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Jakobs T, Wachter S, Haas M, Fleck S, Kolb T. Burner Development for High‐Pressure Entrained‐Flow Gasification. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255022] [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: 11/12/2022]
Affiliation(s)
- T. Jakobs
- Karlsruhe Institute of Technology Institute for Technical Chemistry Hermann von Helmholtz Platz 1 76344 Eggenstein-Leopoldshafen Germany
| | - S. Wachter
- Karlsruhe Institute of Technology Institute for Technical Chemistry Hermann von Helmholtz Platz 1 76344 Eggenstein-Leopoldshafen Germany
| | - M. Haas
- Karlsruhe Institute of Technology Institute for Technical Chemistry Hermann von Helmholtz Platz 1 76344 Eggenstein-Leopoldshafen Germany
| | - S. Fleck
- Karlsruhe Institute of Technology Institute for Technical Chemistry Hermann von Helmholtz Platz 1 76344 Eggenstein-Leopoldshafen Germany
| | - T. Kolb
- Karlsruhe Institute of Technology Institute for Technical Chemistry Hermann von Helmholtz Platz 1 76344 Eggenstein-Leopoldshafen Germany
- Karlsruhe Institute of Technology Engler-Bunte-Ring 1 76131 Karlsruhe Germany
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Haas M, Fleck S, Böning D, Santo U, Kolb T. Entrained‐flow gasification of pyrolysis oil – Influence of flame structure on fuel conversion. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- M. Haas
- Karlsruhe Institute of Technology Institute for Technical Chemistry, Gasification Department Hermann-von-Helmholtz-Platz 1 76344 Eggenstein-Leopoldshafen Germany
| | - S. Fleck
- Karlsruhe Institute of Technology Institute for Technical Chemistry, Gasification Department Hermann-von-Helmholtz-Platz 1 76344 Eggenstein-Leopoldshafen Germany
| | - D. Böning
- Karlsruhe Institute of Technology Institute for Technical Chemistry, Gasification Department Hermann-von-Helmholtz-Platz 1 76344 Eggenstein-Leopoldshafen Germany
| | - U. Santo
- Karlsruhe Institute of Technology Institute for Technical Chemistry, Gasification Department Hermann-von-Helmholtz-Platz 1 76344 Eggenstein-Leopoldshafen Germany
| | - T. Kolb
- Karlsruhe Institute of Technology Institute for Technical Chemistry, Gasification Department Hermann-von-Helmholtz-Platz 1 76344 Eggenstein-Leopoldshafen Germany
- Karlsruhe Institute of Technology Engler-Bunte-Institute, Division of Fuel Technology Engler-Bunte-Ring 1 76131 Karlsruhe Germany
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Thomale UW, Auer C, Spennato P, Schaumann A, Behrens P, Gorelyshev S, Bogoslovskaia E, Shulaev A, Kabanian A, Seliverstov A, Alexeev A, Ozgural O, Kahilogullari G, Schuhmann M, Jimenez-Guerra R, Wittayanakorn N, Sukharev A, Marquez-Rivas J, Linsler S, Damaty AE, Vacek P, Lovha M, Guzman R, Stricker S, Beez T, Wiegand C, Azab M, Buis D, Sáez M, Fleck S, Dziugan C, Ferreira A, Radovnicky T, Bührer C, Lam S, Sgouros S, Roth J, Constantini S, Cavalheiro S, Cinalli G, Kulkarni AV, Bock HC. TROPHY registry - status report. Childs Nerv Syst 2021; 37:3549-3554. [PMID: 34184098 PMCID: PMC8578079 DOI: 10.1007/s00381-021-05258-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/08/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The TROPHY registry has been established to conduct an international multicenter prospective data collection on the surgical management of neonatal intraventricular hemorrhage (IVH)-related hydrocephalus to possibly contribute to future guidelines. The registry allows comparing the techniques established to treat hydrocephalus, such as external ventricular drainage (EVD), ventricular access device (VAD), ventricular subgaleal shunt (VSGS), and neuroendoscopic lavage (NEL). This first status report of the registry presents the results of the standard of care survey of participating centers assessed upon online registration. METHODS On the standard of treatment forms, each center indicated the institutional protocol of interventions performed for neonatal post-hemorrhagic hydrocephalus (nPHH) for a time period of 2 years (Y1 and Y2) before starting the active participation in the registry. In addition, the amount of patients enrolled so far and allocated to a treatment approach are reported. RESULTS According to the standard of treatment forms completed by 56 registered centers, fewer EVDs (Y1 55% Y2 46%) were used while more centers have implemented NEL (Y1 39%; Y2 52%) to treat nPHH. VAD (Y1 66%; Y2 66%) and VSGS (Y1 42%; Y2 41%) were used at a consistent rate during the 2 years. The majority of the centers used at least two different techniques to treat nPHH (43%), while 27% used only one technique, 21% used three, and 7% used even four different techniques. Patient data of 110 infants treated surgically between 9/2018 and 2/2021 (13% EVD, 15% VAD, 30% VSGS, and 43% NEL) were contributed by 29 centers. CONCLUSIONS Our results emphasize the varying strategies used for the treatment of nPHH. The international TROPHY registry has entered into a phase of growing patient recruitment. Further evaluation will be performed and published according to the registry protocol.
