518 results on '"Stefan Wirth"'
Search Results
2. The hazardous (mis)perception of Self-estimated Alcohol intoxication and Fitness to drivE—an avoidable health risk: the SAFE randomised trial
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Jöran Köchling, Berit Geis, Cho-Ming Chao, Jana-K. Dieks, Stefan Wirth, and Kai O. Hensel
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Perceived alcohol intoxication ,Road safety ,Public health concern ,Alcohol-related road traffic accident ,Driving under the influence ,DUI ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Worldwide, alcohol-related road traffic accidents represent a major avoidable health risk. The aim of this study was to evaluate the accuracy of self-estimating the degree of acute alcohol intoxication regarding the legal driving limit, and to identify risk factors for misjudgement. Methods In this prospective randomised controlled crossover trial, 90 social drinkers (mean age 23.9 ± 3.5 years, 50% female) consumed either beer or wine. Study group subjects were made aware when exceeding the legal driving limit (BrAC = 0.05%). Controls received no information about their BrAC. For crossover, beer or wine were consumed in the opposite order. Results 39–53% of all participants exceeded the legal driving limit whilst under the impression to be still permitted to drive. Self-estimation was significantly more accurate on study day 2 (p = 0.009). Increasing BrAC positively correlated with self-estimation inaccuracy, which was reproducible during crossover. Multiple regression analysis revealed fast drinking and higher alcohol levels as independent risk factors for inaccurate self-estimation. Conclusions Social drinkers are commonly unaware of exceeding the legal driving limit when consuming alcohol. Self-estimating alcohol intoxication can be improved through awareness. Dedicated awareness programs, social media campaigns and government advice communications should be utilised to address this avoidable hazard. Trial registration The trial was registered prospectively at the Witten/Herdecke University Ethics Committee (trial registration number 140/2016 on 04/11/2016) and at the DRKS—German Clinical Trials Register (trial registration number DRKS00015285 on 08/22/2018—Retrospectively registered). Trial protocol can be accessed online.
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- 2021
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3. Occurrence of Thromboembolism in Paediatric Patients With Inflammatory Bowel Disease: Data From the CEDATA-GPGE Registry
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Jan De Laffolie, Antje Ballauff, Stefan Wirth, Carolin Blueml, Frank Risto Rommel, Martin Claßen, Martin Laaß, Thomas Lang, Almuthe Christina Hauer, and the CEDATA-GPGE Study Group
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IBD ,paediarics ,inflammatory bowel disease ,colitis ,Crohn’s disease ,thromboembolism ,Pediatrics ,RJ1-570 - Abstract
ObjectiveAmong patients with inflammatory bowel disease (IBD), the risk of thromboembolism (TE) is increased, representing a relevant cause of morbidity and mortality. In contrast to other extraintestinal IBD manifestations, TE receives much less attention because of its low incidence, estimated at merely 0.4–0.9% in hospitalised children with IBD.MethodsCases with TE, as documented in the German-Austrian Paediatric IBD registry gesellschaft für pädiatrische gastroenterologie und ernährung – large paediatric patient registry (CEDATA-GPGE), were analyzed retrospectively. For all patients with signs of TE, a questionnaire was filled in by the treating paediatric gastroenterologist.ResultsOver 10 years, 4,153 paediatric patients with IBD (0–18 years) were registered in the registry, and 12 of them identified with TE. Eight patients were diagnosed with ulcerative colitis (UC), three with Crohn’s disease (CD), and one with IBD-unclassified. The median age at IBD diagnosis was 10 years and at the manifestation of TE 13 years, respectively, with a median latency to TE of 2 years. Prevalence of TE was 0.3%, with a significantly higher risk for patients with UC than CD (OR 5.9, CI 1.56–22.33, p = 0.008). More girls than boys were affected (f:m = 7:5) without reaching significance. Approximately 90% of patients experienced TE during active disease, with relevant cerebral and limb involvement in 6/12 patients. Various risk factors, e.g., hospitalisation, coagulopathy, or anaemia were identified. TE management included intensive care and surgery. Among the 12 patients, 11 recovered fully, in which one patient has focal epilepsy as a sequela.ConclusionPaediatric patients with IBD have a substantially increased risk for TE. Risk factors, such as those identified should be considered when managing paediatric IBD and preventive measures for those hospitalised taken routinely. Initiating pharmacological thromboprophylaxis is challenging for the lack of published trials on efficacy and safety in paediatric IBD but should be considered carefully in each case.
