56 results on '"Burkhard Bewig"'
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2. ECMO-Therapie beim akuten Lungenversagen
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L. Balke, Burkhard Bewig, A. Haneya, and B. Panholzer
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Gynecology ,medicine.medical_specialty ,business.industry ,Emergency Medicine ,Internal Medicine ,Medicine ,Emergency Nursing ,Critical Care and Intensive Care Medicine ,business - Published
- 2019
3. Die Cytomegalievirus-Pneumonie
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Lorenz Balke and Burkhard Bewig
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Pulmonary and Respiratory Medicine ,Gynecology ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,030228 respiratory system ,business.industry ,medicine ,030212 general & internal medicine ,business - Abstract
Die Cytomegalievirus(CMV)-Pneumonie ist eine schwere Erkrankung des immunsupprimierten Patienten. Insbesondere in der Transplantationsmedizin muss das CMV als Verursacher ernster Komplikationen berucksichtigt werden. Die Diagnostik ist nicht trivial, weil Symptomatik und Erstbefunde unspezifisch und wenig suggestiv sind. Differenzialdiagnosen, wie beispielsweise die bakterielle Pneumonie, interstitielle Lungenerkrankungen oder Abstosungsreaktionen, mussen erwogen werden und konnen parallel mit einer relevanten CMV-Infektion auftreten. Aufgrund der speziellen antiviralen Therapieoptionen hat die sorgfaltige Diagnostik erhebliche Relevanz. Nur wenn der Arzt die CMV-Pneumonie bedenkt, wird er sie erkennen und behandeln konnen.
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- 2019
4. IL23R on myeloid cells is involved in murine pulmonary granuloma formation
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Stefan Schreiber, Nicolas Gisch, Konrad Aden, Maren Falk-Paulsen, Jan W. P. Kuiper, Philip Rosenstiel, Tina Schreiber, Burkhard Bewig, and Rainer Noth
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Pulmonary and Respiratory Medicine ,musculoskeletal diseases ,Granuloma ,Sarcoidosis ,business.industry ,Mechanism (biology) ,Macrophages ,Clinical Biochemistry ,Pneumonia ,Receptors, Interleukin ,Disease pathogenesis ,PULMONARY GRANULOMA ,medicine.disease ,Mice ,Myeloid cells ,Cancer research ,Medicine ,Animals ,Cytokines ,business ,Molecular Biology ,Lung - Abstract
The involvement of the IL-23/IL23R pathway is well known in the disease pathogenesis of sarcoidosis and other inflammatory diseases. To date, the pathogenic mechanism of IL-23 is most notably described on CD4+ Th17 lymphocytes. However, the function of the IL23R on myeloid cells in sarcoidosis is poorly understood. Thus, the aim of the study is to investigate the role of the IL23R on myeloid cell in pulmonary granuloma formation. Methods: We generated IL23RLysMCre mice lacking the IL23R gene in myeloid cells. The importance of IL23R in myeloid cells for the development of sarcoidosis was studied in a mouse model of inflammatory lung granuloma formation through embolization of PPD from Mycobacterium bovis-coated Sepharose beads into previously PPD-immunized mice. In addition the function of IL23R on myeloid cells was studied in LPS or IFNγ stimulated BMDMs and BMDCs. The mRNA and protein expression levels of relevant cytokines were analyzed by RT-PCR (TaqMan) and ELISA. The composition of immune cells in BALF was quantified by flow cytometry and alteration in granuloma sizes were observed by H&E stained lung sections. Results: Mycobacterium Ag-elicted pulmonary granulomas tend to be smaller in IL23RLysMCre mice and NF-κB dependent Th1 cytokines in the murine lungs are reduced compared to wildtype mice. In line, we observed that IL23R-deficient bone marrow-derived macrophages show a reduced production of Th1 cytokines after LPS stimulation. Conclusion: We here for the first time demonstrate a role for IL23R on myeloid cells in pulmonary inflammation and granuloma formation. Our findings provide essential insights in the pathogenesis of inflammatory lung diseases like sarcoidosis, which might be useful for the development of novel therapeutics targeting distinct immunological pathways like IL-23/IL23R.
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- 2021
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5. Acute Kidney Injury in Patients with Severe ARDS Requiring Extracorporeal Membrane Oxygenation: Incidence, Prognostic Impact and Risk Factors
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Kevin Pilarczyk, Katharina Huenges, Burkhard Bewig, Lorenz Balke, Jochen Cremer, Assad Haneya, and Bernd Panholzer
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surgical procedures, operative ,acute respiratory distress syndrome ,extracorporeal membrane oxygenation ,acute kidney injury ,General Medicine - Abstract
(1) Background: Acute kidney injury (AKI) is a common but under-investigated complication in patients receiving extracorporeal membrane oxygenation (ECMO). We aimed to define the incidence and clinical course, as well as the predictors of AKI in adults receiving ECMO support. (2) Materials and Methods: This is a retrospective analysis of all patients undergoing veno-venous ECMO treatment in a tertiary care center between December 2008 and December 2017. The primary endpoint was the new occurrence of an AKI of stage 2 or 3 according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification after ECMO implantation. (3) Results: During the observation period, 103 patients underwent veno-venous ECMO implantation. In total, 59 patients (57.3%) met the primary endpoint with an AKI of stage 2 or 3 and 55 patients (53.4%) required renal replacement therapy. Patients with an AKI of 2 or 3 suffered from more bleeding and infectious complications. Whereas weaning failure from ECMO (30/59 (50.8%) vs. 15/44 (34.1%), p = 0.08) and 30-day mortality (35/59 (59.3%) vs. 17/44 (38.6%), p = 0.06) only tended to be higher in the group with an AKI of stage 2 or 3, long-term survival of up to five years was significantly lower in the group with an AKI of stage 2 or 3 (p = 0.015). High lactate, serum creatinine, and ECMO pump-speed levels, and low platelets, a low base excess, and a low hematocrit level before ECMO were independent predictors of moderate to severe AKI. Primary hypercapnic acidosis was more common in AKI non-survivors (12 (32.4%) vs. 0 (0.0%), p < 0.01). Accordingly, pCO2-levels prior to ECMO implantation tended to be higher in AKI non-survivors (76.12 ± 27.90 mmHg vs. 64.44 ± 44.31 mmHg, p = 0.08). In addition, the duration of mechanical ventilation prior to ECMO-implantation tended to be longer (91.14 ± 108.16 h vs. 75.90 ± 86.81 h, p = 0.078), while serum creatinine (180.92 ± 115.72 mmol/L vs. 124.95 ± 77.77 mmol/L, p = 0.03) and bicarbonate levels were significantly higher in non-survivors (28.22 ± 8.44 mmol/L vs. 23.36 ± 4.19 mmol/L, p = 0.04). (4) Conclusion: Two-thirds of adult patients receiving ECMO suffered from moderate to severe AKI, with a significantly increased morbidity and long-term mortality.
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- 2022
6. Utilization and determinants of use of non-pharmacological interventions in COPD: Results of the COSYCONET cohort
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Larissa Schwarzkopf, Rolf Holle, Kathrin Kahnert, Michael Studnicka, Johanna I. Lutter, Marco Lukas, Stefan Karrasch, Claus Vogelmeier, Rudolf A. Jörres, and Burkhard Bewig
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Treatment Guidelines ,Non-pharmacological Intervention ,Gender Differences ,Vaccination ,Smoking Cessation ,Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Psychological intervention ,Disease ,Severity of Illness Index ,Cohort Studies ,03 medical and health sciences ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Patient Education as Topic ,Medicine ,Humans ,Pulmonary rehabilitation ,030212 general & internal medicine ,Physical Therapy Modalities ,Aged ,COPD ,Sex Characteristics ,business.industry ,Middle Aged ,medicine.disease ,Exercise Therapy ,030228 respiratory system ,Influenza Vaccines ,Cohort ,Emergency medicine ,Smoking cessation ,Regression Analysis ,Female ,business ,Educational program ,Patient education ,Sports - Abstract
Background: Guidelines for chronic obstructive pulmonary disease (COPD) recommend supplementing pharmacotherapy with non-pharmacological interventions. Little is known about the use of such interventions by patients. We analyzed the utilization of a number of non-pharmacological interventions and identified potential determinants of use.Methods: Based on self-reports, use of interventions (smoking cessation, influenza vaccination, physiotherapy, sports program, patient education, pulmonary rehabilitation) and recommendation to use were assessed in 1410 patients with COPD. The utilization was analyzed according to sex and severity of disease. Potential determinants of utilization included demographic variables and disease characteristics and were analyzed using logistic regression models.Results: Influenza vaccination in the previous autumn/winter was reported by 73% of patients. About 19% were currently participating in a reimbursed sports program, 10% received physiotherapy, 38% were ever enrolled in an educational program, and 34% had ever participated in an outpatient or inpatient pulmonary rehabilitation program. Out of 553 current or former smokers, 24% had participated in a smoking cessation program. While reports of having received a recommendation to use mainly did not differ according to sex, women showed significantly (p < 0.05) higher utilization rates than men for all interventions except influenza vaccination. Smoking was a predictor for not having received a recommendation for utilization and also significantly associated with a reduced odds of utilization. We found a correlation between recommendation to use and utilization.Conclusions: Utilization of non-pharmacological interventions was lower in men and smokers. A recommendation or offer to use by the physician could help to increase uptake.
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- 2020
7. CAT score single item analysis in patients with COPD: results from COSYCONET
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J. Randerath Winfried, Pfeifer Michael, Kenn Klaus, Joachim H. Ficker, Gogol Manfred, Grohé Christian, Höffken Gerd, Zaklina Hinz, Julia Tobias, Henke Markus, Teschler Helmut, Welte Tobias, Benjamin Waschki, Buhl Roland, Paul W. Jones, Kirsten Anne-Marie, A. Katus Hugo, Taube Christian, Bewig Burkhard, Beate Polte, Kronsbein Juliane, Stubbe Beate, Bals Robert, Johanna I. Lutter, Sarah Marietta von Siemens, Lange Christoph, Vogelmeier Claus, Ellen Burmann, Wirtz Hubert, Kathrin Kahnert, Erich Traugott, Behr Jürgen, Birte Struck, Vivien Janke, Lenka Krabbe, Timmermann Hartmut, Wagner Ulrich, Anita Reichel, Sabine Michalewski, Gudrun Hübner, Seeger Werner, Doris Lehnert, Jany Berthold, Kropf-Sanchen Cornelia, Sandra Söhler, Jeanette Pieper, Ulrike Rieber, Peter Alter, Herth Felix, Zabel Peter, Andreas Stefan, Koczulla Rembert, Held Matthias, Tobias Welte, Franziska C. Trudzinski, Patricia Berger, Kahnert Kathrin, Jana Graf, Jürgen Behr, Rosalie Untsch, Rudolf A. Jörres, Kornelia Speth, Britta Markworth, Ewert Ralf, Gertraud Weiß, Hans-Ulrich Kauczor, Claus Vogelmeier, Katrin Schwedler, Katrin Wons, Bertram J. Jobst, Barbara Arikan, Margret Gleiniger, Henrik Watz, Watz Henrik, Studnicka Michael, Beate Schaufler, Diana Schottel, Sonja Rohweder, Robert Bals, Ilona Kietzmann, Virchow J. Christian, Burkhard Bewig, Hauck Rainer, and Michaela Schrade-Illmann
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Pulmonary and Respiratory Medicine ,Percentile ,medicine.medical_specialty ,Medizin ,Diagnostic Techniques, Respiratory System ,Single item ,CAT score ,03 medical and health sciences ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Internal medicine ,medicine ,COPD ,In patient ,030212 general & internal medicine ,Lung function ,Emphysema ,business.industry ,Regression analysis ,Cat Score ,Copd ,medicine.disease ,Exploratory factor analysis ,respiratory tract diseases ,030228 respiratory system ,Cohort ,business - Abstract
The COPD Assessment Test (CAT) is in widespread use for the evaluation of patients with chronic obstructive pulmonary disease (COPD). We assessed whether the CAT items carry additional information beyond the sum score regarding COPD characteristics including emphysema. Patients of GOLD grades 1 to 4 from the COPD cohort COSYCONET (German COPD and Systemic Consequences - Comorbidities Network) with complete CAT data were included (n = 2270), of whom 493 had chest CT evaluated for the presence of emphysema. Comorbidities and lung function were assessed following standardised procedures. Cross-sectional data analysis was based on multiple regression analysis of the single CAT items against a panel of comorbidities, lung function, or CT characteristics (qualitative score, 15th percentile of mean lung density), with age, BMI and gender as covariates. This was supported by exploratory factor analysis. Regarding the relationship to comorbidities and emphysema, there were marked differences between CAT items, especially items 1 and 2 versus 3 to 8. This grouping was basically confirmed by factor analysis. Items 4 and 5, and to a lower degree 1, 2 and 6, appeared to be informative regarding the presence of emphysema, whereas the total score was not or less informative. Regarding comorbidities, similar findings as for the total CAT score were obtained for the modified Medical Research Council scale (mMRC) which was also informative regarding emphysema. Our findings suggest that the usefulness of the CAT can be increased if evaluated on the basis of single items which may be indicating the presence of comorbidities and emphysema.