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Affiliation(s)
- U. W. Thomale
- Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin, Berlin Augustenburger Platz 1, 13353 Berlin, Germany
| | - C. Auer
- Division of Pediatric Neurosurgery, Kepler Universitätsklinikum, Linz, Austria
| | - P. Spennato
- Pediatric Neurosurgery, AORN Santobono Pausilipon, Naples, Italy
| | - A. Schaumann
- Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin, Berlin Augustenburger Platz 1, 13353 Berlin, Germany
| | - P. Behrens
- Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin, Berlin Augustenburger Platz 1, 13353 Berlin, Germany
| | - S. Gorelyshev
- Pediatric Neurosurgery, Moscow Bashlyaeva Pediatric Hospital, Moscow, Russia
| | - E. Bogoslovskaia
- Pediatric Neurosurgery, Surgut Clinical Perinatal Center, Surgut, Russia
| | - A. Shulaev
- Pediatric Neurosurgery, Children’s Republic Clinical Hospital, Kazan, Russia
| | - A. Kabanian
- Pediatric Neurosurgery, Children’s Regional Hospital, Krasnodar, Russia
| | - A. Seliverstov
- Pediatric Neurosurgery, Kemerovo Regional Pediatric Hospital, Kemerovo, Russia
| | - A. Alexeev
- Pediatric Neurosurgery, Chelyabinsk Regional Children’s Clinical Hospital, Chelyabinsk, Russia
| | - O. Ozgural
- Neurosurgery, Ankara University, Ankara, Turkey
| | | | - M. Schuhmann
- Pediatric Neurosurgery, University Hospital of Tübingen, Tubingen, Germany
| | - R. Jimenez-Guerra
- Neonatal Neurosurgery, National Institute of Perinatology, Mexico City, Mexico
| | - N. Wittayanakorn
- Surgery, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - A. Sukharev
- Pediatric Neurosurgery, Regional Children Hospital, Yekaterinburg, Russia
| | | | - S. Linsler
- Neurosurgery, Saarland University Hospital, Homburg, Saarland Germany
| | - A. El Damaty
- Pediatric Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - P. Vacek
- Neurosurgery, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - M. Lovha
- Neurosurgery, Volyn Regional Pediatric Hospital, Lutsk, Ukraine
| | - R. Guzman
- Neurosurgery, Universitätskinderspital Beider Basel, Basel, Switzerland
| | - S. Stricker
- Neurosurgery, Universitätskinderspital Beider Basel, Basel, Switzerland
| | - T. Beez
- Neurosurgery, Heinrich-Heine-University, Duesseldorf, Germany
| | - C. Wiegand
- Neurosurgery, Marienhospital, Osnabrück, Germany
| | - M. Azab
- Neurosurgery, Damietta Specialized Hospital, Damietta, Egypt
| | - D. Buis
- Neurosurgery, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - M. Sáez
- Neurosurgery, Hospital La Paz, Madrid, Spain
| | - S. Fleck
- Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - C. Dziugan
- Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
| | - A. Ferreira
- Neurosurgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - T. Radovnicky
- Neurosurgery, Masaryk Hospital, Usti Nad Labem, Czech Republic
| | - C. Bührer
- Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin, Berlin Augustenburger Platz 1, 13353 Berlin, Germany
| | - S. Lam
- Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
| | - S. Sgouros
- Pediatric Neurosurgery, Iaso Childrens Hospital, Athens, Greece
| | - J. Roth
- Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - S. Constantini
- Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - S. Cavalheiro
- Pediatric Neurosurgery, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - G. Cinalli
- Pediatric Neurosurgery, AORN Santobono Pausilipon, Naples, Italy
| | - A. V. Kulkarni
- Pediatric Neurosurgery, Sick Children Hospital, University of Toronto, Toronto, Canada
| | - H. C. Bock
- Pediatric Neurosurgery, University Medical Center Göttingen, Gottingen, Germany
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Haidari G, Day S, Wood M, Ridgers H, Cope AV, Fleck S, Yan C, Reijonen K, Hannaman D, Spentzou A, Hayes P, Vogt A, Combadiere B, Cook A, McCormack S, Shattock RJ. The Safety and Immunogenicity of GTU ®MultiHIV DNA Vaccine Delivered by Transcutaneous and Intramuscular Injection With or Without Electroporation in HIV-1 Positive Subjects on Suppressive ART. Front Immunol 2019; 10:2911. [PMID: 31921170 PMCID: PMC6923267 DOI: 10.3389/fimmu.2019.02911] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/27/2019] [Indexed: 12/25/2022] Open
Abstract
Previous studies have shown targeting different tissues via the transcutaneous (TC) and intramuscular injection (IM) with or without electroporation (EP) has the potential to trigger immune responses to DNA vaccination. The CUTHIVTHER 001 Phase I/II randomized controlled clinical trial was designed to determine whether the mode of DNA vaccination delivery (TC+IM or EP+IM) could influence the quality and function of induced cellular immune responses compared to placebo, in an HIV positive clade B cohort on antiretroviral therapy (ART). The GTU®MultiHIV B DNA vaccine DNA vaccine encoded a MultiHIV B clade fusion protein to target the cellular response. Overall the vaccine and regimens were safe and well-tolerated. There were robust pre-vaccination IFN-γ responses with no measurable change following vaccination compared to placebo. However, modest intracellular cytokine staining (ICS) responses were seen in the TC+IM group. A high proportion of individuals demonstrated potent viral inhibition at baseline that was not improved by vaccination. These results show that HIV positive subjects with nadir CD4+ counts ≥250 on suppressive ART display potent levels of cellular immunity and viral inhibition, and that DNA vaccination alone is insufficient to improve such responses. These data suggest that more potent prime-boost vaccination strategies are likely needed to improve pre-existing responses in similar HIV-1 cohorts (This study has been registered at http://ClinicalTrials.gov under registration no. NCT02457689).
