1
|
Rafieezadeh A, Prabhakaran K, Kirsch J, Klein J, Shnaydman I, Bronstein M, Con J, Zangbar B. Shock Index is a Stronger Predictor of Outcomes in Older Compared to Younger Patients. J Surg Res 2024; 300:8-14. [PMID: 38788482 DOI: 10.1016/j.jss.2024.04.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION The shock index (SI) is a known predictor of unfavorable outcomes in trauma. This study seeks to examine and compare the SI values between geriatric patients and younger adults. METHODS We conducted a retrospective study of the Trauma Quality Improvement Program database from 2017 to 2019. All patients≥ 25 y with injury severity score ≥ 16 were included. Age groups were defined as 25-44 y (group A), 45-64 y (group B), and ≥65 y (group C). SI was calculated for all patients. The primary outcome was mortality and secondary outcomes were need for blood transfusion and need for major surgical intervention (consisting angiography, exploratory laparotomy, and thoracotomy). RESULTS A total of 244,943 patients were studied. The SI was highest in group A (0.82 ± 0.33) and lowest in group C (0.62 ± 0.30) (P < 0.001). Mortality rate of group C (17%) was significantly higher than group A (9.7%) and B (11.3%) (P < 0.001). In group A, each 0.1 increase in SI was associated with mortality (odds ratio [OR] = 1.079), need for blood transfusion (OR = 1.225) and need for major surgical intervention (OR = 1.347) (P < 0.001 for all). In group C, each 0.1 increase in SI was associated with mortality (OR = 1.126), need for blood transfusion (OR = 1.318), and need for major surgical intervention (OR = 1.648) (P < 0.001 for all). The area under the curve of SI was significantly higher in group C compared to other groups for needing a major surgical intervention and need for blood transfusion (P < 0.05 for both). CONCLUSIONS These results highlight the significance of the SI as a valuable indicator in geriatric patients with severe trauma. The findings show that SI predicts outcomes in geriatrics more strongly than in younger counterparts.
Collapse
Affiliation(s)
- Aryan Rafieezadeh
- Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Kartik Prabhakaran
- Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Jordan Kirsch
- Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Joshua Klein
- Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Ilya Shnaydman
- Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Matthew Bronstein
- Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Jorge Con
- Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Bardiya Zangbar
- Westchester Medical Center, New York Medical College, Valhalla, New York.
| |
Collapse
|
2
|
Bhattacharya B, Kodadek L, Nichiporenko I, Morrissey S, Kirsch J, Choi J, Ladhani H, Kasotakis G, Mukherjee K, Narsule C, Sharma R, Ruangvoravat L, Grushka J, Rattan R, Bugaev N. Role of Vena Cava Filter in the Prophylaxis and Treatment of Venous Thromboembolism in Injured Adult Patients: A Systematic Review, Meta-Analysis, and Practice Management Guideline from the Eastern Association for the Surgery of Trauma [RETRACTED]. J Trauma Acute Care Surg 2024:01586154-990000000-00653. [PMID: 38454308 DOI: 10.1097/ta.0000000000004289] [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: 03/09/2024]
Affiliation(s)
| | - Lisa Kodadek
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | | | | | - Jordan Kirsch
- Section of Trauma and Acute Care Surgery, Westchester Medical Center, Valhalla, NY
| | - Jeff Choi
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Husayn Ladhani
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO
| | - George Kasotakis
- Division of Trauma & Acute Care Surgery, Inova Fairfax Medical Campus, Falls Church, VA, University of Virginia
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University Health, Loma Linda, CA
| | - Chaitan Narsule
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA
| | - Rahul Sharma
- Section of Trauma and Acute Care Surgery, Mercy Hospital - St. Louis, St. Louis, MO
| | | | | | - Rishi Rattan
- Department of Surgery, Legacy Emanuel Medical Center, Portland, OR
| | - Nikolay Bugaev
- Associate Professor of Surgery, Emergency Surgical Services, Executive Director of Research, Department of Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington st, #4488, Boston, MA, 02111
| |
Collapse
|
3
|
Rafieezadeh A, Zangbar B, Zeeshan M, Gandhi C, Al-Mufti F, Jehan F, Kirsch J, Rodriguez G, Samson D, Prabhakaran K. Predictors of mortality after craniotomy for geriatric traumatic brain injury. Injury 2024:111585. [PMID: 38704345 DOI: 10.1016/j.injury.2024.111585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/02/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND With a sustained increase in the proportion of elderly trauma patients, geriatric traumatic brain injury (TBI) is a significant source of morbidity, mortality and resource utilization. The aim of our study was to assess the predictors of mortality in geriatric TBI patients who underwent craniotomy. METHODS We performed a 4-year analysis of ACS-TQIP database (2016-2019) and included all geriatric trauma patients (≥65y) with isolated severe TBI who underwent craniotomy. We calculated 11- point modified frailty index (mFI) for patients. Our primary and secondary outcomes were mortality and unfavorable outcome, respectively. Multivariate regression analysis was performed to identify the predictors of outcomes. Patients with mFI ≥ 0.25 were defined as Frail, whereas patient with mFI of 0.08 or higher (<0.25) were identified as pre-frail; Non-frail patients were identified as mFI of <0.08. RESULTS We analyzed data from 20,303 patients. The mortality rate was 17.7 % (3,587 patients). Having ≥ 2 concomitant types of intra-cranial hemorrhage (OR = 2.251, p < 0.001), and pre-hospital anticoagulant use (OR = 1.306, p < 0.001) increased the risks of mortality. Frailty, as a continuous variable, was not considered as a risk factor for mortality (p = 0.058) but after categorization, it was shown that compared to non-frails, patients with pre-frailty (OR = 1.946, p = 0.011) and frailty (OR = 1.786, p = 0.026) had increased risks of mortality. Higher mFI (OR = 4.841), age (OR = 1.034), ISS (OR = 1.052), having ≥ 2 concomitant types of intra-cranial hemorrhage (OR = 1.758), and use of anticoagulants (OR = 1.117) were significant risk factors for unfavorable outcomes (p < 0.001, for all). CONCLUSIONS Having more than two types of intra-cranial hemorrhage and pre-hospital anticoagulant use were significant risk factors for mortality. The study's findings also suggest that frailty may not be a sufficient predictor of mortality after craniotomy in geriatric patients with TBI. However, frailty still affects the discharge disposition and favorable outcome. LEVEL OF EVIDENCE Level III retrospective study.
Collapse
Affiliation(s)
- Aryan Rafieezadeh
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Bardiya Zangbar
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States.
| | - Muhammad Zeeshan
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Chirag Gandhi
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Fawaz Al-Mufti
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Faisal Jehan
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Jordan Kirsch
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Gabriel Rodriguez
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - David Samson
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Kartik Prabhakaran
- Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| |
Collapse
|
4
|
Hanna K, Zangbar B, Kirsch J, Bronstein M, Okumura K, Gogna S, Shnaydman I, Prabhakaran K, Con J. Non-operative management of cirrhotic patients with acute calculous cholecystitis: How effective is it? Am J Surg 2023; 226:668-674. [PMID: 37482476 DOI: 10.1016/j.amjsurg.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Nonoperative management (NOM) of acute calculous cholecystitis (ACC) in patients with cirrhosis was proposed. We examined the outcomes of cirrhotic patients with ACC treated with cholecystectomy compared to NOM. METHODS We analyzed the 2017-Nationwide Readmissions Database including cirrhotic patients with ACC. Patients were stratified: cholecystectomy, percutaneous cholecystostomy (PCT), and antibiotics only. PRIMARY OUTCOMES complications, failure of NOM. SECONDARY OUTCOMES mortality, length of stay (LOS), and charges. RESULTS 3454 patients were identified. 1832 underwent cholecystectomy, 360 PCT, and 1262 were treated with antibiotics. PCT patients had higher mortality 16.9% vs. the antibiotics group 10.9% vs. cholecystectomy group 4.2%. PCT patients had longer LOS, but lower charges compared to the operative group. Failure of NOM was 28.2%. On regression, PCT was associated with mortality. CONCLUSION ACC remains a morbid disease in cirrhosis patients. One in three failed NOM, had longer LOS, and higher mortality. Further studies are warranted to identify predictors of NOM failure. LEVEL OF EVIDENCE Level III, prognostic.
Collapse
Affiliation(s)
- Kamil Hanna
- Department of Surgery, Westchester Medical Center, New York, USA.
| | - Bardiya Zangbar
- Department of Surgery, Westchester Medical Center, New York, USA.
| | - Jordan Kirsch
- Department of Surgery, Westchester Medical Center, New York, USA.
| | | | - Kenji Okumura
- Department of Surgery, Westchester Medical Center, New York, USA.
| | - Shekhar Gogna
- Department of Surgery, Medstar Health, Washington, USA.
| | - Ilya Shnaydman
- Department of Surgery, Westchester Medical Center, New York, USA.
| | | | - Jorge Con
- Department of Surgery, Westchester Medical Center, New York, USA.
