate. This study applied the fractal dimension (FD) in a congestive heart failure (CHF) population. METHODS FD and HRV were evaluated in a healthy population (n=21) and an end-stage heart failure population (n=21) using 1-h segments during the day and night from Holter recordings. RESULTS CHF patients presented a loss of circadian variation in both FD and conventional time- and frequency-domain HRV indices. FD was higher in the CHF population both during the day and night. In the CHF population the correlation between FD and high-frequency power of HRV was lost. CONCLUSION Day-night variations of heart rate fluctuations are lost in heart failure. Changes in FD reflecting physiological and pathophysiological changes were observed.
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Affiliation(s)
- Frank Beckers
- Laboratory of Experimental Cardiology, Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Leuven, Belgium.
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Beckers F, Verheyden B, Ramaekers D, Swynghedauw B, Aubert AE. EFFECTS OF AUTONOMIC BLOCKADE ON NON-LINEAR CARDIOVASCULAR VARIABILITY INDICES IN RATS. Clin Exp Pharmacol Physiol 2006; 33:431-9. [PMID: 16700875 DOI: 10.1111/j.1440-1681.2006.04384.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
1. The present study assesses the effects of autonomic blockade (alpha- and beta-adrenoceptor and cholinergic) on cardiovascular function studied by heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity in rats using non-linear dynamics. Little is known about the influence of pharmacological autonomic nervous system interventions on non-linear cardiovascular regulatory indices. 2. In 13 conscious rats, heart rate and aortic blood pressure were measured continuously before, during and after autonomic blockade with atropine, phentolamine and propranolol. Non-linear scaling properties were studied using 1/f slope, fractal dimension and long- and short-term correlation. Non-linear complexity was described with correlation dimension, Lyapunov exponent and approximate entropy. Non-linear indices were compared with linear time and frequency domain indices. 3. Beta-adrenoceptor blockade did not alter the non-linear characteristics of HRV and BPV, although low-frequency power of HRV was depressed. Alpha-adrenoceptor blockade decreased the scaling behaviour of HRV, whereas cholinergic blockade decreased the complexity of the non-linear system of HRV. For BPV, the scaling behaviour was increased during alpha-adrenoceptor blockade and the complexity was increased during cholinergic blockade. The linear indices of HRV and BPV were decreased. 4. The present results indicate that the beta-adrenoceptor system has little involvement in the generation of non-linear HRV and BPV in rats. 5. Alpha-adrenoceptor blockade mostly influenced the scaling properties of the time series, whereas cholinergic blockade induced changes in the complexity measures. 6. The absence of the baroreflex mechanism can trigger a compensatory feed-forward system increasing the complexity of BPV.
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Affiliation(s)
- Frank Beckers
- Laboratory of Experimental Cardiology, School of Medicine, Gasthuisberg University Hospital, KU Leuven, Leuven, Belgium.
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Anne W, Willems R, Holemans P, Beckers F, Roskams T, Lenaerts I, Ector H, Heidbuchel H. AB46-5. Heart Rhythm 2006. [DOI: 10.1016/j.hrthm.2006.02.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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