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Affiliation(s)
- G Haidari
- Group of Mucosal Infection and Immunity, Department of Medicine, Imperial College London, London, United Kingdom
| | - Suzanne Day
- Group of Mucosal Infection and Immunity, Department of Medicine, Imperial College London, London, United Kingdom
| | - M Wood
- Group of Mucosal Infection and Immunity, Department of Medicine, Imperial College London, London, United Kingdom
| | - H Ridgers
- Group of Mucosal Infection and Immunity, Department of Medicine, Imperial College London, London, United Kingdom
| | - Alethea V Cope
- Group of Mucosal Infection and Immunity, Department of Medicine, Imperial College London, London, United Kingdom
| | - Sue Fleck
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Celine Yan
- Group of Mucosal Infection and Immunity, Department of Medicine, Imperial College London, London, United Kingdom
| | | | - Drew Hannaman
- Ichor Medical Systems Inc, San Diego, CA, United States
| | - Aggeliki Spentzou
- Group of Mucosal Infection and Immunity, Department of Medicine, Imperial College London, London, United Kingdom
| | - Peter Hayes
- Human Immunology Laboratory, International AIDS Vaccine Initiative, Imperial College London, London, United Kingdom
| | - A Vogt
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Behazine Combadiere
- Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), INSERM U1135, Paris, France
| | - Adrian Cook
- Medical Research Council Clinical Trials Unit at UCL, University College London, London, United Kingdom
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit at UCL, University College London, London, United Kingdom
| | - Robin J Shattock
- Group of Mucosal Infection and Immunity, Department of Medicine, Imperial College London, London, United Kingdom
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Lakovschek IC, Tomasch G, Fleck S, Görög CM, El-Shabrawi A, Uranüs S, Lang U, Schöll W. Fulminanter Verlauf eines Ileus während der Schwangerschaft mit plötzlichem Fruchttod und abdominellem Kompartmentsyndrom – Fallbericht. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1693880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- IC Lakovschek
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Graz
| | - G Tomasch
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Graz
| | - S Fleck
- Universitätsklinik für Anästhesiologie und Intensivmedizin, Graz
| | - CM Görög
- Universitätsklinik für Anästhesiologie und Intensivmedizin, Graz
| | - A El-Shabrawi
- Universitätsklinik für Chirurgie, Klinische Abteilung für Allgemeinchirurgie, Graz
| | - S Uranüs
- Universitätsklinik für Chirurgie, Klinische Abteilung für Allgemeinchirurgie, Graz
| | - U Lang
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Graz
| | - W Schöll
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Graz
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Cheeseman HM, Day S, McFarlane LR, Fleck S, Miller A, Cole T, Sousa-Santos N, Cope A, Cizmeci D, Tolazzi M, Hwekwete E, Hannaman D, Kratochvil S, McKay PF, Chung AW, Kent SJ, Cook A, Scarlatti G, Abraham S, Combadiere B, McCormack S, Lewis DJ, Shattock RJ. Combined Skin and Muscle DNA Priming Provides Enhanced Humoral Responses to a Human Immunodeficency Virus Type 1 Clade C Envelope Vaccine. Hum Gene Ther 2019; 29:1011-1028. [PMID: 30027768 PMCID: PMC6214652 DOI: 10.1089/hum.2018.075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Intradermal (i.d.) and intramuscular (i.m.) injections when administered with or without electroporation (EP) have the potential to tailor the immune response to DNA vaccination. This Phase I randomized controlled clinical trial in human immunodeficiency virus type 1–negative volunteers investigated whether the site and mode of DNA vaccination influences the quality of induced cellular and humoral immune responses following the DNA priming phase and subsequent protein boost with recombinant clade C CN54 gp140. A strategy of concurrent i.d. and i.m. DNA immunizations administered with or without EP was adopted. Subtle differences were observed in the shaping of vaccine-induced virus-specific CD4+ and CD8+ T cell–mediated immune responses between groups receiving: i.d.EP + i.m., i.d. + i.m.EP, and i.d.EP + i.m.EP regimens. The DNA priming phase induced 100% seroconversion in all of the groups. A single, non-adjuvanted protein boost induced a rapid and profound increase in binding antibodies in all groups, with a trend for higher responses in i.d.EP + i.m.EP. The magnitude of antigen-specific binding immunoglobulin G correlated with neutralization of closely matched clade C 93MW965 virus and Fc-dimer receptor binding (FcγRIIa and FcγRIIIa). These results offer new perspectives on the use of combined skin and muscle DNA immunization in priming humoral and cellular responses to recombinant protein.
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Affiliation(s)
- Hannah Mary Cheeseman
- 1 Department of Medicine, Section of Virology, Group of Mucosal Infection and Immunity, Imperial College London, London, United Kingdom; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Suzanne Day
- 1 Department of Medicine, Section of Virology, Group of Mucosal Infection and Immunity, Imperial College London, London, United Kingdom; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Leon Robert McFarlane
- 1 Department of Medicine, Section of Virology, Group of Mucosal Infection and Immunity, Imperial College London, London, United Kingdom; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Sue Fleck
- 2 Medical Research Council Clinical Trials Unit at UCL, University College London, London, United Kingdom; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Aleisha Miller
- 1 Department of Medicine, Section of Virology, Group of Mucosal Infection and Immunity, Imperial College London, London, United Kingdom; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Tom Cole
- 3 Imperial Clinical Research Facility, Hammersmith Hospital, Imperial College Healthcare NHS Trust, United Kingdom; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Nelson Sousa-Santos
- 3 Imperial Clinical Research Facility, Hammersmith Hospital, Imperial College Healthcare NHS Trust, United Kingdom; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Alethea Cope
- 1 Department of Medicine, Section of Virology, Group of Mucosal Infection and Immunity, Imperial College London, London, United Kingdom; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Deniz Cizmeci
- 1 Department of Medicine, Section of Virology, Group of Mucosal Infection and Immunity, Imperial College London, London, United Kingdom; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Monica Tolazzi
- 4 Viral Evolution and Transmission Unit, Division of Immunology, Transplant and Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Edith Hwekwete
- 3 Imperial Clinical Research Facility, Hammersmith Hospital, Imperial College Healthcare NHS Trust, United Kingdom; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Drew Hannaman