| |
Collapse
|
5
|
Choi J, Badrinathan A, Shine R, Benz C, Toia A, Crown T, Whitbeck SA, Kryskow M, White T, Kirsch J. Challenges in closing the gap between evidence and practice: International survey of institutional surgical stabilization of rib fractures guidelines. J Trauma Acute Care Surg 2023; 94:562-566. [PMID: 36149855 DOI: 10.1097/ta.0000000000003785] [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: 11/25/2022]
Abstract
BACKGROUND Surgical stabilization of rib fractures (SSRF) has gained increasing interest over the past decade, yet few candidates who could benefit from SSRF undergo operative management. We conducted an international survey of institutional SSRF guidelines comparing congruence between practice and contemporary evidence. We hypothesized that few guidelines reflect comprehensive evidence to facilitate standardized patient selection, operation, and postoperative management. METHODS A request for institutional rib fracture guidelines was distributed from the Chest Wall Injury Society. Surgical stabilization of rib fractures-specific guideline contents were extracted using a priori-designed extraction sheets and compared against 28 SSRF evidence-based recommendations outlined by a panel of 14 international experts. Fisher's exact test compared the proportion of strong and weak evidence-based recommendations specified within a majority of institutional guidelines to evaluate whether strength of evidence is associated with implementation. RESULTS A total of 36 institutions from 3 countries submitted institutional rib fracture management guidelines, among which 30 had SSRF-specific guidance. Twenty-eight guidelines (93%) listed at least one injury pattern criteria as an indication for SSRF, while 22 (73%) listed pain and 21 (70%) listed impaired respiratory function as other indications. Quantitative pain and respiratory function impairment thresholds that warrant SSRF varied across institutions. Few guidelines specified nonacute indications for SSRF or perioperative considerations. Seven guidelines (23%) detailed postoperative management but recommended timing and interval for follow-up varied. Overall, only 3 of the 28 evidence-based SSRF recommendations were specified within a majority of institutional practice guidelines. There was no statistically significant association ( p = 0.99) between the strength of recommendation and implementation within institutional guidelines. CONCLUSION Institutional SSRF guidelines do not reflect the totality of evidence available in contemporary literature. Guidelines are especially important for emerging interventions to ensure standardized care delivery and minimize low-value care. Consensus effort is needed to facilitate adoption and dissemination of evidence-based SSRF practices. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
Collapse
Affiliation(s)
- Jeff Choi
- From the Department of Surgery (J.C.), Stanford University, Stanford, California; Department of Surgery (A.B.), The Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio; Department of Surgery (R.S.), The University of Texas Rio Grande Valley, Edinburg, Texas; Department of Cardiovascular and Thoracic Surgery (C.B.), The University of Texas Medical Branch at Galveston, Galveston, Texas; Department of Surgery (T.C.), Menorah Medical Center, Overland Park, KS; Department of Surgery (A.T., M.K.), Berkshire Health Systems, Pittsfield, Massachusetts; Chest Wall Injury Society (S.A.W.), Salt Lake City, Utah; Department of Surgery (T.W.), Intermountain Healthcare, Salt Lake City, Utah; and Department of Surgery (J.K.), Westchester Medical Center, Valhalla, New York
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Matthay ZA, Hellmann ZJ, Callcut RA, Matthay EC, Nunez-Garcia B, Duong W, Nahmias J, LaRiccia AK, Spalding MC, Dalavayi SS, Reynolds JK, Lesch H, Wong YM, Chipman AM, Kozar RA, Penaloza L, Mukherjee K, Taghlabi K, Guidry CA, Seng SS, Ratnasekera A, Motameni A, Udekwu P, Madden K, Moore SA, Kirsch J, Goddard J, Haan J, Lightwine K, Ontengco JB, Cullinane DC, Spitzer SA, Kubasiak JC, Gish J, Hazelton JP, Byskosh AZ, Posluszny JA, Ross EE, Park JJ, Robinson B, Abel MK, Fields AT, Esensten JH, Nambiar A, Moore J, Hardman C, Terse P, Luo-Owen X, Stiles A, Pearce B, Tann K, Abdul Jawad K, Ruiz G, Kornblith LZ. Outcomes after ultramassive transfusion in the modern era: An Eastern Association for the Surgery of Trauma multicenter study. J Trauma Acute Care Surg 2021; 91:24-33. [PMID: 34144557 PMCID: PMC8243874 DOI: 10.1097/ta.0000000000003121] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Indexed: 01/28/2023]
Abstract
BACKGROUND Despite the widespread institution of modern massive transfusion protocols with balanced blood product ratios, survival for patients with traumatic hemorrhage receiving ultramassive transfusion (UMT) (defined as ≥20 U of packed red blood cells [RBCs]) in 24 hours) remains low and resource consumption remains high. Therefore, we aimed to identify factors associated with mortality in trauma patients receiving UMT in the modern resuscitation era. METHODS An Eastern Association for the Surgery of Trauma multicenter retrospective study of 461 trauma patients from 17 trauma centers who received ≥20 U of RBCs in 24 hours was performed (2014-2019). Multivariable logistic regression and Classification and Regression Tree analysis were used to identify clinical characteristics associated with mortality. RESULTS The 461 patients were young (median age, 35 years), male (82%), severely injured (median Injury Severity Score, 33), in shock (median shock index, 1.2; base excess, -9), and transfused a median of 29 U of RBCs, 22 U of fresh frozen plasma (FFP), and 24 U of platelets (PLT). Mortality was 46% at 24 hours and 65% at discharge. Transfusion of RBC/FFP ≥1.5:1 or RBC/PLT ≥1.5:1 was significantly associated with mortality, most pronounced for the 18% of patients who received both RBC/PLT and RBC/FFP ≥1.5:1 (odds ratios, 3.11 and 2.81 for mortality at 24 hours and discharge; both p < 0.01). Classification and Regression Tree identified that age older than 50 years, low initial Glasgow Coma Scale, thrombocytopenia, and resuscitative thoracotomy were associated with low likelihood of survival (14-26%), while absence of these factors was associated with the highest survival (71%). CONCLUSION Despite modern massive transfusion protocols, one half of trauma patients receiving UMT are transfused with either RBC/FFP or RBC/PLT in unbalanced ratios ≥1.5:1, with increased associated mortality. Maintaining focus on balanced ratios during UMT is critical, and consideration of advanced age, poor initial mental status, thrombocytopenia, and resuscitative thoracotomy can aid in prognostication. LEVEL OF EVIDENCE Prognostic, level III.
Collapse
Affiliation(s)
- Zachary A Matthay
- From the Department of Surgery at Zuckerberg San Francisco General Hospital, University of California San Francisco (Z.A.M., Z.J.H., R.A.C., B.N.-G., L.Z.K., E.E.R., J.J.P., B.R., M.K.A., A.T.F.), San Francisco, California; Department of Epidemiology and Biostatistics, University of California San Francisco (E.C.M), San Francisco, California; Department of Laboratory Medicine, University of California, San Francisco (J.H.E., A.N., J.M.), San Francisco, California; Department of Surgery, University of California Irvine (W.D., J.N.), Irvine, Orange, California; Department of Surgery, Ohio Health Grant Medical Center (A.K.L., M.C.S.), Columbus, Ohio; Department of Surgery, University of Kentucky (S.S.D., J.K.R.), Lexington, Kentucky; Department of Surgery, Miami Valley Hospital (H.L., Y.W., C.H.), Dayton, Ohio; Department of Surgery, R Adams Cowley Shock Trauma Center (A.M.C., R.A.K., P.T.), University of Maryland School of Medicine, Baltimore, Maryland; Department of Surgery, Loma Linda Medical Center (L.P., K.M., X.L.-O.), Loma Linda, California; Department of Surgery, University of Kansas Medical Center (K.T., C.A.G.), Kansas City, Kansas; Department of Surgery, Crozer-Chester Medical Center (S.S.S., A.R.), Upland, Pennsylvania; Department of Surgery, WakeMed Health and Hospitals (A.M., P.U., A.S., B.P., K.T.), Raleigh, North Carolina; Department of Surgery, University of New Mexico School of Medicine (K.M., S.A.M.), Albuquerque, New Mexico; Department of Surgery, Wellspan York Hospital (J.G.), York, Pennsylvania; Department of Surgery, Ascension Via Christi Hospitals St. Francis (J.K., J.H., K.L.), Wichita, Kansas; Department of Surgery, Maine Medical Center (J.B.O., D.C.C.), Portland, Maine; Department of Surgery, South Shore Hospital/Brigham and Women's Hospital (S.A.S., J.C.K.), Boston, Massachusetts; Department of Surgery, Penn State Hershey Medical Center (J.G., J.P.H.), Hershey, Pennsylvania; Department of Surgery, Northwestern University Feinberg School of Medicine (A.Z.B., J.A.P.), Chicago, Illinois; Department of Surgery, University of California (R.A.C.), UC Davis, Sacramento, California; Department of Surgery, Ryder Trauma Center (K.A.J., G.R.), University of Miami Miller School of Medicine, Miami, Florida; and Washington University School of Medicine St. Louis (J.K.), Missouri
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Pieracci FM, Schubl S, Gasparri M, Delaplain P, Kirsch J, Towe C, White TW, Whitbeck S, Doben AR. The Chest Wall Injury Society Recommendations for Reporting Studies of Surgical Stabilization of Rib Fractures. Injury 2021; 52:1241-1250. [PMID: 33795145 DOI: 10.1016/j.injury.2021.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/20/2021] [Accepted: 02/12/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Publications investigating the efficacy of surgical stabilization of rib fractures (SSRF) have increased exponentially. However, there is currently no standardized reporting structure for these studies, rendering both comparisons and extrapolation problematic. METHODS A subject matter expert group was formed by the Chest Wall Injury Society. This group conducted a review of the SSRF investigational literature and identified variable reporting within several general categories of relevant parameters. A compliment of guidelines was then generated. RESULTS The reporting guidelines consist of 26 recommendations in the categories of: (1) study type, (2) patient and injury characteristics, (3) patient treatments, (4) outcomes, and (5) statistical considerations. CONCLUSION Our review identified inconsistencies in reporting within the investigational SSRF literature. In response to these inconsistencies, we propose a set of recommendations to standardize reporting of original investigations into the efficacy of SSRF.