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- 2020
8. Occupation-Associated Fatal Limbic Encephalitis Caused by Variegated Squirrel Bornavirus 1, Germany, 2013
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Anthonina Ott, Andi Krumbholz, Sven-Kevin Hotop, Bernd Hoffmann, Donata Hoffmann, Jonas Schmidt-Chanasit, Walter J. Schulz-Schaeffer, Helmut Fickenscher, Philip Eisermann, Monika Huhndorf, Maria Rosenthal, Mark Brönstrup, Dennis Tappe, Helmut Laufs, Lorenz Balke, Martin Beer, Gabriele Ismer, Burkhard Bewig, Daniel Cadar, Kore Schlottau, and Helmholtz-Zentrum für Infektionsforschung GmbH, Inhoffenstr. 7, 38124 Braunschweig, Germany.
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0301 basic medicine ,Epidemiology ,Spillover infection ,viruses ,animal diseases ,variegated squirrel bornavirus 1 ,lcsh:Medicine ,0302 clinical medicine ,Zoonoses ,Germany ,occupational risk ,Phylogeny ,Sciurus ,biology ,Transmission (medicine) ,Limbic encephalitis ,transmission ,Sciuridae ,Middle Aged ,Immunohistochemistry ,Magnetic Resonance Imaging ,Bornavirus ,Infectious Diseases ,VSBV-1 ,RNA, Viral ,Female ,Encephalitis ,psychological phenomena and processes ,Microbiology (medical) ,History, 21st Century ,behavioral disciplines and activities ,Virus ,lcsh:Infectious and parasitic diseases ,Structure-Activity Relationship ,Viral Proteins ,03 medical and health sciences ,limbic encephalitis ,Occupational Exposure ,Callosciurus ,medicine ,Animals ,Humans ,Serologic Tests ,lcsh:RC109-216 ,Whole Genome Sequencing ,lcsh:R ,Mononegavirales Infections ,medicine.disease ,biology.organism_classification ,Virology ,zoonoses ,030104 developmental biology ,Variegated squirrel ,nervous system ,Bornaviridae ,Epitope Mapping ,030217 neurology & neurosurgery ,squirrel - Abstract
Limbic encephalitis is commonly regarded as an autoimmune-mediated disease. However, after the recent detection of zoonotic variegated squirrel bornavirus 1 in a Prevost's squirrel (Callosciurus prevostii) in a zoo in northern Germany, we retrospectively investigated a fatal case in an autoantibody-seronegative animal caretaker who had worked at that zoo. The virus had been discovered in 2015 as the cause of a cluster of cases of fatal encephalitis among breeders of variegated squirrels (Sciurus variegatoides) in eastern Germany. Molecular assays and immunohistochemistry detected a limbic distribution of the virus in brain tissue of the animal caretaker. Phylogenetic analyses demonstrated a spillover infection from the Prevost's squirrel. Antibodies against bornaviruses were detected in the patient's cerebrospinal fluid by immunofluorescence and newly developed ELISAs and immunoblot. The putative antigenic epitope was identified on the viral nucleoprotein. Other zoo workers were not infected; however, avoidance of direct contact with exotic squirrels and screening of squirrels are recommended.
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- 2018
9. Pseudomonas aeruginosa populations in the cystic fibrosis lung lose susceptibility to newly applied β-lactams within 3 days
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Ingrid Bobis, Burkhard Bewig, Hinrich Schulenburg, Anette Friedrichs, Malte C. Rühlemann, Camilo Barbosa, Andre Franke, Leif Tueffers, Helmut Fickenscher, Marc P. Höppner, Stefan Schreiber, Annegret Krenz-Weinreich, Sabine Schubert, and Philip Rosenstiel
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Adult ,DNA, Bacterial ,Male ,0301 basic medicine ,Microbiology (medical) ,Cystic Fibrosis ,medicine.drug_class ,030106 microbiology ,Antibiotics ,Ceftazidime ,beta-Lactams ,medicine.disease_cause ,DNA, Ribosomal ,Cystic fibrosis ,Meropenem ,beta-Lactam Resistance ,Microbiology ,Cohort Studies ,Young Adult ,03 medical and health sciences ,Antibiotic resistance ,RNA, Ribosomal, 16S ,medicine ,Cluster Analysis ,Humans ,Pseudomonas Infections ,Pharmacology (medical) ,Microbiome ,Lung ,Phylogeny ,Pharmacology ,Pseudomonas aeruginosa ,business.industry ,Sequence Analysis, DNA ,medicine.disease ,Antimicrobial ,Bacterial Load ,Anti-Bacterial Agents ,030104 developmental biology ,Infectious Diseases ,Female ,business ,medicine.drug - Abstract
BackgroundChronic pulmonary infections by Pseudomonas aeruginosa require frequent intravenous antibiotic treatment in cystic fibrosis (CF) patients. Emergence of antimicrobial resistance is common in these patients, which to date has been investigated at long-term intervals only.ObjectivesTo investigate under close to real-time conditions the dynamics of the response by P. aeruginosa to a single course of antibiotic therapy and the potentially associated rapid spread of antimicrobial resistance, as well as the impact on the airway microbiome.MethodsWe investigated a cohort of adult CF patients that were treated with a single course of antimicrobial combination therapy. Using daily sampling during treatment, we quantified the expression of resistance by P. aeruginosa (median of six isolates per daily sample, 347 isolates in total), measured bacterial load by P. aeruginosa-specific quantitative PCR and characterized the airway microbiome with a 16S rRNA-based approach. WGS was performed to reconstruct intrapatient strain phylogenies.ResultsIn two patients, we found rapid and large increases in resistance to meropenem and ceftazidime. Phylogenetic reconstruction of strain relationships revealed that resistance shifts are probably due to de novo evolution and/or the selection of resistant subpopulations. We observed high interindividual variation in the reduction of bacterial load, microbiome composition and antibiotic resistance.ConclusionsWe show that CF-associated P. aeruginosa populations can quickly respond to antibiotic therapy and that responses are patient specific. Thus, resistance evolution can be a direct consequence of treatment, and drug efficacy can be lost much faster than usually assumed. The consideration of these patient-specific rapid resistance shifts can help to improve treatment of CF-associated infections, for example by deeper sampling of bacteria for diagnostics, repeated monitoring of pathogen susceptibility and switching between drugs.
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- 2019
10. Combination of National Quality Assurance Data Collection With a Standard Operating Procedure in Community-Acquired Pneumonia: A Win-Win Strategy?
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Iris Jahnke, Lorenz Balke, Kai Wehkamp, Rainer Petzina, Demian Graf, Falko C. Schulte, Ulrike Wehkamp, and Burkhard Bewig
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Health (social science) ,Quality Assurance, Health Care ,Leadership and Management ,Computer science ,media_common.quotation_subject ,Context (language use) ,03 medical and health sciences ,0302 clinical medicine ,Documentation ,Germany ,Humans ,Quality (business) ,Operations management ,030212 general & internal medicine ,Care Planning ,media_common ,Quality Indicators, Health Care ,Retrospective Studies ,Data collection ,business.industry ,030503 health policy & services ,Health Policy ,Data Collection ,Pneumonia ,Quality Improvement ,Community-Acquired Infections ,Win-win game ,Data quality ,0305 other medical science ,business ,Quality assurance ,Delivery of Health Care ,Standard operating procedure - Abstract
PURPOSE The primary contact for German physicians with national quality assurance in community-acquired pneumonia (CAP) is frequently experienced as time-consuming obligatory documentation. Since the regular feedback loop stretches up to 18 months, the immediate impact on quality is perceived as rather low. Ultimately, a method leading to increase in the quality of data collection, clarification on expected clinical treatment standards, and improvement in the acceptance and feedback mechanism is needed. METHODS We developed a form merging data collection for quality indicators with a standard operating procedure (SOP) in CAP and implemented it in the daily routine of a university's department for internal medicine. Fulfillment of quality indicators before and after the implementation of the new form was measured. RESULTS Critical parameters such as the documentation of breathing rate and clinical parameters at discharge strongly improved after implementation of the intervention. Uncritical parameters showed slight improvement or stable results at a high level. CONCLUSION The combination of collection of quality data with a clinical SOP and context information may improve the impact of quality measures by increasing acceptance, quality of data capture, short-loop feedback, and possibly quality of care.