- 5 Ichor Medical Systems, Inc., San Diego, California; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Sven Kratochvil
- 1 Department of Medicine, Section of Virology, Group of Mucosal Infection and Immunity, Imperial College London, London, United Kingdom; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Paul Francis McKay
- 1 Department of Medicine, Section of Virology, Group of Mucosal Infection and Immunity, Imperial College London, London, United Kingdom; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Amy W Chung
- 6 Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, and UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Stephen J Kent
- 6 Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, and UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France .,7 ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of Melbourne, Melbourne, Australia; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France .,8 Melbourne Sexual Health Centre, Department of Infectious Diseases, Alfred Health, Central Clinical School, Monash University , Melbourne, Australia; and UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Adrian Cook
- 2 Medical Research Council Clinical Trials Unit at UCL, University College London, London, United Kingdom; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Gabriella Scarlatti
- 4 Viral Evolution and Transmission Unit, Division of Immunology, Transplant and Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Sonya Abraham
- 3 Imperial Clinical Research Facility, Hammersmith Hospital, Imperial College Healthcare NHS Trust, United Kingdom; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Behazine Combadiere
- 9 Sorbonne Universités, UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Sheena McCormack
- 2 Medical Research Council Clinical Trials Unit at UCL, University College London, London, United Kingdom; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - David John Lewis
- 3 Imperial Clinical Research Facility, Hammersmith Hospital, Imperial College Healthcare NHS Trust, United Kingdom; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Robin John Shattock
- 1 Department of Medicine, Section of Virology, Group of Mucosal Infection and Immunity, Imperial College London, London, United Kingdom; UPMC Univ Paris 06, INSERM, U1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
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Hargreaves L, Anderson JDC, Fleck S, Dixon JJ. Diagnostic investigation of an unusually large osseous cyst-like lesion of the radial carpal bone. EQUINE VET EDUC 2018. [DOI: 10.1111/eve.12951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - J. D. C. Anderson
- The Surgery; Bishopton Equine Veterinary Services; Ripon North Yorkshire UK
| | - S. Fleck
- The Surgery; Bishopton Equine Veterinary Services; Ripon North Yorkshire UK
| | - J. J. Dixon
- Rainbow Equine Hospital; Malton North Yorkshire UK
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Ten Cate K, Fleck S, Drayton V. Improved Patient Activation in Underserved U.S. Seniors Through a National Community-Based Diabetes Self-Management Program. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nowak S, Rehberg S, Schroeder H, Fleck S. Pupillary dilatation associated with volatile anaesthetics: a small case series. Br J Anaesth 2017; 119:169-170. [DOI: 10.1093/bja/aex183] [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] [Indexed: 11/12/2022] Open
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Grothe F, Grothe S, Fleck S, Rathmann E, Langner S. Prävalenz einer neurovaskulären Kompression der rostralen ventrolateralen Medulla oblongata in einer populationsbasierten MR-Studie. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- F Grothe
- Universitätsmedizin Greifswald, Institut für Diagnostische Radiologie und Neuroradiologie, Greifswald
| | - S Grothe
- Universitätsmedizin Greifswald, Institut für Diagnostische Radiologie und Neuroradiologie, Greifswald
| | - S Fleck
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald
| | - E Rathmann
- Universitätsmedizin Greifswald, Institut für Diagnostische Radiologie und Neuroradiologie, Greifswald
| | - S Langner
- Universitätsmedizin Greifswald, Institut für Diagnostische Radiologie und Neuroradiologie, Greifswald
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11
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Affiliation(s)
- S. Langner
- Institute for Diagnostic Radiology and Neuroradiology, Universitymedicine Greifswald, Germany
| | - R. Buelow
- Institute for Diagnostic Radiology and Neuroradiology, Universitymedicine Greifswald, Germany
| | - S. Fleck
- Department of Neurosurgery, Universitymedicine Greifswald, Germany
| | - A. Angermaier
- Department of Neurology, Universitymedicine Greifswald, Germany
| | - M. Kirsch
- Institute for Diagnostic Radiology and Neuroradiology, Universitymedicine Greifswald, Germany
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Arenas-Pinto A, Winston A, Stöhr W, Day J, Wiggins R, Quah SP, Ainsworth J, Fleck S, Dunn D, Accoroni A, Paton NI. Neurocognitive function in HIV-infected patients: comparison of two methods to define impairment. PLoS One 2014; 9:e103498. [PMID: 25078406 PMCID: PMC4117499 DOI: 10.1371/journal.pone.0103498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 07/02/2014] [Indexed: 12/02/2022] Open
Abstract
Objective To compare two definitions of neurocognitive impairment (NCI) in a large clinical trial of effectively-treated HIV-infected adults at baseline. Methods Hopkins Verbal Learning test-Revised (HVLT-R), Colour Trail (CTT) and Grooved Pegboard (GPT) tests were applied exploring five cognitive domains. Raw scores were transformed into Z-scores and NCI defined as summary NPZ-5 score one standard deviation below the mean of the normative dataset (i.e. <−1SD) or Z-scores <−1SD in at least two individual domains (categorical scale). Principal component analysis (PCA) was performed to explore the contribution of individual tests to the total variance. Results Mean NPZ-5 score was −0.72 (SD 0.98) and 178/548 (32%) participants had NPZ-5 scores <−1SD. When impairment was defined as <−1SD in at least two individual tests, 283 (52%) patients were impaired. Strong correlations between the two components of the HVLT-R test (learning/recall) (r = 0.73), and the CTT and (attention/executive functioning) (r = 0.66) were observed. PCA showed a clustering with three components accounting for 88% of the total variance. When patients who scored <−1SD only in two correlated tests were considered as not impaired, prevalence of NCI was 43%. When correlated test scores were averaged, 36% of participants had NPZ-3 scores <−1SD and 32% underperformed in at least two individual tests. Conclusion Controlling for differential contribution of individual test-scores on the overall performance and the level of correlation between components of the test battery used appear to be important when testing cognitive function. These two factors are likely to affect both summary scores and categorical scales in defining cognitive impairment. Trial registration EUDRACT: 2007-006448-23 and ISRCTN04857074.