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- 2022
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4. Isolated Crohn's Colitis: Is Localization Crucial? Characteristics of Pediatric Patients From the CEDATA–GPGE Registry
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Lotta Elonen, Lena Wölfle, Jan de Laffolie, Carsten Posovszky, the CEDATA–GPGE-Study-Group, Tobias Schwerdt, Rainer Ganschow, Stefan Trenkel, Burkhard Rodeck, Stefan Wirth, Marlen Zurek, Matthias Heiduk, Michael Paulussen, Gunter Flemming, Ekkehard Sturm, Axel Enninger, Söhnke Dammann, Henning Böhme, Michael Melter, Thomas Lang, Philip Bufler, Thomas Lücke, Markus Knuf, Norbert Wagner, Thomas Kaiser, Ralf Pallacks, Andre Hörning, Jens Klinge, Steffen Reinsch, Rüdiger Adam, Stefan Buderus, Markus Richter, Antje Ballauf, Ilse Broekaert, Lars Heerdts, Carolin Blüml, Sabine Peitzsch, Andreas Krahl, Simone Jedwilayties, Maik Heine, Marko Reitmann, Kai Nils Pargac, Jutta Kringel, Anke Dick, Patrick Gerner, Michael Friedt, Enno Iven, Gunter Burmester, Anke Esser, Olaf Raecke, Kerstin Ehrentraut, Esther Schmidt, Jan Däbritz, Stefan Sgoll, Ahlke Willenborg, Sebastian Horn, Ralph Melchior, Rüdiger Kardoff, Martina Kohl-Sobania, Benedikt Pircher, Christoph Ehrsam, Daniela Nolkemper, Adrian Lieb, Almuth Hauer, Markus Prenninger, Martin Laaß, and Dieter Furthner
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IBD ,pediatric ,Crohn's disease ,ulcerative colitis ,Crohn's colitis ,isolated colonic Crohn's ,Pediatrics ,RJ1-570 - Abstract
IntroductionPediatric patients with inflammatory bowel disease (IBD) are classified into Crohn's disease (CD), ulcerative colitis (UC), and unclassifiable (IBD-U). However, data provide evidence that ileal CD (L1) is distinct from colonic CD (L2). The aim of this study was to investigate the clinical features of isolated Crohn's colitis in a pediatric population.Material and MethodsChildren who were prospectively included in the CEDATA–GPGE registry on diagnosis were compared according to the diagnosis of CD with L2 vs. L1 and ileocolonic (L3) involvement pattern as well as IBD-U and UC. The clinical significance of L2 was investigated with regard to extraintestinal manifestations, treatment, surgery, and disease activity.ResultsFifty-two patients with L2 CD at a median age of 13.4 years (±3.8 SD) were compared with 182 L1 (13.8 ± 2.9 SD), 782 with L3 (12.8 ± 3.3 SD), 653 with UC (12.7 ± 3.8 SD), and 111 patients with IBD-U (11.9 ± 4.7 SD). Bloody stools at diagnosis were more common in L2 (44%) than in L1 (19.7%) and L3 (28.8%), but not as common as in UC (66.5%) and IBD-U (61.3%). Fewer CD patients with L2 (10.2%) received exclusive enteral nutrition therapy (EEN) as induction than patients with L1 (34.3%) and L3 (33.3%). After induction therapy, 42.3% of patients with L2 received immunosuppressants and 21% biologicals during follow-up (L1 56.5/10.5%; L3 59/21%; CU 43.5/11.9%; IBD-U 26.1/12.6%). Extraintestinal manifestations were more frequent in L2 (23.1%) vs. L1 (18.7%), L3 (20.2%), CU (15.8%), and IBD-U (11.7%). The number of patients requiring surgery did not differ within the CD subgroups and was significantly lower in UC and IBD-U. Perianal fistula surgery was significantly more common in L2 (44%) than in L1 (4.8%) or L3 (21.7%). In addition, the frequency of surgery for perianal abscesses was also more frequent in L2 (55.6%) than in L1 (12.7%) or L3 (38.4%).ConclusionsThe consideration of pediatric Crohn's colitis as a distinct disease seems necessary as it is characterized by extraintestinal manifestations (EIMs) with mainly joint involvement and perianal fistulas or abscesses requiring surgery and biologic therapy. Thus, colonic Crohn's disease may have an influence on the therapeutic stratification and should be addressed in further studies.