Collapse
Affiliation(s)
- Fredric M Pieracci
- Department Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO.
| | - Sebastian Schubl
- Department of Surgery, University of California-Irvine, Irvine, CA
| | - Mario Gasparri
- Department of Surgery, Division of CT Surgery, Medical College of Wisconsin, Milwaukee, WI
| | | | - Jordan Kirsch
- Department of Surgery, Section of Acute and Critical Care Surgery, Barnes-Jewish Hospital/Washington University, St. Louis, MI
| | - Christopher Towe
- Department of CT Surgery, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Thomas W White
- Department of Surgery, Intermountain Medical Center, Murray, UT
| | | | - Andrew R Doben
- Department of Surgery, St. Francis Medical Center, Hartford, CT
| |
Collapse
|
8
|
Rösch D, Ruckelshaußen S, Kirsch J, Gerhards S, Sroka LA, Imhoff R. Schwachsinnig und abartig? Wahrgenommene Stigmatisierung und tatsächliche Etikettierungseffekte der alten und modernisierten Eingangsmerkmale in § 20 Strafgesetzbuch (StGB). Forens Psychiatr Psychol Kriminol 2021. [DOI: 10.1007/s11757-020-00640-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
ZusammenfassungBei der Beurteilung der Schuldfähigkeit eines Beschuldigten nach §§ 20, 21 StGB muss zunächst beurteilt werden, ob ein Eingangsmerkmal vorliegt, das verminderte oder reduzierte Schuldfähigkeit bedingen könnte, sowie ob dieses Eingangsmerkmal den Beschuldigten hinreichend in Einsichts- und/oder Steuerungsfähigkeit beeinflusst. Die bislang geltenden Eingangsmerkmale sind z. T. als veraltet und stigmatisierend kritisiert worden – insbesondere die der schweren anderen seelischen Abartigkeit und des Schwachsinns –, sodass im Jahr 2019 ein Gesetz zur Änderung des Strafgesetzbuches vorgelegt wurde, das eine Modernisierung der Begriffe beinhaltet. Die vorliegende Studie überprüft erstmals, ob die verschiedenen Begriffe (Intelligenzminderung vs. Schwachsinn; seelische Störung vs. seelische Abartigkeit) als unterschiedlich stigmatisierend wahrgenommen werden und zu unterschiedlicher Personenwahrnehmung führen. Zu diesem Zweck füllten 208 Personen, darunter rechtspsychologische Laien (n = 131) und Personen mit Vorwissen (n = 77), Onlinefragebogen aus, in denen sie sowohl anhand von Fallvignetten u. a. Schuldfähigkeit, Gefährlichkeit und Einsichtsfähigkeit von Personen einschätzen mussten als auch die unterschiedlichen Eingangsmerkmale direkt beurteilten. Die Ergebnisse zeigen, dass die überarbeiteten Begriffe als signifikant juristisch angemessener, positiver konnotiert, weniger stigmatisierend und weniger abwertend eingestuft werden. Auch bei einer qualitativen Untersuchung von Assoziationen der Probanden zu den jeweiligen Begriffen zeigten sich deutlich negativere Konnotationen der alten Begriffe. Gleichzeitig zeigte sich jedoch, dass sich die Bewertung von Individuen, die jeweils mit diesen Begriffen betitelt wurden, nicht unterschied, auch nicht bei rechtspsychologischen Laien. Sowohl rechtspsychologische Laien als auch Personen mit Vorwissen haben demnach zwar eindeutige Ansichten zu den vorliegenden Begriffen, diese wirken sich jedoch nicht signifikant auf ihre Personenwahrnehmung aus.
Collapse
|
9
|
Barthes J, Lagarrigue P, Riabov V, Lutzweiler G, Kirsch J, Muller C, Courtial EJ, Marquette C, Projetti F, Kzhyskowska J, Lavalle P, Vrana NE, Dupret-Bories A. Biofunctionalization of 3D-printed silicone implants with immunomodulatory hydrogels for controlling the innate immune response: An in vivo model of tracheal defect repair. Biomaterials 2020; 268:120549. [PMID: 33278685 DOI: 10.1016/j.biomaterials.2020.120549] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 12/23/2022]
Abstract
The recent advances in 3D-printed silicone (PDMS: polydimethylsiloxane) implants present prospects for personalized implants with highly accurate anatomical conformity. However, a potential adverse effect, such as granuloma formation due to immune reactions, still exists. One potential way to overcome this problem is to control the implant/host interface using immunomodulatory coatings. In this study, a new cytokine cocktail composed of interleukin-10 and prostaglandin-E2 was designed to decrease adverse immune reactions and promote tissue integration by fixing macrophages into M2 pro-healing phenotype for an extended period of time. In vitro, the cytokine cocktail maintained low levels of pro-inflammatory cytokine (TNF-α and IL-6) secretions and induced the secretion of IL-10 and the upregulation of multifunctional scavenging and sorting receptor stabilin-1, expressed by M2 macrophages. This cocktail was then loaded in a gelatine-based hydrogel to develop an immunomodulatory material that could be used as a coating for medical devices. The efficacy of this coating was demonstrated in an in vivo rat model during the reconstruction of a tracheal defect by 3D-printed silicone implants. The coating was stable on the silicone implants for over 2 weeks, and the controlled release of the cocktail components was achieved for at least 14 days. In vivo, only 33% of the animals with bare silicone implants survived, whereas 100% of the animals survived with the implant equipped with the immunomodulatory hydrogel. The presence of the hydrogel and the cytokine cocktail diminished the thickness of the inflammatory tissue, the intensity of both acute and chronic inflammation, the overall fibroblastic reaction, the presence of oedema and the formation of fibrinoid (assessed by histology) and led to a 100% survival rate. At the systemic level, the presence of immunomodulatory hydrogels significantly decreased pro-inflammatory cytokines such as TNF-α, IFN-γ, CXCL1 and MCP-1 levels at day 7 and significantly decreased IL-1α, IL-1β, CXCL1 and MCP-1 levels at day 21. The ability of this new immunomodulatory hydrogel to control the level of inflammation once applied to a 3D-printed silicone implant has been demonstrated. Such thin coatings can be applied to any implants or scaffolds used in tissue engineering to diminish the initial immune response, improve the integration and functionality of these materials and decrease potential complications related to their presence.
Collapse
Affiliation(s)
- J Barthes
- Institut National de La Santé et de La Recherche Médicale, INSERM UMR1121 "Biomaterials and Bioengineering", 11 Rue Humann, 67085, Strasbourg, France.
| | - P Lagarrigue
- Institut National de La Santé et de La Recherche Médicale, INSERM UMR1121 "Biomaterials and Bioengineering", 11 Rue Humann, 67085, Strasbourg, France
| | - V Riabov
- Institute for Transfusion Medicine and Immunology, Medical, Faculty Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
| | - G Lutzweiler
- Institut National de La Santé et de La Recherche Médicale, INSERM UMR1121 "Biomaterials and Bioengineering", 11 Rue Humann, 67085, Strasbourg, France
| | - J Kirsch
- Institute for Transfusion Medicine and Immunology, Medical, Faculty Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
| | - C Muller
- Institut National de La Santé et de La Recherche Médicale, INSERM UMR1121 "Biomaterials and Bioengineering", 11 Rue Humann, 67085, Strasbourg, France
| | - E-J Courtial
- 3d.FAB, Université Lyon1, CNRS, INSA, CPE-Lyon, ICBMS, UMR 5246, 43, Bd du 11 Novembre 1918, 69622, Villeurbanne cedex, France
| | - C Marquette
- 3d.FAB, Université Lyon1, CNRS, INSA, CPE-Lyon, ICBMS, UMR 5246, 43, Bd du 11 Novembre 1918, 69622, Villeurbanne cedex, France
| | - F Projetti
- Department of Pathology, 18 rue du general Catroux, 87039, Limoges Cedex 1, France
| | - J Kzhyskowska
- Institute for Transfusion Medicine and Immunology, Medical, Faculty Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany; German Red Cross Blood Service Baden-Württemberg - Hessen, Mannheim, Germany; National Research Tomsk State University, Tomsk, 634050, Russia
| | - P Lavalle
- Institut National de La Santé et de La Recherche Médicale, INSERM UMR1121 "Biomaterials and Bioengineering", 11 Rue Humann, 67085, Strasbourg, France
| | - N E Vrana
- Institut National de La Santé et de La Recherche Médicale, INSERM UMR1121 "Biomaterials and Bioengineering", 11 Rue Humann, 67085, Strasbourg, France; Spartha Medical, 14B rue de La Canardière, 67100, Strasbourg, France
| | - A Dupret-Bories
- Department of Otorhinolaryngology, Head and Neck Surgery, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse Oncopole, 31009, Toulouse, France.
| |
Collapse
|
10
|
Kensche A, Buschbeck E, König B, Koch M, Kirsch J, Hannig C, Hannig M. Effect of fluoride mouthrinses and stannous ions on the erosion protective properties of the in situ pellicle. Sci Rep 2019; 9:5336. [PMID: 30926846 PMCID: PMC6441001 DOI: 10.1038/s41598-019-41736-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 08/07/2018] [Accepted: 03/13/2019] [Indexed: 12/19/2022] Open
Abstract
The particular feature of this study is the investigation of effects of pure fluoride- or stannous ions based mouthrinses on the erosion protective properties and the ultrastructure of the in situ pellicle (12 volunteers). Experimental solutions were prepared either from 500 ppm NaF, SMFP, AmF or SnF2 or 1563 ppm SnCl2, respectively. After 1 min of in situ pellicle formation on bovine enamel slabs, rinses with one of the preparations were performed for 1 min and intraoral specimens’ exposure was continued for 28 min. Native enamel slabs and rinses with bidestilled water served as controls. After oral exposure, slabs were incubated in HCl (pH 2; 2.3; 3) for 120 s and kinetics of calcium- and phosphate release were measured photometrically; representative samples were analysed by TEM and EDX. All mouthrinses reduced mineral loss compared to the native 30-min pellicle. The effect was pH-dependent and significant at all pH values only for the tin-containing mouthrinses. No significant differences were observed between the SnF2- and the SnCl2-containing solutions. TEM/EDX confirmed ultrastructural pellicle modifications. SnF2 appears to be the most effective type of fluoride to prevent erosive enamel demineralisation. The observed effects primarily have to be attributed to the stannous ions’ content.