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Affiliation(s)
- Alejandro Arenas-Pinto
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, United Kingdom
- Centre for Sexual Health and HIV Research, University College London, London, United Kingdom
- * E-mail:
| | - Alan Winston
- Section of Infectious Diseases, Division of Medicine, Imperial College, St Mary’s Hospital Campus, London, United Kingdom
- Department of HIV and GU Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Wolfgang Stöhr
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, United Kingdom
| | - John Day
- Infectious Diseases, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, United Kingdom
| | - Rebecca Wiggins
- Centre for Immunology and Infection, Department of Biology, University of York, York, United Kingdom
| | - Say Pheng Quah
- Department of GU Medicine, Royal Victoria Hospital, Belfast, United Kingdom
| | - Jonathan Ainsworth
- Infectious Diseases, North Middlesex University Hospital, London, United Kingdom
| | - Sue Fleck
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, United Kingdom
| | - David Dunn
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, United Kingdom
| | - Alex Accoroni
- Psychology and Psychotherapy Department, The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Nicholas I. Paton
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, United Kingdom
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Nijagal A, Fleck S, Hills NK, Feng S, Tang Q, Kang SM, Rosenthal P, MacKenzie TC. Decreased risk of graft failure with maternal liver transplantation in patients with biliary atresia. Am J Transplant 2012; 12:409-19. [PMID: 22221561 DOI: 10.1111/j.1600-6143.2011.03895.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The presence of maternal cells in offspring may promote tolerance to noninherited maternal antigens (NIMAs). Children with biliary atresia (BA) have increased maternal cells in their livers, which may impact tolerance. We hypothesized that patients with BA would have improved outcomes when receiving a maternal liver. We reviewed all pediatric liver transplants recorded in the SRTR database from 1996 to 2010 and compared BA and non-BA recipients of maternal livers with recipients of paternal livers for the incidences of graft failure and retransplantation. Rejection episodes after parental liver transplantation were examined for patients transplanted at our institution. BA patients receiving a maternal graft had lower rates of graft failure compared to those receiving a paternal graft (3.7% vs. 10.5%, p = 0.02) and, consequently, fewer episodes of retransplantation (2.7% vs. 7.5%, p = 0.04). These differences were not seen among non-BA patients or among BA patients who received female deceased donor grafts. In patients transplanted at our institution, paternal liver transplantation was associated with an increased incidence of refractory rejection compared to maternal liver transplantation only in BA. Our data support the concept that maternal cells in BA recipients promote tolerance to NIMAs and may be important in counseling BA patients who require liver transplantation.
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Affiliation(s)
- A Nijagal
- Department of Surgery, University of California, San Francisco, CA, USA
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Mohr M, Pillich D, Kirsch M, Mueller JU, Fleck S, Hosten N, Langner S. Percutaneous balloon kyphoplasty with the patient under intravenous analgesia and sedation: a feasibility study. AJNR Am J Neuroradiol 2011; 32:649-53. [PMID: 21273350 DOI: 10.3174/ajnr.a2345] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Kyphoplasty is a minimally invasive procedure for the treatment of malignant or osteoporotic vertebral compression fractures, normally performed with the patient under general anesthesia. This may cause a therapeutic dilemma because these patients often have a very high risk for general anesthesia due to concomitant diseases. The aim of this study was to evaluate the safety and feasibility of percutaneous kyphoplasty by using IV anesthesia and sedation with midazolam and piritramide. MATERIALS AND METHODS From June 2007 to June 2009, we prospectively included 133 patients (77 women, 56 men; mean age, 69.18 ± 11.45 years) who were referred for BKP. Kyphoplasty was always performed under fluoroscopic guidance with a biplane angiographic system by using a transpedicular or extrapedicular approach. The individual anesthesia risk was assessed by using the ASA criteria. All procedures were performed with the patient under IV anesthesia and sedation with fractionated administration of midazolam and piritramide. Pain was assessed before and after treatment by using a VAS. RESULTS Ninety-nine patients (74.4%) had a significantly increased risk for general anesthesia (ASA score, ≥ 3). A total of 162 kyphoplasty procedures were performed. The mean amounts of midazolam and piritramide used were 11.3 ± 4.38 mg and 11.8 ± 3.98 mg, respectively. No complications related to IV anesthesia and sedation occurred. Periprocedural pain management was rated as sufficient, and all patients would undergo the procedure again. CONCLUSIONS Percutaneous BKP with the patient under IV anesthesia and sedation with midazolam and piritramide is a safe and feasible method for treating vertebral compression fractures in patients with an increased risk for general anesthesia.
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Affiliation(s)
- M Mohr
- Institute for Diagnostic Radiology and Neuroradiology, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
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Schütte J, Kümmel A, Fleck S, Mielke R, Langenbach M. Mentalisierungsfähigkeit im Verlauf stationärer psychotherapeutischer Behandlung von depressiven Patienten. Psychother Psych Med 2011. [DOI: 10.1055/s-0031-1272433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mohr M, Pillich DT, Kirsch M, Fleck S, Hosten N, Langner S. Durchführbarkeit der Ballonkyphoplastie unter i.v.- Analgosedierung und Verwendung einer biplanären Angiographieeinheit. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Langner S, Pillich DT, Fleck S, Petrik M, Hosten N, Kirsch M. Ballonkyphoplastie unter Verwendung einer iv-Analgosedierung – eine Machbarkeitsstudie. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Langner S, Fleck S, Luehken C, Schroeder HW, Hosten N, Kirsch M. Evaluation des extra-intrakraniellen Bypasses mittels Perfusions-CT und CT Angiographie. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Junge T, Fleck S, Albrecht C, Nauck M, Wallaschofski H, Schröder HS. Pituitary dysfunction in patients operated on for non-pituitary intracranial tumors – a retrospectic clinical study. Exp Clin Endocrinol Diabetes 2008. [DOI: 10.1055/s-0028-1096368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Langner S, Fleck S, Kirsch M, Petrik M, Hosten N. Whole-body CT trauma imaging with adapted and optimized CT angiography of the craniocervical vessels: do we need an extra screening examination? AJNR Am J Neuroradiol 2008; 29:1902-7. [PMID: 18784210 DOI: 10.3174/ajnr.a1261] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Blunt carotid and vertebral artery injury (BCVI) is rare but potentially devastating. The objective of our study was to prospectively evaluate the usefulness of a dedicated and optimized CT angiography (CTA) protocol of the craniocervical vessels as part of a whole-body CT work-up of patients with multiple trauma in a population of patients with blunt trauma. MATERIAL AND METHODS From February 2006 to July 2007, a total of 368 consecutive patients with trauma were evaluated. All examinations were performed on a 16-row multisection CT (MSCT) scanner. CTA was performed from the level of the T2 vertebra to the roof of the lateral ventricles with 40 mL of iodinated contrast agent. Images were reconstructed with use of the angiography and bone window settings to evaluate vessels and bones. RESULTS Of all eligible patients imaged, 100 had injuries to the head and neck including 35 skull base fractures (9.5%), 24 maxillofacial (6.5%), and 11 cervical spine fractures (3%). CTA was diagnostic in all patients. BCVI was diagnosed in 6 cases (6 lesions of the internal carotid artery, 3 lesions of the vertebral artery); among them were 2 who did not meet the screening criteria. No patient with negative results on CTA subsequently had development of neurologic deficits suspicious for BCVI. CONCLUSION This study confirms that optimized craniocervical CTA can be easily integrated into a whole-body CT protocol for patients with multiple trauma. No additional screening technique is necessary to identify clinically relevant vascular injuries. Earlier recognition enables earlier treatment and may decrease mortality and morbidity rates of these rare but potentially devastating injuries.