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- 2019
11. Amikacin liposome inhalation suspension for chronic Pseudomonas aeruginosa infection in cystic fibrosis
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Diana Bilton, Tacjana Pressler, Isabelle Fajac, John Paul Clancy, Dorota Sands, Predrag Minic, Marco Cipolli, Ivanka Galeva, Amparo Solé, Alexandra L. Quittner, Keith Liu, John P. McGinnis, Gina Eagle, Renu Gupta, Michael W. Konstan, Sabine Renner, Christiane Knoop, Anne Malfroot, Lieven Dupont, Kristine Desager, Frans De Baets, Miroslava Bosheva, Vania Nedkova, Ivan Galabov, Andreas Freitag, Nancy Morrison, Pearce Wilcox, Tanja Pressler, Yves Martinet, Raphael Chiron, Stephan Dominique, Philippe Reix, Anne Prevotat, Isabelle Sermet, Isabelle Durieu, Rainald Fischer, Rudolf Huber, Doris Staab, Uwe Mellies, Wolfgang Sextro, Tobias Welte, Heinrike Wilkens, Urte Sommerwerk, Burkhard Bewig, Ilias Inglezos, Stavros-Eleftherios Doudounakis, Olga Bede, Ferenc Gönczi, Rita Újhelyi, Edward McKone, Paul McNally, Vincenzina Lucidi, Mario La Rosa, Laura Minicucci, Rita Padoan, Giovanna Pisi, Rolando Gagliardini, Carla Colombo, Inez Bronsveld, Ewa Sapiejka, Henryk Mazurek, Grażyna Górnicka, Iwona Stelmach, Halina Batura-Gabryel, Marta Rachel, Jaroslava Orosova, Branko Takac, Anna Feketova, Carmen Martinez, Gloria Garcia Hernandez, Jose Ramon Villa-Asensi, Silvia Gartner, Amparo Sole, Anders Lindblad, Martin Ledson, Joanna Whitehouse, Alan Smyth, Ian Ketchell, Timothy Lee, and Gordon MacGregor
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0301 basic medicine ,Male ,Cystic Fibrosis ,Gastroenterology ,Cystic fibrosis ,0302 clinical medicine ,Surveys and Questionnaires ,Tobramycin ,education.field_of_study ,Inhalation ,Symptom Flare Up ,3. Good health ,Anti-Bacterial Agents ,Respiratory Function Tests ,Hospitalization ,medicine.anatomical_structure ,Treatment Outcome ,Amikacin ,Pseudomonas aeruginosa ,Female ,medicine.symptom ,Symptom Assessment ,medicine.drug ,Pulmonary and Respiratory Medicine ,Adult ,medicine.medical_specialty ,Population ,Article ,03 medical and health sciences ,Internal medicine ,Administration, Inhalation ,medicine ,Humans ,Pseudomonas Infections ,education ,Adverse effect ,Lung ,Dose-Response Relationship, Drug ,business.industry ,Sputum ,medicine.disease ,respiratory tract diseases ,030104 developmental biology ,030228 respiratory system ,Pediatrics, Perinatology and Child Health ,Liposomes ,business - Abstract
Background Shortcomings of inhaled antibiotic treatments for Pseudomonas aeruginosa infection in patients with cystic fibrosis (CF) include poor drug penetration, inactivation by sputum, poor efficiency due to protective biofilm, and short residence in the lung. Methods Eligible patients with forced expiratory volume in 1 s (FEV1) ≥25% of predicted value at screening and CF with chronic P. aeruginosa infection were randomly assigned to receive 3 treatment cycles (28 days on, 28 days off) of amikacin liposome inhalation suspension (ALIS, 590 mg QD) or tobramycin inhalation solution (TIS, 300 mg BID). The primary endpoint was noninferiority of ALIS vs TIS in change from baseline to day 168 in FEV1 (per-protocol population). Secondary endpoints included change in respiratory symptoms by Cystic Fibrosis Questionnaire-Revised (CFQ-R). Results The study was conducted February 2012 to September 2013. ALIS was noninferior to TIS (95% CI, −4.95 to 2.34) for relative change in FEV1 (L) from baseline. The mean increases in CFQ-R score from baseline on the Respiratory Symptoms scale suggested clinically meaningful improvement in both arms at the end of treatment in cycle 1 and in the ALIS arm at the end of treatment in cycles 2 and 3; however, the changes were not statistically significant between the 2 treatment arms. Treatment-emergent adverse events (TEAEs) were reported in most patients (ALIS, 84.5%; TIS, 78.8%). Serious TEAEs occurred in 17.6% and 19.9% of patients, respectively; most were hospitalisations for infective pulmonary exacerbation of CF. Conclusions Cyclical dosing of once-daily ALIS was noninferior to cyclical twice-daily TIS in improving lung function. ClinicalTrials.gov Identifier: NCT01315678
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- 2019
12. Acute Kidney Injury in Patients with Severe Acute Respiratory Distress Syndrome Requiring Extracorporeal Membrane Oxygenation: Incidence, Prognostic Impact, and Risk Factors
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N. Haake, A.M. Eide, J. Cremer, R. Rusch, G. Morun, K. Pilarczyk, L. Balke, Burkhard Bewig, Bernd Panholzer, A. Haneya, and K. Huenges
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business.industry ,medicine.medical_treatment ,Anesthesia ,Incidence (epidemiology) ,Acute kidney injury ,Extracorporeal membrane oxygenation ,Medicine ,In patient ,Acute respiratory distress ,business ,medicine.disease - Published
- 2019
13. Long-term safety of pirfenidone: results of the prospective, observational PASSPORT study
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Vincent Cottin, Dirk Koschel, Andreas Günther, Carlo Albera, Arata Azuma, C. Magnus Sköld, Sara Tomassetti, Philip Hormel, John L. Stauffer, Indiana Strombom, Klaus-Uwe Kirchgaessler, Toby M. Maher, PASSPORT study group, Peter Cerkl, Holger Flick, Christian Geltner, Judith Löffler-Ragg, Michael Studnicka, Elisabeth Bendstrup, Helle Dall Madsen, Saher B. Shaker, Maritta Kilpelainen, Marjukka Myllaerniemi, Minna Purokivi, Seppo Saarelainen, Emmanuel Bergot, Philippe Bonniaud, Raphael Borie, Pascal Chanez, Francis Couturaud, Claire Dromer, Frederic Gagnadoux, Anne-Sophie Gamez, Anne Gondouin, Dominique Israel-Biet, Stephane Jouneau, Romain Kessler, Francois Lebargy, Sylvain Marchand-Adam, Borsi Melloni, Jean-Marc Naccache, Christophe Pison, Gregoire Prevot, Martine Reynaud-Gaubert, Abdellatif Tazi, Dominique Valeyre, Benoit Wallaert, Jost Achenbach, Stefan Andreas, Burkhard Bewig, Reiner Bonnet, Stephan Budweiser, Ulrich Costabel, Martin Faehling, Joachim Ficker, Juergen Fisher, Sven Glaeser, Christian Grah, Christian Grohe, Martin Hetzel, Wolfgang Hohenforst-Schmidt, David Jungck, Peter Kardos, Claus Keller, Martin Kohlhaeufl, Claus Kroegel, Rainer Kruegel, Berthold Michels, Joachim Mueller-Quernheim, Claus Neurohr, Heinz-Theodor Pelzer, Michael Pfeifer, Michael Prediger, Klaus F. Rabe, Winifried Randerath, Nicolas Scheonfeld, Robert Scheubel, Jens Schreiber, Hartwig Schutte, Bernd Schoenhofer, Barbara Wagener, Tobias Welte, Michael Westhoff, Heinrike Wilkens, Hubert Wirtz, Michael Henry, Michael Keane, Anthony O'Regan, Katherine O'Reilly, Fabrizio Luppi, Sandra Nutini, Alberto Pesci, Venerino Poletti, Elisabetta Rosi, Paola Rottoli, Thomas Eagan, Durdica Kulosman, Tone Blorg Sjaheim, Karl Axel Karlsson, Magnus Sköld, Sanjay Agrawal, Kesavan Suresh Babu, Stephen Bianchi, Nazia Chaudhuri, Sophie Fletcher, Michael Gibbons, Simon Hart, Gisli Jenkins, Toby Maher, Ann Millar, Joanna Porter, Nicky Simler, Lisa Spencer, Monica Spiteri, and Melissa Wickremasinghe
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Nausea ,MEDLINE ,lcsh:Medicine ,Interstitial Lung Disease ,law.invention ,03 medical and health sciences ,Idiopathic pulmonary fibrosis ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,medicine ,030212 general & internal medicine ,business.industry ,lcsh:R ,Original Articles ,Pirfenidone ,Stepwise regression ,medicine.disease ,Discontinuation ,030228 respiratory system ,Observational study ,medicine.symptom ,business ,medicine.drug - Abstract
Real-world studies include a broader patient population for a longer duration than randomised controlled trials (RCTs) and can provide relevant insights for clinical practice. PASSPORT was a multicentre, prospective, post-authorisation study of patients who were newly prescribed pirfenidone and followed for 2 years after initiating treatment. Physicians collected data on adverse drug reactions (ADRs), serious ADRs (SADRs) and ADRs of special interest (ADRSI) at baseline and then every 3 months. Post hoc stepwise logistic regression models were used to identify baseline characteristics associated with discontinuing treatment due to an ADR. Patients (n=1009, 99.7% with idiopathic pulmonary fibrosis) had a median pirfenidone exposure of 442.0 days. Overall, 741 (73.4%) patients experienced ADRs, most commonly nausea (20.6%) and fatigue (18.5%). ADRs led to treatment discontinuation in 290 (28.7%) patients after a median of 99.5 days. Overall, 55 (5.5%) patients experienced SADRs, with a fatal outcome in six patients. ADRSI were reported in 693 patients, most commonly gastrointestinal symptoms (38.3%) and photosensitivity reactions/skin rashes (29.0%). Older age and female sex were associated with early treatment discontinuation due to an ADR. Findings were consistent with the known safety profile of pirfenidone, based on RCT data and other post-marketing experience, with no new safety signals observed., Real-world safety results from 1009 patients in PASSPORT were consistent with the known pirfenidone safety profile http://ow.ly/oXjv30lrzAf
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- 2018
14. Parenting stress in mothers with cystic fibrosis
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Burkhard Bewig, Ingrid Bobis, and Gerald Ullrich
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Adult ,Male ,Cystic Fibrosis ,Mothers ,Cystic fibrosis ,Developmental psychology ,03 medical and health sciences ,Social support ,0302 clinical medicine ,Surveys and Questionnaires ,Adaptation, Psychological ,medicine ,Humans ,030212 general & internal medicine ,Child ,Psychiatric Status Rating Scales ,Parenting ,business.industry ,Rehabilitation ,Infant ,Social Support ,Parenting stress ,Mean age ,medicine.disease ,Biological Child ,Cross-Sectional Studies ,030228 respiratory system ,Child, Preschool ,Reference values ,Normative ,Female ,Parental stress ,business ,Stress, Psychological ,Clinical psychology - Abstract
To assess the parenting experience of mothers with cystic fibrosis (CF) and to compare with normative data.Cross-sectional study with a validated generic parental stress questionnaire (PSQ). This PSQ differentiates four components of parental stress: main factor "parental stress", compounding factor "role restrictions", protective factors "support from spouse", and "social support". Cut-off scores categorise results as "normal", "borderline" or "concerning".Seventy-three women were informed by their local CF centre. Of these, 36 enrolled and had a first-born child aged 1-12 years (consistent with reference values of the PSQ). Of these, 31 (86%) returned the PSQ. Mean age of mothers was 32.6 years ± 6.9 years, mean age of first-born child was 5.2 years ± 3.4 years. Most of the mothers had one biological child, five women had two children and one had three children.Parental stress scores were normally distributed, the same applies for contributing factors and for the two protective factors. Favourable scores were twice as frequent as concerning scores. Mothers of younger children scored slightly better than mothers of school-aged children.In line with the only comparable study, mothers with CF seem to be a remarkably resilient group who mostly cope well with parental stress even in the face of a progressive, chronic disease requiring time-consuming treatment.Today, motherhood is increasingly becoming an option in fertile women with cystic fibrosis. The additional burden of parenting seems to be rewarded by fulfilling essential personal goals. CF clinics should routinely address a possible wish for a child and to discuss it, openly.
- Published
- 2015
15. Mütter mit Mukoviszidose: Ergebnisse einer Befragung einer nahezu unbekannten Patientengruppe
- Author
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Gerald Ullrich, Burkhard Bewig, and I. Bobis
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Pulmonary and Respiratory Medicine ,Gynecology ,medicine.medical_specialty ,business.industry ,medicine ,business - Abstract
Hintergrund: Von Muttern mit Zystischer Fibrose (CF) gibt es bislang keine Daten uber Schwangerschaft und Mutterschaft aus Patientinnensicht. Methode: Befragung der Mutter mit eigens zusammengestelltem Fragebogen, unter anderem zu: Schwangerschaft und Geburt (Reaktionen im personlichen Umfeld der Frauen, ihr Vorwissen, Sorgen, Gesamturteil) sowie dem ersten Jahr nach der Geburt (Gesamturteil). Stichprobe: 38 von 73 angefragten Muttern beteiligten sich (Durchschnittsalter 33,8 ± 7,1 Jahre, Alter erstgeborenes Kind 6,9 ± 5,7 Jahre). Neun Frauen hatten mehr als ein Kind. Aktuell berufstatig waren 18 der Mutter (47 %), davon 12 Frauen mindestens halbtags (19 – 30 Std./Woche). Die durchschnittliche Lungenfunktion (FEV1) lag zum Zeitpunkt der Befragung bei 66 ± 19 % des Solls. Ergebnisse: Bei 28 /38 Frauen waren die Schwangerschaften – wie man es bei CF anstrebt – geplant, in 10 Fallen ungeplant. Die Reaktionen im Umfeld auf Kinderwunsch bzw. Schwangerschaft fielen bei ungeplanter Schwangerschaft negativer aus. Unabhangig davon reagierten die Eltern der Frauen durchweg weniger positiv als andere wichtige Personen im Umfeld. Die Reaktionen der CF-Behandler waren abhangig von der Lungenfunktion der Frau. Vorkenntnisse der Frauen uber „Schwangerschaft und CF“ waren eher gering. Ihre Befurchtungen richteten sich primar auf eine mogliche Schadigung des Foten durch CF-Medikamente. Schlussfolgerungen: Mutterschaft trotz CF ist fur junge Frauen zunehmend ein Thema und CF-Teams sollten dazu Gesprachsangebote in der Sprechstunde unterbreiten. Anzustreben ist auch ein besseres Verstandnis der Zusammenhange von Schwangerschaft und CF.