Collapse
Affiliation(s)
- A Kensche
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, D-01307, Dresden, Germany.
| | - E Buschbeck
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, D-01307, Dresden, Germany
| | - B König
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital, Saarland University, Building 73, D-66421, Homburg/Saar, Germany
| | - M Koch
- Physical Analytics, INM - Leibnitz Institute for New Materials, D-66123, Saarbrücken, Germany
| | - J Kirsch
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, D-01307, Dresden, Germany
| | - C Hannig
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, D-01307, Dresden, Germany
| | - M Hannig
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital, Saarland University, Building 73, D-66421, Homburg/Saar, Germany
| |
Collapse
|
11
|
Maharjan D, Rodas-González A, Tanner A, Kennedy V, Kirsch J, Gaspers J, Negrin-Pereira N, Fontoura A, Bauer M, Swanson K, Reynolds L, Stokka G, Ward A, Dahlen C, Neville B, Wittenberg K, McGeough E, Vonnahme K, Schaefer A, López-Campos Ó, Aalhus J, Ominski K. PSIX-14 Impact of needle-free injection device on injection-site tissue damage in beef sub-primals. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Maharjan
- University of Manitoba, Winnipeg, MB, Canada
| | | | - A Tanner
- North Dakota State University,Fargo, ND, United States
| | - V Kennedy
- North Dakota State University,Fargo, ND, United States
| | - J Kirsch
- North Dakota State University,Fargo, ND, United States
| | - J Gaspers
- North Dakota State University,Fargo, ND, United States
| | | | - A Fontoura
- Cornell University,Ithaca, NY, United States
| | - M Bauer
- North Dakota State University,Fargo, ND, United States
| | - K Swanson
- North Dakota State University,Fargo, ND, United States
| | - L Reynolds
- North Dakota State University,Fargo, ND, United States
| | - G Stokka
- North Dakota State University,Fargo, ND, United States
| | - A Ward
- North Dakota State University,Fargo, ND, United States
| | - C Dahlen
- North Dakota State University,Fargo, ND, United States
| | - B Neville
- Carrington REC,Carrington, ND, United States
| | | | - E McGeough
- University of Manitoba, Winnipeg, MB, Canada
| | - K Vonnahme
- North Dakota State University,Fargo, ND, United States
| | - A Schaefer
- University of Alberta,Lacombe, AB, Canada
| | - Ó López-Campos
- Agriculture and Agri-Food Canada, Lacombe Research and Development Centre, 6000 C & E Trail,Lacombe, Alberta, Canada T4L 1W1
| | - J Aalhus
- Agriculture and Agri-Food Canada, Lacombe Research and Development Centre, 6000 C & E Trail,Lacombe, Alberta, Canada T4L 1W1
| | - K Ominski
- University of Manitoba, Winnipeg, MB, Canada
| |
Collapse
|
12
|
Maharjan D, Rodas-González A, Tanner A, Kennedy V, Kirsch J, Gaspers J, Negrin-Pereira N, Fontoura A, Bauer M, Swanson K, Reynolds L, Stokka G, Ward A, Dahlen C, Neville B, Wittenberg K, McGeough E, Vonnahme K, Schaefer A, López-Campos Ó, Aalhus J, Gardiner P, Ominski K. PSI-35 Corn supplementation of beef cows and its impact on growth performance and carcass outcomes of their progeny. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Maharjan
- University of Manitoba, Winnipeg, MB, Canada
| | | | - A Tanner
- North Dakota State University,Fargo, ND, United States
| | - V Kennedy
- North Dakota State University,Fargo, ND, United States
| | - J Kirsch
- North Dakota State University,Fargo, ND, United States
| | - J Gaspers
- North Dakota State University,Fargo, ND, United States
| | | | - A Fontoura
- Cornell University,Ithica, NY, United States
| | - M Bauer
- North Dakota State University,Fargo, ND, United States
| | - K Swanson
- North Dakota State University,Fargo, ND, United States
| | - L Reynolds
- North Dakota State University,Fargo, ND, United States
| | - G Stokka
- North Dakota State University,Fargo, ND, United States
| | - A Ward
- North Dakota State University,Fargo, ND, United States
| | - C Dahlen
- North Dakota State University,Fargo, ND, United States
| | - B Neville
- Carrington REC, Foster County, ND, United States
| | | | - E McGeough
- University of Manitoba, Winnipeg, MB, Canada
| | - K Vonnahme
- North Dakota State University,Fargo, ND, United States
| | - A Schaefer
- University of Alberta,Lacombe, AB, Canada
| | - Ó López-Campos
- Agriculture and Agri-Food Canada, Lacombe Research and Development Centre,Lacombe, AB, Canada
| | - J Aalhus
- Agriculture and Agri-Food Canada, Lacombe Research and Development Centre,Lacombe, AB, Canada
| | - P Gardiner
- University of Manitoba, Winnipeg, MB, Canada
| | - K Ominski
- University of Manitoba, Winnipeg, MB, Canada
| |
Collapse
|
13
|
Rosshirt N, Hagmann S, Tripel E, Gotterbarm T, Kirsch J, Zeifang F, Lorenz HM, Tretter T, Moradi B. A predominant Th1 polarization is present in synovial fluid of end-stage osteoarthritic knee joints: analysis of peripheral blood, synovial fluid and synovial membrane. Clin Exp Immunol 2018; 195:395-406. [PMID: 30368774 DOI: 10.1111/cei.13230] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 01/16/2023] Open
Abstract
Thorough understanding of the complex pathophysiology of osteoarthritis (OA) is necessary in order to open new avenues for treatment. The aim of this study was to characterize the CD4+ T cell population and evaluate their activation and polarization status in OA joints. Fifty-five patients with end-stage knee OA (Kellgren-Lawrence grades III-IV) who underwent surgery for total knee arthroplasty (TKA) were enrolled into this study. Matched samples of synovial membrane (SM), synovial fluid (SF) and peripheral blood (PB) were analysed for CD3+ CD4+ CD8- T cell subsets [T helper type 1 (Th1), Th2, Th17, regulatory T cells] and activation status (CD25, CD69, CD45RO, CD45RA, CD62L) by flow cytometry. Subset-specific cytokines were analysed by cytometric bead array (CBA). SM and SF samples showed a distinct infiltration pattern of CD4+ T cells. In comparison to PB, a higher amount of joint-derived T cells was polarized into CD3+ CD4+ CD8- T cell subsets, with the most significant increase for proinflammatory Th1 cells in SF. CBA analysis revealed significantly increased immunomodulating cytokines [interferon (IFN)-γ, interleukin (IL)-2 and IL-10] in SF compared to PB. Whereas in PB only a small proportion of CD4+ T cells were activated, the majority of joint-derived CD4+ T cells can be characterized as activated effector memory cells (CD69+ CD45RO+ CD62L- ). End-stage OA knees are characterized by an increased CD4+ T cell polarization towards activated Th1 cells and cytokine secretion compared to PB. This local inflammation may contribute to disease aggravation and eventually perpetuate the disease process.
Collapse
Affiliation(s)
- N Rosshirt
- Clinic for Orthopaedic and Trauma Surgery, University Hospital Heidelberg, Germany
| | - S Hagmann
- Clinic for Orthopaedic and Trauma Surgery, University Hospital Heidelberg, Germany
| | - E Tripel
- Clinic for Orthopaedic and Trauma Surgery, University Hospital Heidelberg, Germany
| | - T Gotterbarm
- Clinic for Orthopaedic and Trauma Surgery, University Hospital Heidelberg, Germany
| | - J Kirsch
- Clinic for Orthopaedic and Trauma Surgery, University Hospital Heidelberg, Germany
| | - F Zeifang
- Clinic for Orthopaedic and Trauma Surgery, University Hospital Heidelberg, Germany
| | - H-M Lorenz
- Department of Internal Medicine V, Division of Rheumatology, University Hospital Heidelberg, Germany
| | - T Tretter
- Department of Internal Medicine V, Division of Rheumatology, University Hospital Heidelberg, Germany
| | - B Moradi
- Clinic for Orthopaedic and Trauma Surgery, University Hospital Heidelberg, Germany
| |
Collapse
|
14
|
Kensche A, Kirsch J, Mintert S, Enders F, Pötschke S, Basche S, König B, Hannig C, Hannig M. Impact of customary fluoride rinsing solutions on the pellicle's protective properties and bioadhesion in situ. Sci Rep 2017; 7:16584. [PMID: 29185495 PMCID: PMC5707358 DOI: 10.1038/s41598-017-16677-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/10/2017] [Indexed: 01/20/2023] Open
Abstract
This study investigated the impact of customary fluoride based mouthrinses on the ultrastructure and the functional properties of the in situ pellicle, considering the prevention of erosion (8 volunteers) and initial biofilm formation (12 volunteers). Bovine enamel slabs were carried intraorally. After 1 min of pellicle formation, the subjects rinsed with elmex Kariesschutz (A), Dontodent Med Care (B), meridol (C) or elmex Zahnschmelzschutz Professional (D) for 1 min. In situ pellicle formation was continued up to 30 min/8 h before processing the slabs in vitro. Erosion was simulated by incubating the specimens in HCl (pH 3.0, 2.3, 2.0) for 120 s, measuring the kinetics of calcium/phosphate release photometrically; representative samples were evaluated by TEM and EDX. Bacterial adhesion was visualized fluorescence microscopically (DAPI/BacLight). Native enamel slabs or physiological pellicle samples served as controls. All investigated mouthrinses enhanced the erosion preventive pellicle effect in dependence of the pH-value. A significant decrease of Ca/P release at all pH values was achieved after rinsing with D; TEM/EDX confirmed ultrastructural pellicle modifications. All mouthrinses tendentially reduced bacterial adherence, however not significantly. The mouthrinse containing NaF/AmF/SnCl2 (D) offers an effective oral hygiene supplement to prevent caries and erosion.
Collapse
Affiliation(s)
- A Kensche
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, D-01307, Dresden, Germany.
| | - J Kirsch
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, D-01307, Dresden, Germany
| | - S Mintert
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, D-01307, Dresden, Germany
| | - F Enders
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, D-01307, Dresden, Germany
| | - S Pötschke
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, D-01307, Dresden, Germany
| | - S Basche
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, D-01307, Dresden, Germany
| | - B König
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital, Saarland University, Building 73, D- 66421, Homburg/Saar, Germany
| | - C Hannig
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstr. 74, D-01307, Dresden, Germany
| | - M Hannig
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital, Saarland University, Building 73, D- 66421, Homburg/Saar, Germany
| |
Collapse
|
15
|
Kirsch J, Tchorz J, Hellwig E, Tauböck T, Attin T, Hannig C. Decision criteria for replacement of fillings: a retrospective study. Clin Exp Dent Res 2016; 2:121-128. [PMID: 29744158 PMCID: PMC5839197 DOI: 10.1002/cre2.30] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/09/2016] [Accepted: 03/14/2016] [Indexed: 12/04/2022] Open
Abstract
The exchange of restorations goes along with the loss of healthy tooth structure. Therefore, it is important to investigate helpful decision criteria for the replacement of fillings. Five hundred forty-four filling replacements were evaluated retrospectively. Thereby, different clinical parameters were correlated with the clinical finding of caries directly after removal of the existing filling. The parameters checked for correlations were amalgam and composite, age, and size of the filling, morphology, condition of the filling, type of caries, oral hygiene, anamnesis of the respective tooth, and the decisive factor to replace the restoration. Statistical evaluation was performed by chi-squared-test (P < 0,05) and by regression analysis (Power: 80%). A percentage of 69.8% of all cavities showed softened dentin if exploring with the probe after the removal of the restoration, 7.6% were stainable with caries detector, and 22.6% of the cavities were caries free. Significant indicators for a carious lesion were high age of restoration, imperfections at the margin of the filling, a positive pain sensation in correlation with composite fillings, and multi-surface amalgam fillings. On suspicion of caries, the following decision criteria should encourage the dentist to remove a filling: High age of the filling, imperfections at the margin of the filling, especially fillings with marginal cracks, visible secondary caries, a positive pain sensation in composite filled teeth, and multi-surface amalgam fillings. Filling removals only performed due to the patient's desire for removal should be critically regarded, as most of these fillings are caries free.