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- 2022
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5. European Society of Emergency Radiology: guideline on radiological polytrauma imaging and service (short version)
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Stefan Wirth, Julian Hebebrand, Raffaella Basilico, Ferco H. Berger, Ana Blanco, Cem Calli, Maureen Dumba, Ulrich Linsenmaier, Fabian Mück, Konraad H. Nieboer, Mariano Scaglione, Marc-André Weber, and Elizabeth Dick
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Europe ,Guideline ,Radiology ,Polytrauma ,Whole-body-CT ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Abstract Background Although some national recommendations for the role of radiology in a polytrauma service exist, there are no European guidelines to date. Additionally, for many interdisciplinary guidelines, radiology tends to be under-represented. These factors motivated the European Society of Emergency Radiology (ESER) to develop radiologically-centred polytrauma guidelines. Results Evidence-based decisions were made on 68 individual aspects of polytrauma imaging at two ESER consensus conferences. For severely injured patients, whole-body CT (WBCT) has been shown to significantly reduce mortality when compared to targeted, selective CT. However, this advantage must be balanced against the radiation risk of performing more WBCTs, especially in less severely injured patients. For this reason, we recommend a second lower dose WBCT protocol as an alternative in certain clinical scenarios. The ESER Guideline on Radiological Polytrauma Imaging and Service is published in two versions: a full version (download from the ESER homepage, https://www.eser-society.org ) and a short version also covering all recommendations (this article). Conclusions Once a patient has been accurately classified as polytrauma, each institution should be able to choose from at least two WBCT protocols. One protocol should be optimised regarding time and precision, and is already used by most institutions (variant A). The second protocol should be dose reduced and used for clinically stable and oriented patients who nonetheless require a CT because the history suggests possible serious injury (variant B). Reading, interpretation and communication of the report should be structured clinically following the ABCDE format, i.e. diagnose first what kills first.
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- 2020
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6. Efficacy of conservative treatment of perianal abscesses in children and predictors for therapeutic failure
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Lars Boenicke, Johannes Doerner, Stefan Wirth, Hubert Zirngibl, and Mike Ralf Langenbach
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anal fistula ,conservative treatment ,child ,perianal abscess ,recurrence ,Pediatrics ,RJ1-570 - Abstract
Background The optimal management of perianal abscess in children is controversial. Purpose To evaluate the efficiency of conservative treatment of perianal abscess in children and identify parameters that predict therapy failure. Methods All cases of children younger than 14 years of age with perianal abscesses between 2001–2016 were evaluated. Results Of the 113 enrolled patients, 64 underwent subsequent surgery for advanced disease (primary surgery group). Conservative treatment was initiated in 49 patients (primary conservative group) but was stopped because of inefficiency in 25 patients, who were referred for surgery after a median 7.03 days (range, 2 to 16 days). The other 24 patients (48%) initially achieved complete remission after conservative treatment, but 10 were readmitted after a median 34 months (range, 3 to 145 months) with recurrent disease. There were no significant differences in permanent success after conservative treatment between infants (10 of 29, 34%) and older children (4 of 20 [20%], P=0.122). Overall, conservative treatment alone was effective in only 14 of 113 patients. Recurrence after surgery occurred in 16 patients (25%) in the primary surgery group and 11 patients (22%) in the primary conservative group (P=0.75). Univariate analysis of predictors for conservative treatment failure revealed inflammatory values (C-reactive protein and white blood count, P=0.017) and abscess size (P=0.001) as significant parameters, whereas multivariate analysis demonstrated that only abscess size (odds ratio, 3.37; P=0.023) was significant. Conclusion Conservative treatment of perianal abscess is permanently efficient in only a minority of children but is not associated with a higher recurrence rate after subsequent surgery. Abscess size is a predictor for therapy failure.
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- 2020
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7. Voir à travers le métal
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Léonard Dumont, Tim De Kock, Guy De Mulder, and Stefan Wirth
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X-ray tomography ,computed tomography ,metallurgy ,copper alloys ,material culture ,Archaeology ,CC1-960 - Abstract
X-ray as a method for the study of archaeological metal artefacts is used since the 1950s in different institutions such as the Römisch-Germanisches Zentralmuseum in Mainz or the Rheinisches Landesmuseum in Bonn. Since then, this technique did not stop being used and is now widespread in archaeology. Since a few years it also evolved with the development of computed applications: digital radiography is replacing traditional films and micro-CT enables 3D visualization of the inner structure of the studied samples. These methods find various applications in archaeology. In the specific case of copper alloy objects, they enable to study them from another angle, revealing invisible aspects from the surface. It offers the opportunity of gathering information about the objects, especially about their production. Beyond the level of the object, these imaging techniques, when performed on a sufficient number of artefacts, are also of particular interest for the study of the cultural context these objects were produced in, especially thanks to the reconstruction of their production techniques. These are indeed precious witnesses left by craftsmen through the material culture components they produced. This point will be illustrated by the presentation of ongoing research on the production techniques of Bronze Age swords. In this case radiography and micro-CT scanning enable the identification of different technical traditions which will be the basis of a discussion of the exchanges these swords were in the centre of, also including the immaterial transfers.