- Published
- 2015
16. Oral glutamine supplementation improves intestinal permeability dysfunction in a murine acute graft-vs.-host disease model
- Author
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Alexander Arlt, Rainer Noth, Martina Böttner, Heiner Schäfer, Philip Rosenstiel, Stefan Schreiber, Eckhard Stüber, Robert Häsler, Claudia Geismann, Thilo Wedel, Burkhard Bewig, Jochen Hampe, and Mark Ellrichmann
- Subjects
medicine.medical_specialty ,Physiology ,Glutamine ,Graft vs Host Disease ,Inflammation ,Biology ,Occludin ,Permeability ,Proinflammatory cytokine ,Mice ,Physiology (medical) ,Internal medicine ,medicine ,Animals ,Barrier function ,Intestinal permeability ,Hepatology ,Tight junction ,Tumor Necrosis Factor-alpha ,Gastroenterology ,medicine.disease ,Gastrointestinal Tract ,Disease Models, Animal ,Jejunum ,surgical procedures, operative ,Endocrinology ,Lymphocyte Transfusion ,Immunology ,Tumor necrosis factor alpha ,medicine.symptom - Abstract
Although a profound barrier dysfunction has been reported, little is known about the pathophysiological mechanism evoking gastrointestinal graft-vs.-host disease (GI-GvHD) and apparent therapeutic options. The aim of this study was to evaluate the influence of oral glutamine on the course of GI-GvHD in an acute semiallogenic graft-vs.-host disease (GvHD) in irradiated B6D2F1 mice. An acute semiallogenic GvHD was induced by intraperitoneal injection of lymphocytes from C57BL/6 mice to irradiated B6D2F1 mice. Half of the GvHD animals received oral glutamine supplementation for 6 days started at the time of lymphocyte transfer. Six days after induction of the semiallogenic GvHD, jejunum specimens were prepared. The expression of the proinflammatory cytokine TNF-α and the tight junction protein occludin was investigated by PCR. Histological changes along with the apoptotic response were evaluated and intestinal permeability was assessed. Animals with GvHD showed a strong increase in paracellular permeability as a sign of the disturbed barrier function. TNF-α expression was significantly increased and the expression of the tight junction protein occludin decreased. GvHD led to mucosal atrophy, crypt hyperplasia, crypt apoptosis, and a disintegration of the tight junctions. Glutamine-treated mice showed reduced expression of TNF-α, increased occludin expression, fewer histological changes in the jejunum, smaller number of apoptotic cells in the crypt, and reduced gastrointestinal permeability. In conclusion, oral glutamine seems to have beneficial effects on the severity of inflammatory changes in the course of GvHD and might be a therapeutic option.
- Published
- 2013
17. Scintigraphy Leading to the Misdiagnosis of Chronic Thromboembolic Disease in a Patient With Pulmonary Veno-Occlusive Disease
- Author
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Tina Schreiber, Lorenz Balke, Christine Winkler, Burkhard Bewig, Christoph Röcken, Marcus Both, and Karoline Koch
- Subjects
Adult ,medicine.medical_specialty ,Cardiac index ,Scintigraphy ,03 medical and health sciences ,Myocardial perfusion imaging ,0302 clinical medicine ,Fatal Outcome ,Physiology (medical) ,Internal medicine ,Thromboembolism ,Pulmonary angiography ,Medicine ,Humans ,030212 general & internal medicine ,Diagnostic Errors ,Pulmonary wedge pressure ,Lung ,medicine.diagnostic_test ,business.industry ,Myocardial Perfusion Imaging ,medicine.disease ,Pulmonary embolism ,medicine.anatomical_structure ,030228 respiratory system ,Chronic Disease ,Cardiology ,Pulmonary Veno-Occlusive Disease ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
A 43-year-old woman experienced increasing dyspnea over a period of 1 year. She was examined first at an outside hospital. Diagnostic workup revealed an elevated precapillary mean pulmonary arterial pressure of >44 mm Hg. Left ventricular function was nearly normal (cardiac index, 2.1 L/min·m2; pulmonary wedge pressure, 15 mm Hg). Computed tomography of the lung demonstrated regional ground glass opacities and pleural effusions but no signs of pulmonary embolism. Perfusion and ventilation scintigraphy showed perfusion defects typical for peripheral lung embolism (Figure 1). The diagnosis of chronic thromboembolic pulmonary hypertension was made. There was no correlate in pulmonary angiography …
- Published
- 2016
18. Anti-TNF-α antibodies improve intestinal barrier function in Crohn's disease
- Author
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Alexander Arlt, Robert Häsler, T Kühbacher, Eckhard Stüber, Stefan Schreiber, Burkhard Bewig, Jochen Hampe, Rainer Noth, and Susanna Nikolaus
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Gastroenterology ,Permeability ,Young Adult ,Lactulose ,Immune system ,Crohn Disease ,Internal medicine ,medicine ,Humans ,Mannitol ,Intestinal Mucosa ,Chromatography, High Pressure Liquid ,Barrier function ,Crohn's disease ,Intestinal permeability ,biology ,Tumor Necrosis Factor-alpha ,business.industry ,Antibodies, Monoclonal ,General Medicine ,Middle Aged ,medicine.disease ,Infliximab ,Intestines ,Intestinal Absorption ,Immunology ,biology.protein ,Female ,Antibody ,business ,medicine.drug - Abstract
Background and aims: Intestinal barrier function in Crohn's disease patients and their first degree healthy relatives is impaired. The increased intestinal permeability may result in an enhanced mucosal immune response and thereby aggravate intestinal inflammation. Humanised anti-TNF-α antibodies have been shown to be effective in the treatment of active Crohn's disease and in the treatment of entero-cutaneous fistula. The aim of the present study was to investigate the influence of anti-TNF-α antibody (infliximab) treatment on the intestinal barrier function of patients with active Crohn's disease. Methods: The differential intestinal uptake of lactulose and mannitol was measured to quantify intestinal permeability in patients with long standing active Crohn's disease (n = 17) directly before and seven days after treatment with infliximab (5 mg/kg bodyweight). In parallel, intestinal permeability was studied in a healthy control group (n = 20). Serum samples were analysed with pulsed amperometric detection after separation on an anion exchange column. Results: Intestinal permeability was significantly increased in all patients with Crohn's disease (L/M ratio 0.24 ± 0.17) prior to infliximab treatment compared to the control group (L/M ratio 0.01 ± 0.02; p-value < 1 × 10− 7). Treatment of patients with infliximab resulted in a marked decrease of intestinal permeability as measured by L/M ratio from 0.24 ± 0.17 before to 0.02 ± 0.02 (p-value < 1 × 10− 7) seven days after infliximab application. Conclusions: Treatment with anti-TNF-α antibodies improved impaired intestinal barrier function in patients with Crohn's disease. This effect may correlate to the well documented anti-inflammatory effect of TNF-α blockade in this intestinal disease.
- Published
- 2012
19. Fatal Pneumocystis Jirovecii Pneumonia in a Case of Ectopic Cushing's Syndrome due to Neuroendocrine Carcinoma of the Kidney
- Author
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Burkhard Bewig, Birgit Harbeck, I Alkatout, G Klöppel, Ulrich R. Fölsch, Heiner Mönig, Alexander Arlt, and M. Anlauf
- Subjects
Adult ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Pneumocystis carinii ,Weight Gain ,Gastroenterology ,Cushing syndrome ,Fatal Outcome ,Endocrinology ,Adrenocorticotropic Hormone ,Internal medicine ,parasitic diseases ,Internal Medicine ,Pneumocystosis ,Humans ,Medicine ,Pneumocystis jirovecii ,Cushing Syndrome ,Metyrapone ,biology ,business.industry ,Pneumonia, Pneumocystis ,Respiratory disease ,Immunosuppression ,General Medicine ,medicine.disease ,biology.organism_classification ,Kidney Neoplasms ,Carcinoma, Neuroendocrine ,Lymphatic Metastasis ,Immunology ,Tomography, X-Ray Computed ,business ,Complication ,medicine.drug - Abstract
Immunosuppression with subsequent opportunistic infections is a well-recognized complication of severe hypercortisolism. We report a case of fatal pneumocystis jirovecii pneumonia (formerly pneumocystis carinii pneumonia) in a case of ectopic Cushing's syndrome caused by a neuroendocrine carcinoma of the kidney. The 36-year old male patient had consulted a physician because of weight gain. Further endocrine diagnostic work-up revealed ACTH-dependent hypercortisolism of non-pituitary origin. Because of rapid clinical deterioration therapy with metyrapone was initiated. A neuroendocrine carcinoma of the right kidney with regional lymph node infiltration was identified and was suspected to be the source of the ACTH excess. Before any causal therapy could be initiated, the patient developed severe pneumocystis jirovecii pneumonia and died shortly thereafter from multiorgan failure one month after he first consulted a physician. Pneumocystosis has been reported in only a few cases of Cushing's syndrome. There seems to be a relationship between the degree of hypercortisolism and the susceptibility to opportunistic infections. Since ACTH concentrations may be excessively high in ectopic Cushing's syndrome and pneumocystosis may deteriorate as a consequence of decreasing circulating cortisol levels under adrenolytic therapy, prophylaxis against pneumocystis jirovecii infection should be considered.
- Published
- 2008
20. Systematic expression profiling of innate immune genes defines a complex pattern of immunosenescence in peripheral and intestinal leukocytes
- Author
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Susanna Nikolaus, Burkhard Bewig, Stefanie Derer, Andreas Till, Huberta von Eberstein, Stefan Schreiber, Philip Rosenstiel, Robert Häsler, and Almut Nebel
- Subjects
Adult ,Male ,Adolescent ,Colon ,Immunology ,Biology ,Immunoglobulin secretion ,Proinflammatory cytokine ,Immune system ,Immunity ,Leukocytes ,Genetics ,Humans ,Receptor ,Cells, Cultured ,Cellular Senescence ,Genetics (clinical) ,Aged ,Aged, 80 and over ,Immunity, Cellular ,Innate immune system ,Gene Expression Profiling ,Toll-Like Receptors ,Immunosenescence ,Middle Aged ,Acquired immune system ,Immunity, Innate ,Gene Expression Regulation ,Cytokines ,Female - Abstract
Immunosenescence is characterized by a quantitative decline of adequate immune responses, which renders the elderly individual particularly susceptible to bacterial, viral and fungal pathogens. Whereas changes of the aging adaptive immune system (for example, reduced immunoglobulin secretion) have been extensively characterized, alterations of the innate immune system are still poorly understood. The aim of the present study was to systematically examine mRNA expression levels of innate immune genes and proinflammatory cytokines in peripheral and intestinal leukocytes of subjects of different ages. In both, whole blood samples and in colonic biopsies most of the Toll-like receptors (TLRs) and nucleotide-binding and oligomerization domain-like receptors (NLRs) transcript levels were significantly downregulated in elderly subjects (90-99 years). Older individuals, when compared to the younger, exhibited an increased expression and/or secretion of proinflammatory cytokines by peripheral and intestinal leukocytes as well as an increased level of nuclear factor-kappaB activation in colonic biopsies. The observed downregulation of TLRs and NLRs during the aging process may contribute to the lack of effective recognition of invading pathogens or the commensal flora. This effect results in aberrant secondary immune cell activation and could significantly contribute to morbidity and mortality at advanced age.