Collapse
Affiliation(s)
- J. Kirsch
- Clinic of Operative Dentistry, Medical Faculty Carl Gustav CarusDresden University of TechnologyD‐01307DresdenGermany
| | - J. Tchorz
- Department of Operative Dentistry and PeriodontologyUniversity of FreiburgD‐79106FreiburgGermany
- Centre for Operative Dentistry and Periodontology, University of Dental Medicine and Oral HealthDanube Private University (DPU)AT‐3500Krems an der DonauAustria
| | - E. Hellwig
- Department of Operative Dentistry and PeriodontologyUniversity of FreiburgD‐79106FreiburgGermany
| | - T.T. Tauböck
- Clinic of Preventive Dentistry, Periodontology and CariologyUniversity of ZürichCH‐8028ZürichSwitzerland
| | - T. Attin
- Clinic of Preventive Dentistry, Periodontology and CariologyUniversity of ZürichCH‐8028ZürichSwitzerland
| | - C. Hannig
- Clinic of Operative Dentistry, Medical Faculty Carl Gustav CarusDresden University of TechnologyD‐01307DresdenGermany
| |
Collapse
|
16
|
Diaz Molina F, Cao Y, Klein E, Knisely J, Gill G, Marrero M, Schulder M, Kirsch J. SU-F-J-170: Comparison of Residual Distortions for MRI Sequences On a 3T MRI Unit Using a 3D Rectilinear Grid Phantom. Med Phys 2016. [DOI: 10.1118/1.4956078] [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: 11/07/2022] Open
|
17
|
|
18
|
Hepp D, Kirsch J, Capanni F. Smartphone supported upper limb prosthesis. Current Directions in Biomedical Engineering 2015. [DOI: 10.1515/cdbme-2015-0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
State of the art upper limb prostheses offer up to six active DoFs (degrees of freedom) and are controlled using different grip patterns. This low number of DoFs combined with a machine-human-interface which does not provide control over all DoFs separately result in a lack of usability for the patient. The aim of this novel upper limb prosthesis is both offering simplified control possibilities for changing grip patterns depending on the patients’ priorities and the improvement of grasp capability. Design development followed the design process requirements given by the European Medical Device Directive 93/42 ECC and was structured into the topics mechanics, software and drive technology. First user needs were identified by literature research and by patient feedback. Consequently, concepts were evaluated against technical and usability requirements. A first evaluation prototype with one active DoF per finger was manufactured. In a second step a test setup with two active DoF per finger was designed. The prototype is connected to an Android based smartphone application. Two main grip patterns can be preselected in the software application and afterwards changed and used by the EMG signal. Three different control algorithms can be selected: “all-day”, “fine” and “tired muscle”. Further parameters can be adjusted to customize the prosthesis to the patients’ needs. First patient feedback certified the prosthesis an improved level of handling compared to the existing devices. Using the two DoF test setup, the possibilities of finger control with a neural network are evaluated at the moment. In a first user feedback test, the smartphone based software application increased the device usability, e.g. the change within preselected grip patterns and the “tired muscle” algorithm. Although the overall software application was positively rated, the handling of the prosthesis itself needs to be proven within a patient study to be performed next. The capability of the neural network to control the hand has also to be proven in a next step.
Collapse
Affiliation(s)
- D. Hepp
- Ulm University of Applied Sciences, Laboratory for Biomechanics, Product Development and Simulation, Albert-Einstein-Allee 55, 89081 Ulm, Germany
| | - J. Kirsch
- Ulm University of Applied Sciences, Laboratory for Biomechanics, Product Development and Simulation, Albert-Einstein-Allee 55, 89081 Ulm, Germany
| | - F. Capanni
- Ulm University of Applied Sciences, Laboratory for Biomechanics, Product Development and Simulation, Albert-Einstein-Allee 55, 89081 Ulm, Germany
| |
Collapse
|
19
|
Moradi B, Rosshirt N, Tripel E, Kirsch J, Barié A, Zeifang F, Gotterbarm T, Hagmann S. Unicompartmental and bicompartmental knee osteoarthritis show different patterns of mononuclear cell infiltration and cytokine release in the affected joints. Clin Exp Immunol 2015; 180:143-54. [PMID: 25393692 DOI: 10.1111/cei.12486] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 01/18/2023] Open
Abstract
It is still controversial which cell types are responsible for synovial inflammation in osteoarthritic (OA) joints. The aim of this study was to quantify the mononuclear cell populations and their cytokines in patients with different knee OA subtypes. Synovial membrane (SM), synovial fluid (SF) and peripheral blood (PB) were harvested from patients with unicompartmental (UC) and bicompartmental (BC) knee OA. Frequencies of mononuclear cells were assessed by flow cytometry in PB and SM. Naive SF samples were analysed for a broad variety of cytokines by multiplex analysis. SM of both groups displayed a distinct mononuclear cell infiltration, with CD14(+) macrophages being the major cell population, followed by CD4(+) T cells and only small numbers of CD8(+) T, CD19(+) B and CD16(+) CD56(+) natural killer (NK) cells. Between the two groups, SM of BC OA showed significantly higher amounts of mononuclear cells (135·7 ± 180 versus 805 ± 675 cells/mg, P = 0·0009) and higher CD4(+) T cell presence (3·4 ± 4·6 versus 9·1 ± 7·5%, P = 0·0267). SF of BC OA displayed significantly higher concentrations for a number of proinflammatory cytokines [CXCL1, eotaxin, interferon (IFN)-γ, interleukin (IL)-7, IL-8, IL-9, IL-12]. UC and BC OA show significant differences in their synovial inflammatory pattern. Whereas in UC OA CD14(+) macrophages are the predominant cell population, BC OA has a higher inflammatory profile and seems to be driven by CD14(+) macrophages and CD4(+) T cells. Inclusion of clinical information into the analysis of cellular and molecular results is pivotal in understanding the pathophysiology of OA.
Collapse
Affiliation(s)
- B Moradi
- Clinic for Orthopedics and Traumatology, University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Van Ooteghem G, El-Mourad M, Slimani A, Margos W, El Nawar A, Patris A, Gallez JF, Kirsch J, Hauters P, Vallot F, Nakad A. Is early enteral nutrition dangerous in acute non surgical complicated diverticulitis? About 25 patients fed with oral fiber free energetic liquid diet. Acta Gastroenterol Belg 2013; 76:235-240. [PMID: 23898562] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND STUDY AIMS Complicated Acute Colonic Diverticulitis (ACD) is usually treated by parenteral way thus keeping the bowel at rest. To date there are no clear recommendations regarding the route of nutrition administration. We study the safety of early feeding by oral energetic fiber-free liquid diet in non-surgical complicated ACD patients. PATIENTS AND METHODS From February 2008 to October 2011, 25 patients were admitted with complicated ACD and took part in this prospective study. Surgical and medical assessments were performed at admission. Initial treatment was given with perfusion, intravenous antibiotics and hydric diet. Within 72 hours of admission, antibiotic therapy was switched to oral administration for 5 up to 15 days depending on the progression of the disease. At the same time the patient received oral liquid fiber-free feeding. Solid but fiber-free diet was introduced 24h hours before discharge. RESULTS 25 cases of ACD were complicated with covered perforation and/or abscess. Mean hospitalisation time was 10A.4 days. 23 cases had good recovery and discharged, while 1 case progressed to colonic stenosis during hospitalisation, requiring a sigmoidectomy with a one-time anastomosis with good recovery. One patient relapsed his abscess during hospitalisation despite CT guided drainage and required sigmoidectomy with transient ileostomy. The mean daily treatment and nutrition cost for the non-surgical 23 patients was 30 euros. CONCLUSIONS Early enteral nutrition in complicated ACD is feasible, not harmful, and reduce both, mean hospitalization time and treatment cost. Further studies comparing enteral with parenteral nutrition are necessary to confirm our hypothesis.
Collapse
|
21
|
Arici M, Reiner E, Kirsch J, Mojibian H, Pollak J, Henderson K, Weiss R, White R. Abstract No. 205: Results of varicocele embolization using sotradecol foam and fibered coils. J Vasc Interv Radiol 2010. [DOI: 10.1016/j.jvir.2009.12.367] [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: 11/28/2022] Open
|
22
|
Vandervaeren D, Kirsch J, Hamoir X. Une application de la tomodensitométrie en double énergie dans le traitement d’un calcul coralliforme. Prog Urol 2010; 20:77-9. [DOI: 10.1016/j.purol.2009.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 04/05/2009] [Accepted: 05/08/2009] [Indexed: 10/20/2022]
|
23
|
Rubinshtein R, Miller TD, Williamson EE, Kirsch J, Gibbons RJ, Primak AN, McCollough CH, Araoz PA. Detection of myocardial infarction by dual-source coronary computed tomography angiography using quantitated myocardial scintigraphy as the reference standard. Heart 2009; 95:1419-22. [DOI: 10.1136/hrt.2008.158618] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
24
|
Vandervaeren D, Kirsch J. La tomodensitométrie en double énergie : une avancée dans l’identification radiologique des lithiases uriques. Prog Urol 2008; 18:562-5. [DOI: 10.1016/j.purol.2008.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 05/29/2008] [Accepted: 06/06/2008] [Indexed: 11/27/2022]
|
25
|
|
26
|
Ghekiere O, Hamoir X, Hamoir V, Kirsch J. Malignant right coronary artery. JBR-BTR 2008; 91:20. [PMID: 18447127] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- O Ghekiere
- Dpt of Radiology, Clinique Notre Dame, Tournai, Belgium
| | | | | | | |
Collapse
|
27
|
Hamoir X, Salovic D, Bouziane T, Kirsch J. Dual source CT: cardio-pulmonary applications. JBR-BTR 2007; 90:77-9. [PMID: 17555062] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Dual source CT is a last generation scanner which allows for coronary imaging without beta-blocker because high quality images are feasible even at high heart rates. Furthermore, with this equipment, dual energy becomes possible in a single acquisition and triple rule-out imaging can be performed in clinical routine. The radiation dose remains limited in comparison with single-source CT because of different efficient mechanisms.