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Affiliation(s)
- S Langner
- Institute for Diagnostic Radiology and Neuroradiology, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany.
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Baldauf J, Müller JU, Fleck S, Hinz P, Chiriac A, Schroeder H. The Value of Intraoperative Three Dimensional Fluoroscopy in Anterior Decompressive Surgery of the Cervical Spine. ACTA ACUST UNITED AC 2008; 69:30-4. [DOI: 10.1055/s-2007-992796] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Langner S, Fleck S, Kirsch M, Petrik M, Lühken C, Hosten N. Whole body CT trauma imaging with adapted and optimized CT- angiography of the cranio-cervical vessels: do we need an extra screening examination? ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Adenauer H, Kessler J, Brand M, Dziobek I, Fleck S, Kalbe E. „Undermentalizing“ als zugrundliegender Mechanismus der Theory-of-Mind-Störung bei Personen mit Asperger-Syndrom? Hinweise durch qualitative Fehleranalysen eines videobasierten ToM-Tests. Akt Neurol 2007. [DOI: 10.1055/s-2007-987736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Adenauer H, Brand M, Lechmann C, Prim W, Dziobek I, Fleck S, Kessler J, Kalbe E. Der Zusammenhang von Theory of Mind-Leistungen mit anderen neuropsychologischen Funktionen bei Personen mit Asperger-Syndrom. Akt Neurol 2006. [DOI: 10.1055/s-2006-953472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Reymann G, Baune B, Fleck S, Sundermann A. Als Alkoholnotfall ins Krankenhaus – und dann? Gesundheitswesen 2005. [DOI: 10.1055/s-2005-920674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Baune B, Reymann G, Fleck S, Sundermann A. Aufnahmeraten und Behandlungsdauer akuter alkoholbedingter Störungen in Notaufnahmen von Krankenhäusern: die Variation der klinischen Krankheitslast und der Therapieerfordernisse in Abhängigkeit von der medizinischen Fachrichtung. Gesundheitswesen 2005. [DOI: 10.1055/s-2005-920688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Adenauer H, Kessler J, Brand M, Fleck S, Lechmann C, Prim W, Kalbe E. Vergleich verschiedener deutschsprachiger Theory-of-Mind Tests bei Menschen mit Asperger Syndrom. Akt Neurol 2005. [DOI: 10.1055/s-2005-919349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Louda J, Adenauer H, Fleck S, Emmans D, Hilker R, Kessler J. KEX-D: Kölner Exekutiv-Diagnostikum. Erste Erfahrungen mit Parkinson-Patienten. Akt Neurol 2005. [DOI: 10.1055/s-2005-919301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fleck S, Riebel U. Influence of Fluid Dynamics on Collection and Agglomeration of Aerosols in a Fluidized Bed. Chem Eng Technol 1999. [DOI: 10.1002/(sici)1521-4125(199912)22:12<1006::aid-ceat1006>3.0.co;2-t] [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: 11/10/2022]
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Fleck S. Impediments in the treatment of schizophrenic patients. Conn Med 1998; 62:707-14. [PMID: 9919797] [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: 02/10/2023]
Abstract
Treatment for schizophrenic patients used to entail long hospitalization, including individual psychotherapy and sociotherapy, and ideally involved significant others, culminating in rehabilitation or continuation of education and follow-up treatment. Under such regimens available mostly in the private sector, one third of patients became well and another third recovered sufficiently to function in the community. There has always been a cohort of between 25% and 33% who failed to recover and who usually became chronic patients in governmental facilities. Comprehensive in-patient programs have virtually disappeared in the United States. This paper will present factors involved in this change and the ensuing deficiencies in care. These impediments will be considered under eight subheadings.
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Affiliation(s)
- S Fleck
- Yale University School of Medicine, Department of Psychiatry School of Medicine, New Haven, USA
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Brunner GA, Fleck S, Pieber TR, Lueger A, Kaufmann P, Smolle KH, Brussee H, Krejs GJ. Near fatal anticholinergic intoxication after routine fundoscopy. Intensive Care Med 1998; 24:730-1. [PMID: 9722045 DOI: 10.1007/s001340050652] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We describe a case of severe anticholinergic intoxication following the topical instillation of tropicamide-containing eyedrops. Tropicamide is a short-acting atropine-like derivative and has been regarded as an effective and safe mydriatic. Half an hour after routine fundoscopy, a 62-year-old man experienced two generalized seizures with respiratory arrest and required intubation and mechanical ventilation. The patient was treated with physostigmine and made a full recovery.