- Published
- 2008
21. Perceived Impact of Motherhood on Adherence to Therapy in Mothers with Cystic Fibrosis
- Author
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Gerald Ullrich, I. Bobis, and Burkhard Bewig
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,Employment ,Pediatrics ,medicine.medical_specialty ,Firstborn ,Cystic Fibrosis ,business.industry ,Mothers ,Mean age ,Workload ,Affect (psychology) ,medicine.disease ,Cystic fibrosis ,Social support ,Antibiotic therapy ,Family medicine ,Germany ,Prevalence ,Medicine ,Humans ,Patient Compliance ,Female ,business ,Patient compliance - Abstract
Aim: To explore the stress related to motherhood and its perceived impact on adherence to therapy in women with cystic fibrosis (CF). Methods: Cross-sectional study with a purpose-designed questionnaire. Sample: 46/73 eligible women were enrolled and 38 returned the questionnaire. Mean age of mothers was 33.8 y ± 7.1 y, mean age of firstborn child was 6.9 y ± 5.7 y. Nine women had more than one biological child. 18 mothers (47 %) were currently employed, 12 of whom worked 19 to 30 hours per week and none full-time. Results: There were mothers who reported a detrimental effect on adherence (time constraints 38 %; intentional nonadherence 42 %), and mothers who reported that adherence had actually improved (29 %). Both of these effects were related to daily CF therapy at home. By contrast, i. v. antibiotic therapy was less impaired by role strains, mainly due to home i. v. therapy being an alternative and/or due to intensive social support (husband, parents). Participants clearly addressed the importance of adherence and the need for adequate self-management in narrative comments. Conclusion: Motherhood may improve adherence to CF therapy as well as it may affect it negatively. Health caregivers are well-advised to address a possible detrimental effect, proactively.
- Published
- 2015
22. Severe adult respiratory distress syndrome from Goodpasture syndrome. Survival using extracorporeal membrane oxygenation
- Author
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Lorenz Balke, Alexander Arlt, Marcus Both, Mark Rosenberg, and Burkhard Bewig
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,medicine.medical_specialty ,Hemoptysis ,Anti-Glomerular Basement Membrane Disease ,medicine.medical_treatment ,Radiography ,Hemorrhage ,Respiratory Mucosa ,Critical Care and Intensive Care Medicine ,Extracorporeal Membrane Oxygenation ,Bronchoscopy ,X ray computed ,Adrenal Cortex Hormones ,Extracorporeal membrane oxygenation ,Medicine ,Goodpasture syndrome ,Humans ,Intensive care medicine ,Respiratory Distress Syndrome ,medicine.diagnostic_test ,Respiratory distress ,business.industry ,Heparin ,Anticoagulants ,medicine.disease ,Respiration, Artificial ,Pulmonary Alveoli ,Dyspnea ,Anesthesia ,Female ,Radiography, Thoracic ,business ,Tomography, X-Ray Computed - Published
- 2015
23. Matrix metalloproteinase-9 in bronchiolitis obliterans syndrome after lung transplantation
- Author
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U. Mundt, Burkhard Bewig, H. Böttcher, N. E. El Mokhtari, T. Pufe, Ralf-Harto Hübner, S. Meffert, Ulrich R. Fölsch, Stephan Hirt, and Sandra Freitag
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,Pathology ,medicine.medical_specialty ,Neutrophils ,medicine.medical_treatment ,Bronchiolitis obliterans ,Cell Count ,Cohort Studies ,Reference Values ,medicine ,Humans ,Lung transplantation ,Zymography ,Bronchiolitis Obliterans ,Retrospective Studies ,Tissue Inhibitor of Metalloproteinase-1 ,Lung ,medicine.diagnostic_test ,business.industry ,Respiratory disease ,Retrospective cohort study ,Middle Aged ,medicine.disease ,humanities ,Respiratory Function Tests ,Transplantation ,Bronchoalveolar lavage ,medicine.anatomical_structure ,Matrix Metalloproteinase 9 ,Female ,business ,Bronchoalveolar Lavage Fluid ,Lung Transplantation - Abstract
Bronchiolitis obliterans syndrome (BOS) is a severe complication after lung transplantation (LTX). In a retrospective cohort study 12 stable healthy recipients (non-BOS) and eight patients with BOS were enrolled after LTX and matrix metalloproteinases (MMP)-9, TIMP-1 and cell characteristics in bronchoalveolar lavage (BAL) samples (n = 145) were analysed. BALs from patients with BOS were further divided according to whether they were obtained before (pre-BOS) or after manifestation of BOS (BOS group). The MMP-9/TIMP-1 ratio was significantly increased in the BOS group compared with non-BOS or pre-BOS; furthermore, the ratio was negatively correlated with forced expiratory volume in one second. In zymography, the active form of MMP-9 was detected predominantly in the BOS group. In addition, zymography showed the banding pattern of neutrophil-derived MMP-9, indicating that polymorphonuclear neutrophils (PMNs) were the main source of MMP-9. According to that, MMP-9 was significantly correlated with the number of PMN. In immunocytochemistry, MMP-9 was also associated predominantly with PMN. This is the first study to evaluate the expression of matrix metalloproteinase-9 and tissue inhibitors of metalloproteinases-1 over time during manifestation of a fibroproliferative lung disease in patients. It demonstrates development of bronchiolitis obliterans syndrome after lung transplantation is associated with an imbalance of matrix metalloproteinases-9/tissue inhibitors of metalloproteinase-1 ratio.
- Published
- 2005
24. Clinical and laboratory effects of recombinant human activated protein C in the treatment of a patient with sepsis-induced multiple organ failure
- Author
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Burkhard Bewig, Markus Seeger, Martina Brueckmann, Jan Wizenmann, and Ursula Hoffmann
- Subjects
Adult ,medicine.medical_specialty ,ARDS ,Knee Joint ,medicine.drug_class ,Multiple Organ Failure ,law.invention ,Sepsis ,Postoperative Complications ,law ,Intensive care ,medicine ,Coagulopathy ,Humans ,Intensive care medicine ,business.industry ,Septic shock ,Drotrecogin alfa ,Anticoagulant ,Anticoagulants ,Hematology ,Disseminated Intravascular Coagulation ,Retropharyngeal Abscess ,medicine.disease ,Combined Modality Therapy ,Intensive care unit ,Recombinant Proteins ,Systemic Inflammatory Response Syndrome ,Anti-Bacterial Agents ,Anesthesia ,Urinary Tract Infections ,Drainage ,Drug Evaluation ,Drug Therapy, Combination ,Female ,Urinary Catheterization ,business ,Protein C ,medicine.drug - Abstract
Objectives: To evaluate clinical and laboratory effects of the administration of recombinant human activated protein C (rhAPC) in the treatment of a 25-year-old patient with septic shock and multiple organ failure secondary to perinephritic abscesses. Interventions: Intravenous administration of rhAPC—or drotrecogin alfa (activated)—(24 mcg/kg/h) for a total of 80 h as an adjunct to antimicrobial therapy, mechanical ventilation, hemodynamic support, hemodiafiltration and surgical intervention. Measurements and Main Results: The administration of rhAPC was associated with a rapid recovery of the patient's clinical condition reflected by decreasing Sepsis-related Organ Failure Assessment (SOFA) scores. Laboratory parameters monitoring inflammation and coagulopathy improved during the treatment. No drug-related adverse events were noted. Conclusions: RhAPC has been observed to have anticoagulant, anti-inflammatory and profibrinolytic properties in vitro and in vivo. This report describes the effects of rhAPC administration on standard laboratory parameters indicating that no single laboratory parameter exists that is capable of monitoring the effects of rhAPC on the coagulation cascade and the clinical course of sepsis. This description of a patient suffering from sepsis-induced multiple organ failure may illustrate a possible beneficial effect of rhAPC on the course of coagulopathy and systemic inflammatory response and provides evidence for rhAPC complementing standard intensive care therapy in severe sepsis.
- Published
- 2003
25. Lung Transplantation in a Multidrug-Resistant Gram-Negative Acinetobacter Baumannii–Colonized Patient: A Case Report
- Author
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Katharina Huenges, Assad Haneya, Burkhard Bewig, Jochen Cremer, and Alexander Reinecke
- Subjects
medicine.medical_specialty ,biology ,Inhalation ,business.industry ,medicine.medical_treatment ,lcsh:Surgery ,lcsh:RD1-811 ,multidrug-resistant acinetobacter baumannii ,biology.organism_classification ,Acinetobacter baumannii ,Surgery ,Transplantation ,Multiple drug resistance ,Internal medicine ,medicine ,Colistin ,lung transplantation ,Lung transplantation ,Colonization ,In patient ,Case Report: Thoracic ,business ,α-1-antitrypsin deficiency ,medicine.drug - Abstract
Colonization or infection with various pathogens is frequently found in patients listed for lung transplantation. We describe a case of a 50-year-old woman with α-1-antitrypsin deficiency, which was listed for double-lung transplantation, with multidrug-resistant gram-negative Acinetobacter baumannii (MRGN4-Ab) skin colonization. Transplantation was successfully performed. Colistin (Polymyxine E) was administered intravenously and through inhalation in the first month. MRGN4-Ab was still detectable in skin swabs without evidence of infection. After good recovery and clinical inapparence, the patient was discharged 2 months after transplantation.
- Published
- 2015
26. 259 Parenting stress in mothers with cystic fibrosis
- Author
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I. Bobis, Gerald Ullrich, and Burkhard Bewig
- Subjects
Pulmonary and Respiratory Medicine ,Pediatrics ,medicine.medical_specialty ,business.industry ,Pediatrics, Perinatology and Child Health ,medicine ,Parenting stress ,Pediatrics, Perinatology, and Child Health ,medicine.disease ,business ,Cystic fibrosis - Published
- 2014
- Full Text
- View/download PDF
27. A role for the novel cytokine wnt-5a in linking inflammation to metabolism in human sepsis
- Author
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Stefan Schreiber, J Schumacher, Burkhard Bewig, N Müller, Matthias Laudes, G Elke, D Kragelund, N Weiler, K Neumann, Dominik M. Schulte, A Titz, and D. Schädler
- Subjects
Sepsis ,Cytokine ,business.industry ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Immunology ,medicine ,Wnt signaling pathway ,Inflammation ,Metabolism ,medicine.symptom ,medicine.disease ,business - Published
- 2014
28. The wnt5a/sFRP5 system is dysregulated in human sepsis
- Author
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Johannes Schumacher, A Titz, Matthias Laudes, N Weiler, Stefan Schreiber, D. Schädler, Dominik M. Schulte, D Kragelund, Gunnar Elke, Burkhard Bewig, and N Müller
- Subjects
WNT5A ,Sepsis ,Endocrinology ,business.industry ,Endocrinology, Diabetes and Metabolism ,Immunology ,Internal Medicine ,Medicine ,General Medicine ,business ,medicine.disease - Published
- 2014
29. Elevation of procalcitonin after implantation of an interventional lung assist device in critically ill patients
- Author
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Dirk Schaedler, Günther Zick, Norbert Weiler, Matthias Kott, Burkhard Bewig, Inéz Frerichs, and Tobias Becher
- Subjects
Adult ,Calcitonin ,Male ,ARDS ,medicine.drug_class ,Calcitonin Gene-Related Peptide ,Critical Illness ,Antibiotics ,Biomedical Engineering ,Biophysics ,Bioengineering ,Context (language use) ,Procalcitonin ,Biomaterials ,parasitic diseases ,medicine ,Interventional lung assist ,Humans ,Protein Precursors ,Aged ,Retrospective Studies ,Respiratory Distress Syndrome ,Lung ,Ventilators, Mechanical ,Critically ill ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Respiration, Artificial ,medicine.anatomical_structure ,Anesthesia ,Breathing ,Female ,business ,hormones, hormone substitutes, and hormone antagonists - Abstract
A pumpless interventional arteriovenous lung assist device (iLA) facilitates the removal of carbon dioxide from the blood and is used as part of the lung-protective ventilation strategy in patients with acute respiratory distress syndrome (ARDS). In case of bacterial infection, delayed antimicrobial therapy increases the mortality in this group of high-risk critically ill patients, whereas overtreatment promotes bacterial resistance and leads to increased drug toxicity and costs. Besides clinical signs and symptoms, antimicrobial treatment is based on the kinetics of biomarkers such as procalcitonin (PCT). We hereby report an up to 10-fold increase in PCT serum concentrations in four mechanically ventilated patients with ARDS detected within 12-20 hours after iLA implantation in the absence of any infection. Procalcitonin concentrations returned to nearly baseline values in all patients on the fourth day after iLA implantation. We discuss the possible mechanisms of PCT induction in this specific patient population and recommend the onset of antibiotics administration after iLA implantation to be carefully considered in the context of other clinical findings and not solely based on the PCT kinetics. Repeated PCT measurements in short time intervals should be performed in these patients.