Collapse
Affiliation(s)
- X Hamoir
- Department of Radiology, Clinique Notre-Dame,Tournai, Belgium.
| | | | | | | |
Collapse
|
28
|
von Boyen GBT, Steinkamp M, Reinshagen M, Schäfer KH, Adler G, Kirsch J. Nerve growth factor secretion in cultured enteric glia cells is modulated by proinflammatory cytokines. J Neuroendocrinol 2006; 18:820-5. [PMID: 17026531 DOI: 10.1111/j.1365-2826.2006.01478.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [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: 12/18/2022]
Abstract
The enteric nervous system is composed of neurones and glial cells. These enteric glia cells (EGC) appear to be essential for the maintenance of gut homeostasis and mucosal integrity. Neurotrophin nerve growth factor (NGF) also plays an important role for the gut integrity by regulating sensory and inflammatory processes in the intestines. Here, we demonstrate EGCs as one source of NGF and show increased levels of NGF mRNA/protein and tropomyosin receptor kinase A (TrkA) mRNA in cultured EGCs upon stimulation with proinflammatory cytokines and lipopolysaccharides. NGF is continuously secreted from cultured EGCs and proinflammatory cytokines and lipopolysaccharides stimulate the secretion of this neurotrophin in a time- and dose- dependent manner, whereas interleukin-4 had no effect on NGF expression. Furthermore, NGF secretion was sustained for more than 12 h after withdrawal of the proinflammatory cytokines, suggesting the involvement of transcriptional and/or translational processes. Thus, the release of proinflammatory cytokines can increase NGF secretion by EGCs and leads to a higher expression of TrkA in EGCs. NGF, in turn, can increase visceral sensitivity and, on the other hand, appears to improve gut inflammation. Therefore, NGF secreting EGCs may play a key role in modulating visceral sensitivity and might be involved in inflammatory processes of the gut.
Collapse
Affiliation(s)
- G B T von Boyen
- Department of Medicine I (Gastroenterology), University of Ulm, Ulm, Germany.
| | | | | | | | | | | |
Collapse
|
29
|
Vincke P, Hamoir X, Kirsch J. [Cardiac anatomy and the radiologist]. J Radiol 2006; 87:664-6. [PMID: 16788541 DOI: 10.1016/s0221-0363(06)74060-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We report a case of myocardial infarction due to occlusion of the left anterior descending artery seen on a routine chest CT performed in order to exclude aortic dissection. This underscores the need for the radiologist to look at the heart and coronary arteries on each thoracic CT-scan, even if acquired without EKG-gating.
Collapse
Affiliation(s)
- P Vincke
- Clinique Notre Dame, Service d'Imagerie Médicale, Avenue Delmée 9, 7500 Tournai Belgique.
| | | | | |
Collapse
|
30
|
Abstract
BACKGROUND Enteric glia protect the integrity of the gut, as loss of enteric glial fibrillary acidic protein (GFAP) positive (+) glia leads to a haemorrhagic jejunoileitis. Crohn's disease (CD) and necrotising enterocolitis (NEC) show pathological changes in enteric glia. Therefore, factors controlling GFAP+ enteric glia are of great interest. The aim of the present study was to characterise enteric glia and determine the effect of interleukin 1beta (IL-1beta), interleukin 4 (IL-4), tumour necrosis factor alpha (TNF-alpha), and lipopolysaccharides (LPS) on cultured enteric glia. METHODS Dissected rat colon and cultured enteric glia cells were double labelled with anti-GFAP and anti-S-100 antibodies. For regulatory studies, enteric glia cells were treated with cytokines and LPS. Proliferation was assayed using bromodeoxyuridine (BrdU) and mitosis of enteric glia was blocked by demecolcine. RESULTS We were able to distinguish GFAP negative (-) from GFAP+ glia subtypes in situ and in primary cultures. Incubation of cells with IL-1beta, TNF-alpha, and LPS led to a significant increase in GFAP+ enteric glia while IL-4 had no effect on GFAP expression. After incubation with IL-1beta, total intracellular GFAP of enteric glia cells was increased. Upregulation of GFAP+ enteric glia could also be observed after stimulation with IL-1beta on blocking mitosis. BrdU uptake in stimulated enteric glia showed no increased proliferation rate. CONCLUSIONS Two different types of enteric glia based on GFAP expression exist in the gut. Proinflammatory cytokines and LPS cause a dramatic increase in GFAP+ enteric glia. This suggests that cytokines play an important role in controlling GFAP+ enteric glia which might in turn be involved in modulating the integrity of the bowel during inflammation.
Collapse
Affiliation(s)
- G B T von Boyen
- Department of Medicine I (Gastroenterology), University of Ulm, Albert-Einstein-Allee 11, 89069 Ulm, Germany
| | | | | | | | | | | |
Collapse
|
31
|
Grulke NE, Preisler HK, Rose C, Kirsch J, Balduman L. O 3 uptake and drought stress effects on carbon acquisition of ponderosa pine in natural stands. New Phytol 2002; 154:621-631. [PMID: 33873463 DOI: 10.1046/j.1469-8137.2002.00403.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
• The effect of O3 exposure or uptake on carbon acquisition (net assimilation (A) or gross photosynthesis (Pg )), with and without drought stress, is reported here in 40-yr-old-ponderosa pine (Pinus ponderosa) trees. • Maximum daily gas exchange was measured monthly for 12 trees at four sites differing in pollutant exposure over two growing seasons with above- and below-average annual precipitation. Gas exchange measures were estimated between sampling periods using a generalized additive regression model. • Both A and Pg generally declined with cumulative O3 exposure or uptake at all sites. As a response variable, Pg was slightly more sensitive than A to cumulative O3 exposure. As a metric, O3 uptake vs exposure permitted slightly better statistical resolution of seasonal response between sites. • The effect of late summer drought stress was statistically significant only at the moderate pollution site, and combined synergistically with O3 exposure or uptake to reduce Pg . The general additive model allows the user to define a deleterious level of cumulative O3 exposure or uptake, and to quantitatively assess biological response.
Collapse
Affiliation(s)
- N E Grulke
- USDA Forest Service, Pacific Southwest Research Station, 4955 Canyon Crest Drive, Riverside, CA 92507, USA
| | - H K Preisler
- USDA Forest Service, Pacific Southwest Research Station, 4955 Canyon Crest Drive, Riverside, CA 92507, USA
| | - C Rose
- USDA Forest Service, Pacific Northwest Research Station, 3200 SW Jefferson Way, Corvallis, OR 97331, USA
| | - J Kirsch
- USDA Forest Service, Pacific Northwest Research Station, 3200 SW Jefferson Way, Corvallis, OR 97331, USA
| | - L Balduman
- USDA Forest Service, Pacific Northwest Research Station, 3200 SW Jefferson Way, Corvallis, OR 97331, USA
| |
Collapse
|
32
|
Affiliation(s)
- G B T von Boyen
- Dept of Internal Medicine I, University Hospital of Ulm, Germany.
| | | | | | | | | |
Collapse
|
33
|
Ramming M, Kins S, Werner N, Hermann A, Betz H, Kirsch J. Diversity and phylogeny of gephyrin: tissue-specific splice variants, gene structure, and sequence similarities to molybdenum cofactor-synthesizing and cytoskeleton-associated proteins. Proc Natl Acad Sci U S A 2000; 97:10266-71. [PMID: 10963686 PMCID: PMC27865 DOI: 10.1073/pnas.97.18.10266] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Gephyrin is essential for both the postsynaptic localization of inhibitory neurotransmitter receptors in the central nervous system and the biosynthesis of the molybdenum cofactor (Moco) in different peripheral organs. Several alternatively spliced gephyrin transcripts have been identified in rat brain that differ in their 5' coding regions. Here, we describe gephyrin splice variants that are differentially expressed in non-neuronal tissues and different regions of the adult mouse brain. Analysis of the murine gephyrin gene indicates a highly mosaic organization, with eight of its 29 exons corresponding to the alternatively spliced regions identified by cDNA sequencing. The N- and C-terminal domains of gephyrin encoded by exons 3-7 and 16-29, respectively, display sequence similarities to bacterial, invertebrate, and plant proteins involved in Moco biosynthesis, whereas the central exons 8, 13, and 14 encode motifs that may mediate oligomerization and tubulin binding. Our data are consistent with gephyrin having evolved from a Moco biosynthetic protein by insertion of protein interaction sequences.
Collapse
Affiliation(s)
- M Ramming
- Department of Neurochemistry, Max-Planck-Institute for Brain Research, Deutschordenstr. 46, 60528 Frankfurt am Main, Germany
| | | | | | | | | | | |
Collapse
|
34
|
Simbürger E, Plaschke M, Kirsch J, Nitsch R. Distribution of the receptor-anchoring protein gephyrin in the rat dentate gyrus and changes following entorhinal cortex lesion. Cereb Cortex 2000; 10:422-32. [PMID: 10769252 DOI: 10.1093/cercor/10.4.422] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We analyzed the distribution of the receptor-anchoring protein gephyrin in the normal and deafferented rat dentate gyrus to investigate whether the expression of this postsynaptic protein is altered in response to the formation of new synaptic contacts. Confocal microscopy and digital image analysis revealed that in normal dentate gyrus immunolabeling was most prominent in the outer molecular layer and decreased successively in the direction of the granule cell layer. Simultaneous immunolabeling for gephyrin and cell-specific markers showed that granule cells and parvalbumin-positive interneurons express gephyrin. Large, intensely stained, gephyrin-positive clusters were distributed along distinct dendrites, and most of them were positive for parvalbumin. Calbindin-immunostained dendrites were associated with smaller, gephyrin-positive clusters. Lesion of the medial entorhinal cortex leads to deafferentiation of the middle molecular layer which resulted in an increased gephyrin immunoreactivity. These changes were due to a significantly increased concentration of the very small gephyrin-positive clusters. Parvalbumin-positive dendrites did not display any increase in co-localizing gephyrin-positive structures. The altered immunolabeling pattern persisted until 12 weeks after lesion, a time when the process of synaptic reorganization is complete. Our findings suggest that synaptogenesis following deafferentiation results in a cell-specific redistribution of gephyrin immunoreactivity at specific inhibitory synapses.