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Affiliation(s)
- G A Brunner
- Department of Internal Medicine, Karl Franzens University Graz, Austria
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Morgan DJ, Kreuwel HT, Fleck S, Levitsky HI, Pardoll DM, Sherman LA. Activation of low avidity CTL specific for a self epitope results in tumor rejection but not autoimmunity. J Immunol 1998; 160:643-51. [PMID: 9551898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
To determine how self-tolerance can alter the ability of the immune system to respond against tumor-associated Ags that are also expressed by normal tissue, we designed experiments in which the same protein was expressed both as a tumor Ag and as a transgene product. Unlike conventional BALB/c mice that rejected renal carcinoma cells transfected with the influenza virus hemagglutinin (Renca-HA), transgenic mice that are tolerant of HA due to its expression as a self-Ag on pancreatic islet beta cells, (Ins-HA mice) supported progressive growth of these tumor cells. However, when Ins-HA mice were immunized with a recombinant strain of vaccinia virus expressing the dominant H-2Kd peptide epitope of HA before receiving Renca-HA cells, they too were able to reject the tumor cells. Rejection of Renca-HA cells by immunized Ins-HA mice was found to be associated with the generation of CTL having much lower avidity for target cells presenting the KdHA epitope than CTL from immunized conventional BALB/c mice. Significantly, we show that self-tolerance to the HA Ag is quantitative rather then absolute, and that vaccination of Ins-HA mice can activate low avidity KdHA-specific CD8+ T cells that are able to reject tumor cells expressing high levels of HA, yet these mice remain tolerant of pancreatic islet beta cells expressing HA.
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Affiliation(s)
- D J Morgan
- Department of Immunology, The Scripps Research Institute, La Jolla, CA 92037, USA
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Smolle KH, Kaufmann P, Fleck S, Lueger A, Mausser G, Pölz W, Kleinberger G, Krejs GJ. Influence of a novel amino acid solution (enriched with the dipeptide glycyl-tyrosine) on plasma amino acid concentration of patients with acute renal failure. Clin Nutr 1997; 16:239-46. [PMID: 16844602 DOI: 10.1016/s0261-5614(97)80035-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/1996] [Accepted: 01/24/1997] [Indexed: 10/26/2022]
Abstract
In this randomized, double-blind controlled study we compared the effect of parenteralnutrition with two different amino acid solutions on the plasma concentration of amino acids in 27 patients with acute renal failure. Fourteen patients received the new dipeptide-containing (glycyl-tyrosine) amino acid solution (AADI) in combination with glucose (60%) and fat (10%) as an 'all-in-one' solution over 120 h continuously via a central venous catheter. In the control group (AAST), parenteral nutrition with a standard amino acid solution in isonitrogenous and isocaloric form (0.7 g amino acids/kg BW/day and 25 kcal/kg BW/day) was administered to 13 patients over the same period of time. The administration of the dipeptide-containing amino acid solution caused a return to within the normal range of most of the amino acid concentrations which were decreased at the onset. A significant difference could be found between the AADI and AAST group for the achieved plasma concentrations of threonine (P < 0.01), phenylalanine (P<0.05), isoleucine (P<0.05), tryptophan (P<0.01) and ornithine (P<0.05), The phenylalanine/tyrosine ratio, did not change in the AADI group, while a marked increase was observed in the AAST group. (152.7 +/- 23.5 - 159.8 +/- 37.6 vs 172.6 +/- 24.6 - 310.6 +/- 136.7, respectively). The plasma concentration of glycyl-tyrosine was at the limit of detectability indicating rapid hydrolysis of the dipeptide in acute renal failure. These data suggest that the new dipeptide-containing amino acid solution offers a clear advantage over a standard amino acid formulation in correcting the amino acid imbalances in plasma of patients with ARF and is able to maintain normal tyrosine concentrations and phenylalanine/tyrosine ratio.
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Affiliation(s)
- K H Smolle
- Department of Internal Medicine, Karl Franzens University, Graz, Austria
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Brettschneider H, Christmann U, Fleck S, Hamann S, Hanisch HM. Hierarchical modelling of recipe controllers — A practical approach. Comput Chem Eng 1997. [DOI: 10.1016/s0098-1354(97)87565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Arbree NS, Fleck S, Askinas SW. The results of a brief survey of complete denture prosthodontic techniques in predoctoral programs in North American dental schools. J Prosthodont 1996; 5:219-25. [PMID: 9028228 DOI: 10.1111/j.1532-849x.1996.tb00300.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A brief mail survey of North American dental schools was undertaken to ascertain the current techniques in complete denture prosthodontics regarding preliminary and final impressions, record bases, and denture teeth. Of the 64 schools surveyed, 54 responded (84%). Seventy-four percent of the respondents used only irreversible hydrocolloid (alginate) for their preliminary impressions; 15% used only modeling plastic impression compound. Eighty-one percent used only modeling plastic impression compound for border molding of the final impression tray; 7% used only polyether impression material. Forty-eight percent used only polysulfide rubber (PR) impression material for their final impression material; 4% used only polyether impression material. Only 1 school still used shellac as one of its materials for record bases. Thirty-five percent used only Triad; 35% used only acrylic resin; 24% used both of these materials. Thirteen percent of responding schools used only nonanatomic teeth. The majority (54%) used all three options (nonanatomic, semianatomic, and anatomic). Eleven percent used lingualized occlusion. As compared with a survey performed in 1985, the use of irreversible hydrocolloid as a preliminary impression material, the use of visible light-cured resins for record bases, and the use of anatomic teeth have increased. The use of plastic impression compound for border molding and PR as the final impression material has largely remained the same.