- Published
- 2014
30. Immunoglobulin A and secretory immunoglobulin A in the bronchoalveolar lavage from patients after lung transplantation
- Author
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Jochen Cremer, Burkhard Bewig, Heidi Böttcher, Andreas Bastian, Christine Tunkel, M. Lins, and Stephan Hirt
- Subjects
Immunoglobulin A ,Transplantation ,Lung ,medicine.diagnostic_test ,biology ,business.industry ,medicine.medical_treatment ,Liver transplantation ,medicine.disease ,fluids and secretions ,Bronchoalveolar lavage ,medicine.anatomical_structure ,Immunology ,medicine ,biology.protein ,Lung transplantation ,Antibody ,business ,Kidney transplantation - Abstract
Secretory immunoglobulin A (sIgA) is the most important Ig on mucosal surfaces. In bronchoalveolar lavage (BAL) fluid, sIgA is mainly produced by bronchus-associated lymphoid tissue (BALT). The presence of pre-formed antibodies against donor tissue in kidney transplantation is associated with hyperacute rejection, indicating a humoral (antibody-mediated) reaction. In heart and liver transplantation, humoral rejection has also been documented. The goal of this study was to evaluate the role of IgA in patients after lung transplantation. An enzyme-linked immunosorbent assay was established to determine the levels of sIgA, IgA, and total protein in the lavage. IgA and sIgA were both detectable in BAL from transplanted lungs. IgA and sIgA levels were both higher during episodes of infection than during episodes of rejection or during the control episodes. The level of IgA during episodes of rejection equaled the level of IgA during the control episodes. The level of sIgA was significantly decreased during episodes of acute rejection (1.8 +/- 1.0 microg/mL) when compared with the control (7.2 +/- 1.0 microg/mL; p = 0.013). This study demonstrates that BALT retains the ability to produce Ig even after lung transplantation. The levels of IgA and sIgA and their ratio do not contribute to the differentiation between rejection and infection in lung-transplanted patients.
- Published
- 2000
31. Topical amphotericin B application in severe bronchial aspergillosis after lung transplantation: report of experiences in 3 cases
- Author
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F Möller, Burkhard Bewig, Stephan Hirt, Jochen Cremer, and Heidi Boettcher
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Antifungal Agents ,Administration, Topical ,Fistula ,medicine.medical_treatment ,Bronchi ,Hemorrhage ,Constriction, Pathologic ,Pulmonary Artery ,Aspergillosis ,Fatal Outcome ,Amphotericin B ,medicine.artery ,Administration, Inhalation ,medicine ,Humans ,Lung transplantation ,Aerosols ,Vascular Fistula ,Transplantation ,Bronchus ,Lung ,Lung Diseases, Fungal ,business.industry ,Anastomosis, Surgical ,Bronchial Diseases ,Middle Aged ,respiratory system ,medicine.disease ,respiratory tract diseases ,Surgery ,Stenosis ,medicine.anatomical_structure ,Pulmonary artery ,Female ,Bronchial Fistula ,Cardiology and Cardiovascular Medicine ,business ,Lung Transplantation - Abstract
Ulcerative tracheobronchial aspergillosis after lung transplantation (ltx) may lead to bronchial-pulmonary artery fistula that results in fatal bleeding. We report our early experience with combined systemic, aerolized and topical application of amphotericin B in 3 cases of bronchial aspergillosis after ltx. Two patients are still alive, but 1 died of bleeding from a fistula between the left upper lobe bronchus and the pulmonary artery. Aspergillosis in the second patient resolved with minimal stenosis of the left main and the left upper lobe bronchus, and the third patient developed an anastomotic stenosis that was successfully dilated.
- Published
- 2000
32. Adhesion molecules in patients after lung transplantation
- Author
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Heidi Böttcher, Axel Haverich, K Padel, Andreas Tiroke, Stephan Hirt, J. Cremer, and Burkhard Bewig
- Subjects
Transplantation ,Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,Cell adhesion molecule ,business.industry ,medicine.medical_treatment ,Leukocyte adhesion molecule ,Intercellular Adhesion Molecule-1 ,CD18 ,respiratory system ,Intercellular adhesion molecule ,Bronchoalveolar lavage ,Immunology ,medicine ,Lung transplantation ,business - Abstract
Leukocyte adhesion molecules, such as intercellular adhesion molecule (ICAM)-1 and its ligands, are involved in inflammatory processes of the lung. For ICAM-1, differential expression during different kinds of complications after transplantation has been proposed. We analyzed the role of ICAM-1, CD18, CD11a, CD11b, and CD11c during episodes of rejection or infection in patients after lung transplantation and compared the results to episodes without apparent complication. A total of 98 bronchoalveolar lavage (BAL) samples and 90 serum samples were analyzed. ICAM-1, CD18, CD11a, CD11b, and CD11c expressions were detected immunocytochemically on alveolar macrophages. Soluble ICAM-1 was quantified in serum and BAL. In the control group, 49.8±18% of macrophages stained positive for CD11b. During rejection, the mean of cells showing CD11b on the surface was significantly higher (64.6±11.4%), with no difference compared to episodes of infection (59.7±22.7). All other epitopes were not expressed differently with regard to a normal clinical course or episodes of infection and rejections. In summary, assessment of ICAM-1 and corresponding ligands did not allow for a reliable discrimination between episodes of rejection or infection in lung transplantation.
- Published
- 1999
33. VEGF 165 Expressed by a Replication-Deficient Recombinant Adenovirus Vector Induces Angiogenesis In Vivo
- Author
-
Mima Bacic, Ronald G. Crystal, Judith Mühlhauser, Antonino Passaniti, Roberto Pili, Nancy A. Edwards, Marsha J. Merrill, Hiroyuki Maeda, Maurizio C. Capogrossi, and Burkhard Bewig
- Subjects
Vascular Endothelial Growth Factor A ,Umbilical Veins ,DNA, Complementary ,Time Factors ,Physiology ,Angiogenesis ,medicine.medical_treatment ,Blotting, Western ,Genetic Vectors ,Neovascularization, Physiologic ,Enzyme-Linked Immunosorbent Assay ,Vascular permeability ,Endothelial Growth Factors ,Biology ,Virus Replication ,Muscle, Smooth, Vascular ,Adenoviridae ,Mice ,chemistry.chemical_compound ,Ischemia ,In vivo ,medicine ,Animals ,Humans ,RNA, Messenger ,Aorta ,Cells, Cultured ,Lymphokines ,Matrigel ,Vascular Endothelial Growth Factors ,Growth factor ,Gene Transfer Techniques ,Cell Differentiation ,Genetic Therapy ,Blotting, Northern ,Immunohistochemistry ,Molecular biology ,Rats ,Vascular endothelial growth factor ,Vascular endothelial growth factor A ,chemistry ,Cell culture ,Data Interpretation, Statistical ,Immunology ,Endothelium, Vascular ,Cardiology and Cardiovascular Medicine ,Cell Division - Abstract
Abstract To evaluate the concept that localized delivery of angiogenic factors via virus-mediated gene transfer may be useful in the treatment of ischemic disorders, the replication-deficient adenovirus (Ad) vector AdCMV.VEGF 165 (where CMV is cytomegalovirus and VEGF is vascular endothelial growth factor) containing the cDNA for human VEGF 165 , a secreted endothelial cell–specific angiogenic growth factor, was constructed. Human umbilical vein endothelial cells (HUVECs) and rat aorta smooth muscle cells (RASMCs) infected with AdCMV.VEGF 165 (5 and 20 plaque-forming units [pfu] per cell) demonstrated VEGF mRNA expression and protein secretion into the supernatant. Furthermore, the conditioned medium from these cells enhanced vascular permeability in vivo. In contrast, neither VEGF mRNA nor secreted protein was found in uninfected HUVECs or RASMCs or in cells infected with the control vector AdCMV.βgal (where βgal is β-galactosidase). Assessment of starved HUVECs at 14 days demonstrated sixfold more cells for AdCMV.VEGF 165 -infected HUVECs (20 pfu per cell) than for either infected or uninfected control cells. RASMC proliferation was unaffected by infection with AdCMV.VEGF 165 . When plated in 2% serum on dishes precoated with reconstituted basement membrane (Matrigel), HUVECs infected with AdCMV.VEGF 165 (20 pfu per cell) differentiated into capillary-like structures. Under similar conditions, both uninfected HUVECs and HUVECs infected with AdCMV.βgal did not differentiate. To evaluate the ability of AdCMV.VEGF 165 to function in vivo, either AdCMV. VEGF 165 or AdCMV.βgal (2×10 10 pfu) was resuspended in 0.5 mL Matrigel and injected subcutaneously into mice. Immunohistochemical staining demonstrated VEGF in the tissues surrounding the Matrigel plugs containing AdCMV.VEGF 165 up to 3 weeks after injection, whereas no VEGF was found in the control plugs with AdCMV.βgal. Two weeks after injection, there was histological evidence of neovascularization in the tissues surrounding the Matrigel containing AdCMV.VEGF 165 , whereas no significant angiogenesis was observed in response to AdCMV.βgal. Furthermore, the Matrigel plugs with AdCMV.VEGF 165 demonstrated hemoglobin content fourfold higher than the plugs with AdCMV.βgal. Together, these in vitro and in vivo studies are consistent with the concept that Ad vectors may provide a useful strategy for efficient local delivery of VEGF 165 in the treatment of ischemic diseases.
- Published
- 1995
34. In VitroandIn VivoTransfer and Expression of Human Surfactant SP-A- and SP-B-Associated Protein cDNAs Mediated by Replication-Deficient, Recombinant Adenoviral Vectors
- Author
-
Robert J. Korst, Burkhard Bewig, and Ronald G. Crystal
- Subjects
Gene Expression Regulation, Viral ,Male ,DNA, Complementary ,Pulmonary Surfactant-Associated Proteins ,Time Factors ,Proteolipids ,Genetic enhancement ,Blotting, Western ,Genetic Vectors ,Biology ,Epithelium ,Adenoviridae ,law.invention ,Rats, Sprague-Dawley ,Pulmonary surfactant ,In vivo ,law ,Complementary DNA ,Intubation, Intratracheal ,Genetics ,medicine ,Animals ,Humans ,RNA, Messenger ,Lung ,Molecular Biology ,Cells, Cultured ,Pulmonary Surfactant-Associated Protein A ,Gene Transfer Techniques ,Defective Viruses ,Epithelial Cells ,Pulmonary Surfactants ,Blotting, Northern ,Molecular biology ,In vitro ,Rats ,medicine.anatomical_structure ,Recombinant DNA ,Molecular Medicine ,Respiratory tract - Abstract
Congenital pulmonary alveolar proteinosis (CPAP) is a fatal disease of full-term infants that is unresponsive to current medical therapy. It is now recognized that at least some forms of this disorder are associated with a deficiency of SP-B, one of the surfactant-associated proteins, as well as probable aberrations in the surfactant-associated proteins SP-A and SP-C. Given these developments, it is logical to hypothesize that CPAP may be amenable to gene therapy, in which the human SP-B cDNA, and possibly the cDNAs of the other surfactant associated proteins, are transferred to the epithelium of the lower respiratory tract. We constructed replication-deficient, recombinant adenovirus vectors in which a constitutive viral promoter drives the expression of the DNAs for the surfactant-associated proteins, SP-B (AdCMV.SP-B) and SP-A (AdCMV.SP-A). Following infection of the human lung A549 epithelial cell line with these vectors in vitro, the appropriately sized mRNAs for these cDNAs were detected, whereas cells infected with a control virus or uninfected cells produced none. Western blots demonstrated expression of these proteins, including appropriate processing of the hydrophobic protein, SP-B. Following in vivo intratracheal infection of rats with these vectors, Northern analysis of the lungs revealed appropriately sized mRNAs for these cDNAs whereas rats infected with control virus or uninfected rats show no hybridization with the human surfactant-associated protein probes. In the AdCM-V.SP-A-infected rats, Western blots confirmed the overproduction of the human SP-A protein in both the bronchoalveolar lavage and lung homogenates compared to controls. Thus, it is feasible to utilize adenovirus vectors to transfer and express the human surfactant associated protein cDNAs in vitro and in vivo, presenting a possible mode of therapy for CPAP, as well as other surfactant deficiency states such as the neonatal respiratory distress syndrome and possibly the adult respiratory distress syndrome.