Collapse
Affiliation(s)
- E Simbürger
- Institute of Anatomy, Humboldt University Berlin (Charité), 10098 Berlin, Germany
| | | | | | | |
Collapse
|
35
|
Abstract
This study considers the feasibility of defining a QALY from disease-specific data using the New York Heart Association (NYHA) classification of heart failure. The study derives health state values for the four different NYHA classifications of disease progression using the time trade-off (TTO) instrument associated with the five dimensional (EQ-5D) health state valuation method. Consistent mappings between the disease classification and the chosen QALY instrument are found. With this being the case, the assumption of constant proportionality, which is necessary to define the QALY as an acceptable measure of health related preferences, is considered. It is found that constant proportionality does not hold across the more severe health states, thus questioning the use of QALYs as representing cardinal preference structures.
Collapse
Affiliation(s)
- J Kirsch
- SmithKline Beecham Limited, Mundells, Welwyn Garden City, UK
| | | |
Collapse
|
36
|
Abstract
The formation of postsynaptic GABAA and glycine receptor clusters requires the receptor-associated peripheral membrane protein gephyrin. Here we describe two splice variants of a novel gephyrin-binding protein, termed collybistin I and II, which belong to the family of dbl-like GDP/GTP exchange factors (GEFs). Co-expression of collybistin II with gephyrin induced the formation of submembrane gephyrin aggregates that accumulate hetero-oligomeric glycine receptors. Our data suggest that collybistin II regulates the membrane deposition of gephyrin by activating a GTPase of the Rho/Rac family. Therefore, this protein may be an important determinant of inhibitory postsynaptic membrane formation and plasticity.
Collapse
Affiliation(s)
- S Kins
- Department of Neurochemistry, Max-Planck-Institute for Brain Research, Deutschordenstr. 46, D-60528 Frankfurt, Germany
| | | | | |
Collapse
|
37
|
Abstract
The postsynaptic membrane and the subsynaptic cell compartment are specialized for inter- and intracellular signaling. Recent work has focused on the role of synaptic activity in regulating the surface distribution of neurotransmitter receptors. In addition, several components of secondary signaling pathways involved in the long-term regulation of synaptic efficacy have been identified.
Collapse
Affiliation(s)
- J Kirsch
- Department of Anatomy & Cellular Neurobiology, University of Ulm, Albert-Einstein-Allee 11, 89069, Ulm, Germany.
| |
Collapse
|
38
|
Sabatini DM, Barrow RK, Blackshaw S, Burnett PE, Lai MM, Field ME, Bahr BA, Kirsch J, Betz H, Snyder SH. Interaction of RAFT1 with gephyrin required for rapamycin-sensitive signaling. Science 1999; 284:1161-4. [PMID: 10325225 DOI: 10.1126/science.284.5417.1161] [Citation(s) in RCA: 156] [Impact Index Per Article: 6.2] [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] [Indexed: 11/02/2022]
Abstract
RAFT1 (rapamycin and FKBP12 target 1; also called FRAP or mTOR) is a member of the ATM (ataxia telangiectasia mutated)-related family of proteins and functions as the in vivo mediator of the effects of the immunosuppressant rapamycin and as an important regulator of messenger RNA translation. In mammalian cells RAFT1 interacted with gephyrin, a widely expressed protein necessary for the clustering of glycine receptors at the cell membrane of neurons. RAFT1 mutants that could not associate with gephyrin failed to signal to downstream molecules, including the p70 ribosomal S6 kinase and the eIF-4E binding protein, 4E-BP1. The interaction with gephyrin ascribes a function to the large amino-terminal region of an ATM-related protein and reveals a role in signal transduction for the clustering protein gephyrin.
Collapse
Affiliation(s)
- D M Sabatini
- The Johns Hopkins University School of Medicine, Department of Neuroscience, 725 North Wolfe Street, Baltimore, MD 21205, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
The strychnine-sensitive glycine receptor (GlyR) is a pentameric chloride channel protein that exists in several developmentally and regionally regulated isoforms in the CNS. These result from the differential expression of four genes encoding different variants (alpha 1-alpha 4) of the ligand-binding subunit of the GlyR. Their assembly with the structural beta subunit is governed by "assembly cassettes" within the extracellular domains of these proteins and creates chloride channels of distinct conductance properties. GlyR gating is potentiated by Zn2+, a metal ion co-released with different neurotransmitters. Site-directed mutagenesis has unraveled major determinants of agonist binding and Zn2+ potentiation. During development, glycine receptors mediate excitation that results in Ca2+ influx and neurotransmitter release. Ca2+ influx triggered by the activation of embryonic GlyRs is required for the synaptic localization of the GlyR and its anchoring protein gepyhrin. In the adult, mutations in GlyR-subunit genes result in motor disorders. The spastic and spasmodic phenotypes in mouse as well as human hereditary startle disease will be discussed.
Collapse
Affiliation(s)
- H Betz
- Max-Planck-Institut für Hirnforschung, Abteilung Neurochemie, Frankfurt am Main, Germany.
| | | | | | | | | | | |
Collapse
|
40
|
Affiliation(s)
- M Sassoè-Pognetto
- Department of Anatomy, Pharmacology and Forensic Medicine, University of Turin, Italy.
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
Glycine receptors (GlyRs) are ligand-gated chloride channel proteins composed of alpha- and beta-subunits. GlyRs are located to and anchored at postsynaptic sites by the receptor-associated protein gephyrin. Previous work from our laboratory has identified a core motif for gephyrin binding in the cytoplasmic loop of the GlyR beta-subunit. Here, we localized amino acid residues implicated in gephyrin binding by site-directed mutagenesis. In a novel transfection assay, a green fluorescent protein-gephyrin binding motif fusion protein was used to monitor the consequences of amino acid substitutions for beta-subunit interaction with gephyrin. Only multiple, but not single, replacements of hydrophobic side chains abolished the interaction between the two proteins. Our data are consistent with gephyrin binding being mediated by the hydrophobic side of an imperfect amphipathic helix.
Collapse
Affiliation(s)
- M Kneussel
- Department of Neurochemistry, Max-Planck-Institute for Brain Research, Frankfurt/Main, Germany
| | | | | | | |
Collapse
|
42
|
Stallmeyer B, Schwarz G, Schulze J, Nerlich A, Reiss J, Kirsch J, Mendel RR. The neurotransmitter receptor-anchoring protein gephyrin reconstitutes molybdenum cofactor biosynthesis in bacteria, plants, and mammalian cells. Proc Natl Acad Sci U S A 1999; 96:1333-8. [PMID: 9990024 PMCID: PMC15463 DOI: 10.1073/pnas.96.4.1333] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.7] [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: 10/09/1998] [Indexed: 11/18/2022] Open
Abstract
The molybdenum cofactor (Moco), a highly conserved pterin compound complexing molybdenum, is required for the enzymatic activities of all molybdenum enzymes except nitrogenase. Moco is synthesized by a unique and evolutionarily old pathway that requires the activities of at least six gene products. Some of the proteins involved in bacterial, plant, and invertebrate Moco biosynthesis show striking homologies to the primary structure of gephyrin, a polypeptide required for the clustering of inhibitory glycine receptors in postsynaptic membranes in the rat central nervous system. Here, we show that gephyrin binds with high affinity to molybdopterin, the metabolic precursor of Moco. Furthermore, gephyrin expression can reconstitute Moco biosynthesis in Moco-deficient bacteria, a molybdenum-dependent mouse cell line, and a Moco-deficient plant mutant. Conversely, inhibition of gephyrin expression by antisense RNA expression in cultured murine cells reduces their Moco content significantly. These data indicate that in addition to clustering glycine receptors, gephyrin also is involved in Moco biosynthesis and illustrate the remarkable conservation of its function in Moco biosynthesis throughout phylogeny.
Collapse
Affiliation(s)
- B Stallmeyer
- Botanical Institute, Technical University of Braunschweig, 38023 Braunschweig, Germany
| | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
The peripheral membrane protein gephyrin is essential for the postsynaptic localization of inhibitory glycine receptors (GlyRs). Binding of gephyrin to the GlyR beta subunit is mediated by a sequence motif located in the intracellular loop region connecting transmembrane segments 3 and 4. Here, insertion of this binding motif is shown to alter the subcellular distribution of an excitatory neurotransmitter receptor in transfected mammalian cells. Upon coexpression with gephyrin, a mutant N-methyl-D-aspartate (NMDA) receptor containing NMDA receptor 1 (NR1) subunits which harboured a gephyrin-binding motif within its cytoplasmic tail region, was targeted to intracellular gephyrin-rich domains, as previously observed for the GlyR beta subunit. Our data indicate that a gephyrin-binding motif located in a cytoplasmic domain of an integral membrane protein suffices for routing to gephyrin-rich domains.