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Affiliation(s)
- N S Arbree
- Tujts University School of Dental Medicine, Medford, MA, USA
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Morgan DJ, Liblau R, Scott B, Fleck S, McDevitt HO, Sarvetnick N, Lo D, Sherman LA. CD8(+) T cell-mediated spontaneous diabetes in neonatal mice. The Journal of Immunology 1996. [DOI: 10.4049/jimmunol.157.3.978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Transgenic mice that express the influenza virus hemagglutinin (HA) on pancreatic islet beta cells (ins-HA) demonstrate tolerance of HA even after immunization with influenza virus. Surprisingly, when Ins-HA mice were mated with a transgenic mouse expressing a TCR specific for an epitope of HA that is restricted by MHC class I H-2Kd (Clone-4 TCR), the resulting double transgenic (Ins-HA x Clone-4 TCR)F1 neonates developed spontaneous autoimmune diabetes immediately after birth and died within 10 days. This represents a unique situation in which all safeguards within the immune system that normally maintain tolerance of self-antigens in the neonate are insufficient.
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Affiliation(s)
- D J Morgan
- Department of Immunology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - R Liblau
- Department of Immunology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - B Scott
- Department of Immunology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - S Fleck
- Department of Immunology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - H O McDevitt
- Department of Immunology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - N Sarvetnick
- Department of Immunology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - D Lo
- Department of Immunology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - L A Sherman
- Department of Immunology, The Scripps Research Institute, La Jolla, CA 92037, USA
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Morgan DJ, Liblau R, Scott B, Fleck S, McDevitt HO, Sarvetnick N, Lo D, Sherman LA. CD8(+) T cell-mediated spontaneous diabetes in neonatal mice. J Immunol 1996; 157:978-83. [PMID: 8757600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Transgenic mice that express the influenza virus hemagglutinin (HA) on pancreatic islet beta cells (ins-HA) demonstrate tolerance of HA even after immunization with influenza virus. Surprisingly, when Ins-HA mice were mated with a transgenic mouse expressing a TCR specific for an epitope of HA that is restricted by MHC class I H-2Kd (Clone-4 TCR), the resulting double transgenic (Ins-HA x Clone-4 TCR)F1 neonates developed spontaneous autoimmune diabetes immediately after birth and died within 10 days. This represents a unique situation in which all safeguards within the immune system that normally maintain tolerance of self-antigens in the neonate are insufficient.
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Affiliation(s)
- D J Morgan
- Department of Immunology, The Scripps Research Institute, La Jolla, CA 92037, USA
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Affiliation(s)
- S Fleck
- Department of Psychiatry, Yale University, New Haven, Connecticut 06519, USA
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Fleck S. Psychiatric illnesses, as well as other diseases, are not solely physical ot organic conditions, but are intertwined with thoughts, feelings, and interpersonal factors. Perspect Biol Med 1995; 39:150-152. [PMID: 8524622 DOI: 10.1353/pbm.1995.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Richard JM, Fleck S. Limits on the domain of coupling constants for binding N-body systems with no bound subsystems. Phys Rev Lett 1994; 73:1464-1467. [PMID: 10056800 DOI: 10.1103/physrevlett.73.1464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Fleck S. Progress in psychiatry. N Engl J Med 1994; 330:285; author reply 286. [PMID: 8272092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Fleck S. A neuroanatomy of obsessive-compulsive disorder. Arch Gen Psychiatry 1993; 50:501. [PMID: 8498889 DOI: 10.1001/archpsyc.1993.01820180103018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Medley GF, Sinden RE, Fleck S, Billingsley PF, Tirawanchai N, Rodriguez MH. Heterogeneity in patterns of malarial oocyst infections in the mosquito vector. Parasitology 1993; 106 ( Pt 5):441-9. [PMID: 8341579 DOI: 10.1017/s0031182000076721] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.7] [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: 01/30/2023]
Abstract
Oocyst prevalence and intensity have been recorded in 349 laboratory infections of Anopheles stephensi with Plasmodium berghei. Intensity and prevalence of infection are shown to be predictably related. The structure and heterogeneity in the infections has been analysed with the objective of describing the biological mechanisms by which the observed negative binomial oocyst distributions are generated. The analysis has revealed that the most likely processes lie within the population dynamic events of malaria within the mosquito, namely gametogenesis, fertilization and mortality. The distribution is similar in all Plasmodium-mosquito combinations examined so far, whether they are of laboratory (P. gallinaceum in Aedes aegypti) or field (P. vivax in An. albimanus and P. falciparum in An. gambiae s.l. and An. funestus) origin. Further we conclude that there is competition between parasites in the vector. Oocyst frequency distribution analysis shows that under natural conditions of transmission intensity, and even under the best laboratory conditions, significant numbers (> 10%) of fully susceptible mosquitoes will not be infected under conditions where the mean infection is as high as 250 oocysts. Failure to infect is not therefore an absolute indicator of refractoriness. In assessing transmission data it is shown that sample sizes should not be less than 50, and ideally 100 mosquitoes, if reliable data are to be obtained. In field it is suggested that difficulties in determining the low natural intensity of oocyst infections indicate that prevalence estimates are a useful and accessible parameter to measure.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G F Medley
- Department of Biology, Imperial College, London, UK
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Abstract
This overview sketches briefly the development of social psychiatry and its clinical application in institutions in modern times. The second and longest part addresses the family as the important social context for everybody throughout life. A systems view of family tasks and functioning is offered. In the third part, some of the highlights of psychiatric epidemiology are cited, and in the last section, community psychiatry is discussed - its failures and its potential. The need to establish interagency networks with continuing consultation and discussion concerning each patient is stressed, as well as the essentiality that our professions learn and cultivate general systems principles. Social psychiatry views the patient and the context in which he or she lives or works as a field in which one element affects all others in circular fashion.
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Affiliation(s)
- S Fleck
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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Fleck S, Silvestre-Brac B, Richard JM. Search for diquark clustering in baryons. Phys Rev D Part Fields 1988; 38:1519-1529. [PMID: 9959299 DOI: 10.1103/physrevd.38.1519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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