- Published
- 1995
35. Images in clinical medicine. Paget-Schroetter syndrome
- Author
-
Marcus, Seeger and Burkhard, Bewig
- Subjects
Upper Extremity Deep Vein Thrombosis ,Anticoagulants ,Humans ,Female ,Middle Aged ,Ultrasonography - Published
- 2010
36. Terminal part of thoracic duct: high-resolution US imaging
- Author
-
Rainer Günther, Christine Hoell, Diana Rubin, Bernd Vollnberg, Jochen Hampe, Burkhard Bewig, Clemens Schafmayer, Stefan Schreiber, Ulrich R. Fölsch, and Marcus Seeger
- Subjects
Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Chyle ,Cirrhosis ,Population ,High resolution ,Inflammatory bowel disease ,Thoracic duct ,Statistics, Nonparametric ,Hepatitis ,Thoracic Duct ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Ultrasonography, Doppler, Color ,education ,Aged ,Aged, 80 and over ,Heart Failure ,education.field_of_study ,business.industry ,Inflammatory Bowel Diseases ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Heart failure ,Linear Models ,Female ,Radiology ,Nuclear medicine ,business - Abstract
Purpose: To assess ultrasonographic (US) examination results of the cervical part of the thoracic duct, to provide standard diameters, and to evaluate the diameter of the cervical thoracic duct in certain diseases suspected to involve an abnormal load of chyle (liver, heart, and inflammatory bowel diseases).Materials and Methods: The study was approved by the institutional review committee, and written informed consent was obtained from all subjects. Diameter and variations of the cervical thoracic duct were assessed by using US in 265 healthy volunteers (age range, 21-82 years) from a population-based study, in 196 subjects with documented liver cirrhosis (age range, 19-87 years), in 68 subjects with chronic hepatitis (age range, 17-73 years), in 39 subjects with congestive heart failure (age range, 46-85 years), and in 17 subjects with inflammatory bowel disease (age range, 18-66 years). US examinations were performed with high-resolution linear probes (7-12 MHz). Results: A standard imaging approach guided by anatomic structures was established. Dynamic imaging of the chyle flow and valve function was possible. The thoracic duct was visualized in 564 (96%) of 585 examinations. The average thoracic duct diameter in healthy volunteers was 2.5 mm, which was independent of the subjects' age. The diameter was significantly higher in subjects with congestive heart failure (6.3 mm, P < .0001) and liver cirrhosis (5.6 mm, P < .0001). Anatomic variations were present in 27% of subjects. Conclusion: High-resolution US with linear probes allows assessment of the cervical thoracic duct with high detection rates. Recognition of local anatomy, diameter, and chyle flow may aid functional assessment.
- Published
- 2009
37. Crohn’s Disease Mimicking Sarcoidosis in Bronchoalveolar Lavage
- Author
-
Rolf Nitsche, Ingrid Manske, Andreas Bastian, Heidi Böttcher, Ulrich R. Fölsch, and Burkhard Bewig
- Subjects
Adult ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Systemic disease ,Pathology ,CD4-CD8 Ratio ,Arthritis ,Gastroenterology ,Diagnosis, Differential ,Crohn Disease ,Sarcoidosis, Pulmonary ,Sulfasalazine ,Internal medicine ,Humans ,Medicine ,Erythema nodosum ,Crohn's disease ,medicine.diagnostic_test ,business.industry ,Perianal Abscess ,medicine.disease ,digestive system diseases ,Bronchoalveolar lavage ,Female ,Sarcoidosis ,business ,Bronchoalveolar Lavage Fluid ,medicine.drug - Abstract
Granulomatous disorders like sarcoidosis or Crohn’s disease are commonly associated with extrapulmonary or extraintestinal manifestations which occasionally may represent the only symptoms. We describe a 28-year-old female patient suffering from atypical erythema nodosum and arthritis. Although the chest x-ray was unremarkable bronchoalveolar lavage revealed lymphocytic alveolitis with an elevated CD4/CD8 ratio of 8 and 11.4 at repeated examinations suggesting a diagnosis of sarcoidosis. Further diagnostic workup included endoscopy of the bowel. The macroscopic aspect and histology of the terminal small bowel and colon ascendens indicated Crohn’s disease. The patient recovered on steroids and sulfasalazine. Six months later she developed a perianal abscess for which she needed surgery supporting the diagnosis of Crohn’s disease. This is the first case of a significantly (>6) elevated CD4/CD8 ratio in Crohn’s disease previously regarded as highly specific for sarcoidosis.
- Published
- 1999
38. Images in clinical medicine. Ultrasound imaging of the thoracic duct
- Author
-
Marcus, Seeger and Burkhard, Bewig
- Subjects
Male ,Humans ,Female ,Middle Aged ,Chylothorax ,Aged ,Thoracic Duct ,Ultrasonography - Published
- 2008
39. Standardized quantification of pulmonary fibrosis in histological samples
- Author
-
Nour Eddine El Mokhtari, Hendrik Bolte, Wolfram Gitter, Burkhard Bewig, Marcus Both, Ralf-Harto Hübner, Micaela Mathiak, and Sandra Freitag-Wolf
- Subjects
Scale (ratio) ,medicine.medical_treatment ,Radiography ,Pulmonary Fibrosis ,Bleomycin ,General Biochemistry, Genetics and Molecular Biology ,chemistry.chemical_compound ,Fibrosis ,Pulmonary fibrosis ,medicine ,Animals ,Saline ,Observer Variation ,Inhalation Exposure ,Lung ,Antibiotics, Antineoplastic ,business.industry ,Lung fibrosis ,Reproducibility of Results ,medicine.disease ,Rats ,medicine.anatomical_structure ,chemistry ,Rats, Inbred Lew ,Nuclear medicine ,business ,Biotechnology - Abstract
The Ashcroft scale for the evaluation of bleomycin-induced lung fibrosis is the analysis of stained histological samples by visual assessment. Based on the knowledge that this procedure is not standardized in animals and results are highly variable, we hypothesized that modification of this method may improve quantification of lung fibrosis in small animals. To prove our hypothesis, we evaluated pulmonary fibrosis in Lewis rats induced by a single intratracheal injection of 0.3 mg/kg body weight bleomycin (n = 13) compared with the same amount of saline in a control group (n = 4). We modified the Ashcroft scale by precisely defining the assignment of grades from 0 to 8 for the increasing extent of fibrosis in lung histological samples. Thirty-two observers were randomly assigned to evaluate 108 photographs of slides using either the Ashcroft scale or the modified scale. Consistent with our hypothesis, there was a significant reduction in the variability of standard deviations with the modified scale compared with the Ashcroft scale (mean of variability 0.25 versus 0.62, P < 0.0001). Applying the κ index, the Ashcroft scale showed only a fair to moderate agreement (0.23–0.59) between the observers and a low intra-observer agreement (0.51–0.74) in contrast to the modified scale, which demonstrated a moderate to good agreement between the observers (0.65–0.93, P < 0.0001) and a high intra-observer agreement (0.87–0.91, P < 0.05). To test the modified scale in vivo, we compared both scales with the results of computed tomography (CT) of the lungs obtained from the same mice. In agreement, the modified scale demonstrated a better correlation to CT scans (R = 0.58) compared with the Ashcroft scale (R = 0.33). In summary, quantification of lung fibrosis in histological lung sections using the modified scale is reliable and reproducible.
- Published
- 2008
40. Fast T1- and T2-weighted pulmonary MR-imaging in patients with bronchial carcinoma
- Author
-
I. Bobis, Ralf-Harto Hübner, M. Reuter, J. Schultze, Martin Heller, Burkhard Bewig, Jürgen Biederer, Marcus Both, and R. Noth
- Subjects
Male ,medicine.medical_specialty ,Atelectasis ,medicine ,Carcinoma ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Lymph node ,Aged ,Aged, 80 and over ,Lung ,business.industry ,Respiratory disease ,Mediastinum ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Carcinoma, Bronchogenic ,Coronal plane ,Female ,Radiology ,Tomography ,business ,Artifacts ,Tomography, X-Ray Computed - Abstract
A prospective study to evaluate the diagnostic potential and limitations of three fast MRI sequences in patients with bronchial carcinoma based on the comparison with spiral CT.Three fast chest MRI sequences from 20 patients with central or peripheral bronchial carcinoma were evaluated by two observers for relation of tumour to adjacent structures, lymph node enlargement, additional pulmonary lesions and artefacts. The information from MR-imaging was compared with the results from spiral CT. MRI comprised a T1-3D-GRE breath-hold examination ("VIBE", TR/TE 4.5/1.9 ms, flip-angle 12 degrees , matrix 502 x 512, 2.5 mm coronal slices), a breath-hold, T2-HASTE sequence (TR/TE 2000/43 ms, matrix 192 x 256, 10 mm coronal slices) and a respiration-triggered T2-TSE sequence (TR/TE 3000-6000/120 ms, matrix 270 x 512, 6 mm transverse slices). The FOV was adapted individually (380-480 mm).The presence of the primary bronchial carcinoma and infiltration of thoracic structures by tumour tissue could be demonstrated by all sequences. VIBE sequence was more suitable for detecting small pulmonary nodules than the other MRI examinations, but compared to CT still 20% of these lesions were missed. Contrary to VIBE and T2-weighted TSE scans, HASTE sequence was limited in imaging mediastinal lymph nodes due to missing relevant findings in 2/20 patients. HASTE images significantly provided the lowest rate of artefacts in imaging lung parenchyma (P0.001 in peripheral parenchyma), but spatial resolution was limited in this sequence. Concerning the differentiation between tumour and adjacent atelectasis (n = 8), T2-weighted TSE imaging was superior to CT and VIBE in all cases and to HASTE sequence in 4/8 patients.The combination of VIBE and HASTE sequence allows for an adaequate imaging of thoracic processes in patients with bronchial carcinoma, limited only in visualizing small pulmonary nodules. To obtain more detail resolution and to differentiate tumour tissue from adjacent atelectasis, T2-TSE examination may be added in selected cases.
- Published
- 2005
41. Bleomycin-induzierte Lungenfibrose: Quantitative CT der Rattenlunge im Vergleich mit der Histologie
- Author
-
Burkhard Bewig, C. Riedel, Ralf-Harto Hübner, Marcus Both, Hendrik Bolte, Michael Reuter, N El-Mokthari, UR Fölsch, Martin Heller, W Gitter, and C Both
- Subjects
Radiology, Nuclear Medicine and imaging - Published
- 2005
42. Analysis of the GM-CSF and GM-CSF/IL-3/IL-5 receptor common beta chain in a patient with pulmonary alveolar proteinosis
- Author
-
Xuanding, Wang, Fuguang, Liu, and Burkhard, Bewig
- Subjects
Male ,DNA, Complementary ,Granulocyte-Macrophage Colony-Stimulating Factor ,Humans ,RNA, Messenger ,Middle Aged ,Pulmonary Alveolar Proteinosis ,Receptors, Cytokine - Abstract
To investigate the expression of the granulocyte-macrophage colony-stimulating factor (GM-CSF) and GM-CSF/IL-3/IL-5 receptor common beta chain (beta c receptor) in an adult patient with idiopathic pulmonary alveolar proteinosis (PAP), so as to demonstrate the possible association of the GM-CSF and beta c receptor with the pathogenesis of human PAP.The GM-CSF levels were measured with a commercial ELISA kit (sensitivity 5 pg/ml) and the beta c receptor expression on the cell surface was detected by flow cytometry analysis. Reverse transcription polymerase chain reaction (RT-PCR) analysis was employed to detect the expression of the GM-CSF mRNA and the beta c receptor mRNA in peripheral blood mononuclear cells and alveolar macrophages. The entire coding regions of the GM-CSF cDNA and the beta c receptor cDNA were sequenced by the Sanger dideoxy-mediated chain termination method to detect possible mutations.The patient with PAP failed to release the GM-CSF protein either from circulating mononuclear cells or from alveolar macrophages. The expression of the GM-CSF mRNA was normal after the stimulation of lipopolysaccharide, whereas a point mutation at position 382 of the GM-CSF cDNA from "T" to "C" was revealed by cDNA sequencing, which caused a change in amino acid 117 of the protein from isoleucine to threonine. The beta c receptor expression on the cell surface was normal, and the beta c receptor mRNA expression and the sequence of the entire coding region of the beta c receptor were also normal.The decreased GM-CSF production is associated with the pathogenesis of human PAP. A point mutation of the GM-CSF cDNA may contribute to the decreased GM-CSF production in our adult PAP patient. The mutation of the beta c receptor in some of paediatric patients with PAP may not be a common problem in adult patients.