Collapse
Affiliation(s)
- S Kins
- Department of Neurochemistry, Max-Planck-Institute for Brain Research, Frankfurt, Germany
| | | | | | | | | |
Collapse
|
44
|
Kaufmann U, Kirsch J, Irintchev A, Wernig A, Starzinski-Powitz A. The M-cadherin catenin complex interacts with microtubules in skeletal muscle cells: implications for the fusion of myoblasts. J Cell Sci 1999; 112 ( Pt 1):55-68. [PMID: 9841904 DOI: 10.1242/jcs.112.1.55] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
M-cadherin, a calcium-dependent intercellular adhesion molecule, is expressed in skeletal muscle cells. Its pattern of expression, both in vivo and in cell culture as well as functional studies, have implied that M-cadherin is important for skeletal muscle development, in particular the fusion of myoblasts into myotubes. M-cadherin formed complexes with the catenins in skeletal muscle cells similar to E-cadherin in epithelial cells. This suggested that the muscle-specific function of the M-cadherin catenin complex might be mediated by additional interactions with yet unidentified cellular components, especially cytoskeletal elements. These include the microtubules which also have been implicated in the fusion process of myoblasts. Here we present evidence that the M-cadherin catenin complex interacts with microtubules in myogenic cells by using three independent experimental approaches. (1) Analysis by laser scan microscopy revealed that the destruction of microtubules by nocodazole leads to an altered cell surface distribution of M-cadherin in differentiating myogenic cells. In contrast, disruption of actin filaments had little effect on the surface distribution of M-cadherin. (2) M-cadherin antibodies coimmunoprecipitated tubulin from extracts of nocodazole-treated myogenic cells but not of nocodazole-treated epithelial cells ectopically expressing M-cadherin. Vice versa, tubulin antibodies coimmunoprecipitated M-cadherin from extracts of nocodazole-treated myogenic cells but not of nocodazole-treated M-cadherin-expressing epithelial cells. (3) M-cadherin and the catenins, but not a panel of control proteins, were copolymerized with tubulin from myogenic cell extracts even after repeated cycles of assembly and disassemly of tubulin. Moreover, neither M-cadherin nor E-cadherin could be found in a complex with microtubules in epithelial cells ectopically expressing M-cadherin. Our data are consistent with the idea that the interaction of M-cadherin with microtubules might be essential to keep the myoblasts aligned during fusion, a process in which both M-cadherin and microtubules have been implicated.
Collapse
Affiliation(s)
- U Kaufmann
- Institut der Anthropologie und Humangenetik fuer Biologen, Johann-Wolfgang-Goethe-Universitaet Frankfurt, Siesmayerstrasse 70, D-60054 Frankfurt/Main, Germany
| | | | | | | | | |
Collapse
|
45
|
Abstract
Glycine receptors are anchored at inhibitory chemical synapses by a cytoplasmic protein, gephyrin. Molecular cloning revealed the similarity of gephyrin to prokaryotic and invertebrate proteins essential for synthesizing a cofactor required for activity of molybdoenzymes. Gene targeting in mice showed that gephyrin is required both for synaptic clustering of glycine receptors in spinal cord and for molybdoenzyme activity in nonneural tissues. The mutant phenotype resembled that of humans with hereditary molybdenum cofactor deficiency and hyperekplexia (a failure of inhibitory neurotransmission), suggesting that gephyrin function may be impaired in both diseases.
Collapse
Affiliation(s)
- G Feng
- Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
In this report we demonstrate that in HEK293 cells stably expressing the human V2 vasopressin receptor, ligand-induced internalization of the hormone receptor occurs via the clathrin-dependent pathway. Studies of receptor trafficking either by direct visualization of the V2 receptor by confocal microscopy or binding experiments show a rapid internalization (half-time 6-7 min). Blocking of the clathrin-dependent pathway by hypertonic sucrose increased vasopressin-induced cellular cAMP production and decreased the desensitization of the V2 receptor-adenylyl cyclase system. Thus, internalization appears to be a major regulatory mechanism terminating vasopressin action in HEK293 cells. Two antagonists of the vasopressin V2 receptor exerted different effects on receptor internalization, as determined by confocal fluorescence microscopy. The nonpeptidic antagonist OPC31260 did not induce any visible receptor internalization, whereas the peptidic antagonist d(CH2)5[D-Tyr(Et)2,Val4,Lys8,Tyr-NH29]VP induced a slow but substantial receptor internalization. These results suggest that long-term treatment with peptidic V2 receptor antagonists might lead to desensitization.
Collapse
Affiliation(s)
- R Pfeiffer
- Institut für Biochemie der Universität Mainz, Joachim-Becher-Weg 30, Mainz, 55099, Germany
| | | | | |
Collapse
|
47
|
Abstract
Water suppression is typically performed in vivo by exciting the longitudinal magnetization in combination with dephasing, or by using frequency-selective coherence generation. MEGA, a frequency-selective refocusing technique, can be placed into any pulse sequence element designed to generate a Hahn spin-echo or stimulated echo, to dephase transverse water coherences with minimal spectral distortions. Water suppression performance was verified in vivo using stimulated echo acquisition mode (STEAM) localization, which provided water suppression comparable with that achieved with four selective pulses in 3,1-DRYSTEAM. The advantage of the proposed method was exploited for editing J-coupled resonances. Using a double-banded pulse that selectively inverts a J-coupling partner and simultaneously suppresses water, efficient metabolite editing was achieved in the point resolved spectroscopy (PRESS) and STEAM sequences in which MEGA was incorporated. To illustrate the efficiency of the method, the detection of gamma-aminobutyric acid (GABA) was demonstrated, with minimal contributions from macromolecules and overlying singlet peaks at 4 T. The estimated occipital GABA concentration was consistent with previous reports, suggesting that editing for GABA is efficient when based on MEGA at high field strengths.
Collapse
Affiliation(s)
- M Mescher
- Department of Radiology, University of Minnesota Medical School, Center for Magnetic Resonance Research, Minneapolis 55455, USA
| | | | | | | | | |
Collapse
|
48
|
Abstract
Water suppression is typically performed in vivo by exciting the longitudinal magnetization in combination with dephasing, or by using frequency-selective coherence generation. MEGA, a frequency-selective refocusing technique, can be placed into any pulse sequence element designed to generate a Hahn spin-echo or stimulated echo, to dephase transverse water coherences with minimal spectral distortions. Water suppression performance was verified in vivo using stimulated echo acquisition mode (STEAM) localization, which provided water suppression comparable with that achieved with four selective pulses in 3,1-DRYSTEAM. The advantage of the proposed method was exploited for editing J-coupled resonances. Using a double-banded pulse that selectively inverts a J-coupling partner and simultaneously suppresses water, efficient metabolite editing was achieved in the point resolved spectroscopy (PRESS) and STEAM sequences in which MEGA was incorporated. To illustrate the efficiency of the method, the detection of gamma-aminobutyric acid (GABA) was demonstrated, with minimal contributions from macromolecules and overlying singlet peaks at 4 T. The estimated occipital GABA concentration was consistent with previous reports, suggesting that editing for GABA is efficient when based on MEGA at high field strengths.
Collapse
Affiliation(s)
- M Mescher
- Department of Radiology, University of Minnesota Medical School, Center for Magnetic Resonance Research, Minneapolis 55455, USA
| | | | | | | | | |
Collapse
|
49
|
Abstract
Water suppression is typically performed in vivo by exciting the longitudinal magnetization in combination with dephasing, or by using frequency-selective coherence generation. MEGA, a frequency-selective refocusing technique, can be placed into any pulse sequence element designed to generate a Hahn spin-echo or stimulated echo, to dephase transverse water coherences with minimal spectral distortions. Water suppression performance was verified in vivo using stimulated echo acquisition mode (STEAM) localization, which provided water suppression comparable with that achieved with four selective pulses in 3,1-DRYSTEAM. The advantage of the proposed method was exploited for editing J-coupled resonances. Using a double-banded pulse that selectively inverts a J-coupling partner and simultaneously suppresses water, efficient metabolite editing was achieved in the point resolved spectroscopy (PRESS) and STEAM sequences in which MEGA was incorporated. To illustrate the efficiency of the method, the detection of gamma-aminobutyric acid (GABA) was demonstrated, with minimal contributions from macromolecules and overlying singlet peaks at 4 T. The estimated occipital GABA concentration was consistent with previous reports, suggesting that editing for GABA is efficient when based on MEGA at high field strengths.
Collapse
Affiliation(s)
- M Mescher
- Department of Radiology, University of Minnesota Medical School, Center for Magnetic Resonance Research, Minneapolis 55455, USA
| | | | | | | | | |
Collapse
|
50
|
McCabe CJ, Akehurst RL, Kirsch J, Whitfield M, Backhouse M, Woolf AD, Scott DL, Emery P, Haslock I. Choice of NSAID and management strategy in rheumatoid arthritis and osteoarthritis. The impact on costs and outcomes in the UK. Pharmacoeconomics 1998; 14:191-199. [PMID: 10186459 DOI: 10.2165/00019053-199814020-00007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Although nonsteroidal anti-inflammatory drugs (NSAIDs) are an effective therapy for rheumatoid arthritis, they are associated with significant adverse effects, the management of which imposes additional costs on the healthcare system. Prescribing NSAIDs which have a lower risk of major adverse effects as the first-line NSAID for patients with rheumatoid arthritis and osteoarthritis may be expected to lead to an improvement in clinical outcomes and reduce overall treatment costs. This analysis examines data from a published randomised controlled trial of 5 NSAIDs to explore these hypotheses. DESIGN AND SETTING Data from a clinical trial comparing 5 NSAIDs were combined with published cost data to construct 2 clinical decision models, reflecting alternative approaches to the management of major and minor adverse effects in the UK. INTERVENTIONS The 5 NSAIDs evaluated in the analysis were nabumetone, diclofenac, ibuprofen, piroxicam and naproxen, although only the results for ibuprofen and nabumetone are reported. MAIN OUTCOME MEASURES AND RESULTS The total cost of care per patient receiving nabumetone was estimated to be between 25 pounds sterling (Pound) and 41 Pounds more expensive than ibuprofen. In a hypothetical cohort of 100,000 patients, there were between 690 and 821 more major adverse effects using ibuprofen than nabumetone. The cost per life-year gained (LYG) from using nabumetone rather than ibuprofen ranged between 1880 Pounds and 2517 Pounds (1995 values), depending upon the management of adverse effects. CONCLUSIONS These results indicate that: (i) prescribing the newer, currently more expensive, NSAIDs will not necessarily lead to cost savings; (ii) the management of adverse effects can have a significant impact on costs; and (iii) the additional cost may be justifiable in terms of the mortality and morbidity gains associated with the new lower-risk NSAIDs.
Collapse
Affiliation(s)
- C J McCabe
- School of Health and Related Research, University of Sheffield, England.
| | | | | | | | | | | | | | | | | |
Collapse
|