- Published
- 2002
43. 256 Mothers with CF: psychosocial data about an almost unknown group
- Author
-
I. Bobis, Gerald Ullrich, and Burkhard Bewig
- Subjects
Pulmonary and Respiratory Medicine ,Pediatrics ,medicine.medical_specialty ,business.industry ,Group (periodic table) ,Pediatrics, Perinatology and Child Health ,Medicine ,Pediatrics, Perinatology, and Child Health ,business ,medicine.disease ,Cystic fibrosis ,Psychosocial - Published
- 2014
44. Accelerated titering of adenoviruses
- Author
-
Burkhard Bewig and Wolfgang E. Schmidt
- Subjects
biology ,Genetic Vectors ,Gene Transfer Techniques ,Viral Plaque Assay ,MOLECULAR BIOLOGY METHODS ,Antibodies, Viral ,Virology ,General Biochemistry, Genetics and Molecular Biology ,Adenoviridae ,Immunoenzyme Techniques ,chemistry.chemical_compound ,Viral genetics ,Antigen ,chemistry ,Immunoenzyme techniques ,DNA, Viral ,biology.protein ,Antibody ,Viral immunology ,Antigens, Viral ,Molecular Biology ,DNA ,Biotechnology - Published
- 2000
45. Detection of CMV pneumonitis after lung transplantation using PCR of DNA from bronchoalveolar lavage cells
- Author
-
P. Rautenberg, Axel Haverich, Heidi Böttcher, Andreas Tiroke, Thyra Caroline Haacke, Stefan Hirt, Burkhard Bewig, and Andreas Bastian
- Subjects
Pulmonary and Respiratory Medicine ,Human cytomegalovirus ,Adult ,Adolescent ,medicine.medical_treatment ,Congenital cytomegalovirus infection ,Cytomegalovirus ,medicine.disease_cause ,Bronchoalveolar Lavage ,Polymerase Chain Reaction ,Sensitivity and Specificity ,Herpesviridae ,Viral Matrix Proteins ,Betaherpesvirinae ,Predictive Value of Tests ,Leukocytes ,Medicine ,Lung transplantation ,Humans ,Prospective Studies ,Antigens, Viral ,Pneumonitis ,biology ,medicine.diagnostic_test ,business.industry ,virus diseases ,Pneumonia ,respiratory system ,medicine.disease ,biology.organism_classification ,Phosphoproteins ,Prognosis ,Transplantation ,Bronchoalveolar lavage ,Immunology ,Cytomegalovirus Infections ,DNA, Viral ,business ,Bronchoalveolar Lavage Fluid ,Lung Transplantation - Abstract
Background: Cytomegalovirus (CMV) is known as a common pathogen causing infections after lung transplantation. Rapid diagnosis of CMV infection is important for the initiation of a specific treatment. Objective: Evaluation of methods for the rapid diagnosis of CMV pneumonitis. Methods: The detection rates of CMV DNA in bronchoalveolar lavage (BAL) and bronchial brushes by polymerase chain reaction (PCR), of viral antigens (p52 and IE1) in BAL and of pp65 antigen in peripheral blood leukocytes were compared to the clinical status after lung transplantation. In 28 patients, 105 BAL, 96 blood samples and 14 brushes were analyzed. Results: In 6 patients, a total of eight episodes of CMV pneumonitis occurred. Five of the 6 with positive CMV antigens in BAL (p52 or IE1) showed signs of CMV pneumonitis. All episodes of CMV pneumonitis were detected by the PCR of BAL cells. Fourteen samples positive for CMV pp65 antigen in blood were negative in BAL PCR. In these cases, no clinical signs of pulmonary CMV infection occurred. Overall sensitivity, specificity, and positive and negative predictive values for the detection of CMV pneumonitis by PCR of BAL cells were 100, 98.9, 88.9 and 100%, respectively. In brush samples, PCR did not provide additional information to the results of the PCR of BAL cells. Conclusions: PCR of DNA from BAL cells is suitable for reliable and rapid detection of CMV pneumonitis.
- Published
- 2000
46. Bronchoalveolar lavage in lung transplantation. State of the art
- Author
-
Burkhard Bewig, Axel Haverich, and Andreas Tiroke
- Subjects
Graft Rejection ,Pathology ,medicine.medical_specialty ,Lymphocytosis ,medicine.medical_treatment ,Biopsy ,Cytodiagnosis ,T-Lymphocytes ,CD4-CD8 Ratio ,Bronchiolitis obliterans ,Cell morphology ,Bronchoalveolar Lavage ,Bronchoscopy ,medicine ,Lung transplantation ,Fiber Optic Technology ,Humans ,Bronchiolitis Obliterans ,Transplantation ,Lung ,medicine.diagnostic_test ,business.industry ,Respiratory disease ,Pneumonia ,respiratory system ,medicine.disease ,respiratory tract diseases ,Bronchoalveolar lavage ,medicine.anatomical_structure ,Phenotype ,Immunology ,Acute Disease ,Chronic Disease ,medicine.symptom ,business ,Bronchoalveolar Lavage Fluid ,Lung Transplantation - Abstract
Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) has become a crucial tool in the management of lung transplant recipients. Detection of pulmonary infectious pathogens by culture, cytology, and histology of BAL, protected brush specimens, and transbronchial biopsies (TBB) is highly effective. Morphologic and phenotypological analyses of BAL cells may be suggestive for certain complications after lung transplantation. For interpretation of BAL findings, the natural course of BAL cell morphology and phenotypology after lung transplantation must be considered. During the first 3 months after pulmonary transplantation, elevated total cell count in BAL and neutrophilic alveolitis are common, representing the cellular response to graft injury and interaction of immunocompetent cells of donor and recipient origin. With increasing time after transplantation the CD4/CD8 ratio decreases due to lowered percentages of CD4 cells in BAL. During bacterial pneumonias, the cellular profile of BAL is characterized by a marked granulocytic alveolitis. Lymphocytic alveolitis with a decreased CD4/CD8 ratio is suggestive of acute rejection, but is also found in viral pneumonias and obliterative bronchiolitis. In the case of a combined lymphocytosis and neutrophilia without any evidence of infection, obliterative bronchiolitis should be considered. Functional analyses of BAL cells can give additional information about the immunologic status of the graft, even before histologic changes become evident but have not been established in routine transplant monitoring. However, functional studies suggest an important role of activated, alloreactive and donor-specific T lymphocytes in the pathogenesis of acute and chronic lung rejection. Investigations of soluble components in BAL have given further insight into the immunologic processes after lung transplantation. In this overview, the characteristics of BAL after lung transplantation will be summarized, and its relevance for the detection of pulmonary complications will be discussed.
- Published
- 1999
47. Vermehrtes Nasenbluten bei zunehmender Leistungseinschränkung
- Author
-
Burkhard Bewig, Ralf-Harto Hübner, Gerrit Krupski, and Nour Eddine El Mokhtari
- Subjects
medicine.medical_specialty ,Lung ,business.industry ,Arteriovenous malformation ,General Medicine ,medicine.disease ,Malaise ,Surgery ,medicine.anatomical_structure ,Tomography x ray computed ,medicine ,Radiology ,medicine.symptom ,Differential diagnosis ,business - Published
- 2004
48. Increased intestinal permeability and tight junction disruption by altered expression and localization of occludin in a murine graft versus host disease model
- Author
-
Stefan Schreiber, Alexander Arlt, Rainer Noth, Burkhard Bewig, Julia Lange-Grumfeld, Robert Häsler, Jochen Hampe, Mark Ellrichmann, Marie-Luise Kruse, Eckhard Stüber, and Philip Rosenstiel
- Subjects
Pathology ,medicine.medical_specialty ,Gastrointestinal bleeding ,Side effect ,medicine.medical_treatment ,Down-Regulation ,Graft vs Host Disease ,Hematopoietic stem cell transplantation ,Occludin ,Polymerase Chain Reaction ,Permeability ,Mice ,Internal medicine ,medicine ,Animals ,Mannitol ,lcsh:RC799-869 ,Intestinal permeability ,Tight junction ,business.industry ,Tumor Necrosis Factor-alpha ,Gastroenterology ,Membrane Proteins ,General Medicine ,Hepatology ,medicine.disease ,Immunohistochemistry ,Lactulose ,Up-Regulation ,Mice, Inbred C57BL ,Disease Models, Animal ,Microscopy, Electron ,Graft-versus-host disease ,Jejunum ,Microscopy, Fluorescence ,Immunology ,lcsh:Diseases of the digestive system. Gastroenterology ,business ,Research Article - Abstract
Background Hematopoietic stem cell transplantation is increasingly performed for hematologic diseases. As a major side effect, acute graft versus host disease (GvHD) with serious gastrointestinal symptoms including diarrhea, gastrointestinal bleeding and high mortality can be observed. Because surveillance and biopsies of human gastrointestinal GvHD are difficult to perform, rare information of the alterations of the gastrointestinal barrier exists resulting in a need for systematic animal models. Methods To investigate the effects of GvHD on the intestinal barrier of the small intestine we utilized an established acute semi allogenic GvHD in C57BL/6 and B6D2F1 mice. Results By assessing the differential uptake of lactulose and mannitol in the jejunum, we observed an increased paracellular permeability as a likely mechanism for disturbed intestinal barrier function. Electron microscopy, immunohistochemistry and PCR analysis indicated profound changes of the tight-junction complex, characterized by downregulation of the tight junction protein occludin without any changes in ZO-1. Furthermore TNF-α expression was significantly upregulated. Conclusions This analysis in a murine model of GvHD of the small intestine demonstrates serious impairment of intestinal barrier function in the jejunum, with an increased permeability and morphological changes through downregulation and localization shift of the tight junction protein occludin.
- Published
- 2011
49. Paget–Schroetter Syndrome
- Author
-
Burkhard Bewig and Marcus Seeger
- Subjects
medicine.medical_specialty ,business.industry ,Paget-schroetter syndrome ,General Medicine ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Clavicle ,Occlusion ,cardiovascular system ,medicine ,Venous valve ,Upper Extremity Deep Vein Thrombosis ,cardiovascular diseases ,Radiology ,Thrombus ,Ultrasonography ,business ,Subclavian vein - Abstract
A 47-year-old woman presented with swelling, pain, and reddish discoloration of the right arm and hand after strenuous effort. Ultrasonography with a microconvex probe revealed a subtotal occlusion in the subclavian vein close to the clavicle, caused by a small thrombus fixed on a venous valve.
- Published
- 2010
50. Ultrasound Imaging of the Thoracic Duct
- Author
-
Marcus Seeger and Burkhard Bewig
- Subjects
medicine.medical_specialty ,Chyle ,business.industry ,media_common.quotation_subject ,Subtraction ,General Medicine ,Thoracic duct ,medicine.anatomical_structure ,medicine ,Ultrasound imaging ,Contrast (vision) ,Radiology ,business ,media_common - Abstract
Recent advances in ultrasound imaging allow visualization of the cervical part of the thoracic duct. The movements of chyle and blood are identified with the use of a method of digital subtraction that separates static tissue from the flow in the vessels without the need for an enhancing contrast agent.
- Published
- 2008
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