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- 2020
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8. The Overlooked Microbiome—Considering Archaea and Eukaryotes Using Multiplex Nanopore-16S-/18S-rDNA-Sequencing: A Technical Report Focusing on Nasopharyngeal Microbiomes
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Carolin Baehren, Anton Pembaur, Patrick P. Weil, Nora Wewers, Frank Schult, Stefan Wirth, Jan Postberg, and Malik Aydin
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archaeome ,archaea ,eukaryotes ,PCR ,sequencing ,MinION ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
In contrast to bacteria, microbiome analyses often neglect archaea, but also eukaryotes. This is partly because they are difficult to culture due to their demanding growth requirements, or some even have to be classified as uncultured microorganisms. Consequently, little is known about the relevance of archaea in human health and diseases. Contemporary broad availability and spread of next generation sequencing techniques now enable a stronger focus on such microorganisms, whose cultivation is difficult. However, due to the enormous evolutionary distances between bacteria, archaea and eukaryotes, the implementation of sequencing strategies for smaller laboratory scales needs to be refined to achieve as a holistic view on the microbiome as possible. Here, we present a technical approach that enables simultaneous analyses of archaeal, bacterial and eukaryotic microbial communities to study their roles in development and courses of respiratory disorders. We thus applied combinatorial 16S-/18S-rDNA sequencing strategies for sequencing-library preparation. Considering the lower total microbiota density of airway surfaces, when compared with gut microbiota, we optimized the DNA purification workflow from nasopharyngeal swab specimens. As a result, we provide a protocol that allows the efficient combination of bacterial, archaeal, and eukaryotic libraries for nanopore-sequencing using Oxford Nanopore Technologies MinION devices and subsequent phylogenetic analyses. In a pilot study, this workflow allowed the identification of some environmental archaea, which were not correlated with airway microbial communities before. Moreover, we assessed the protocol’s broader applicability using a set of human stool samples. We conclude that the proposed protocol provides a versatile and adaptable tool for combinatorial studies on bacterial, archaeal, and eukaryotic microbiomes on a small laboratory scale.
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- 2023
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9. P-6 SOFOSBUVIR CONTAINING REGIMENS ARE SAFE AND EFFECTIVE IN ADOLESCENTS WITH CHRONIC HEPATITIS C INFECTION
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Stefan Wirth, Regino Gonzalez-Peralta, Philip Rosenthal, Winita Hardikar, Jessica Wen, Maureen M. Jonas, Naveen Mittal, Mary Whitworth, Ronen Arnon, Chuan-Hao Lin, Yury Lobzin, Rene Romero, Vladimir Chulanov, Girish Subbarao, Jeffrey Teckman, Vyacheslav Morozov, Eric Bassetti, Kathryn Kersey, Benedetta Massetto, Yanni Zhu, Polina German, Diana M. Brainard, Sanjay Bansal, Karen F. Murray, Kathleen Schwarz, and William Balistreri
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Specialties of internal medicine ,RC581-951 - Abstract
Background: HCV-specific DAAs have transformed treatment of chronic HCV, but few studies have evaluated these therapies in children. Methods: Patients aged 12–17 years old with chronic GT1 HCV were enrolled into an open-label study to receive 12 weeks of LDV/SOF 90 mg/400 mg once daily, and those with HCV GT2 or GT3 to receive SOF (400 mg once daily) + RBV (15 mg/kg/day) for 12 (GT2) or 24 weeks (GT3), respectively. Primary efficacy endpoint was SVR12. Safety was assessed by adverse events and clinical/laboratory data. Pharmacokinetic (PK) sampling was conducted to confirm the appropriateness of the doses. Results: 150 adolescents (100 GT1, 13 GT2 and 37 GT3) were enrolled and treated. The majority were female (56%), white (90%), treatment naive (81%), and vertically infected (80%). The mean age was 15 years (range 12–17). LDV, SOF and GS-331007 (primary metabolite) exposures were within the range of adult exposures observed in the SOF and LDV/SOF phase 2/3 studies. The SVR12 rate was 98% in GT1, 100% in GT2 and 97% in GT3; all 3 patients who were considered not to have achieved SVR12 were lost to follow-up. No adverse event (AE) leading to study drug discontinuation or serious AEs have been reported. Conclusion: In adolescents, LDV/SOF for 12 weeks and SOF + RBV for 12 or 24 weeks, resulted in a SVR12 rate of 97–100% with no virologic failures. These regimens were well tolerated, demonstrating their potential as an important treatment option for children with HCV infection.
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- 2021
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10. Microarray-Based Analyses of Rhinovirus Species-Specific Antibody Responses in Exacerbated Pediatric Asthma in a German Pediatric Cohort
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Erwan Sallard, Katarzyna Niespodziana, Maja Bajic, Thomas Schlederer, Peter Errhalt, Ann-Kathrin Behrendt, Stefan Wirth, Almut Meyer-Bahlburg, Anja Ehrhardt, Rudolf Valenta, and Malik Aydin
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rhinovirus ,RV ,virus infection ,asthma ,wheeze ,exacerbation ,Microbiology ,QR1-502 - Abstract
Rhinoviruses (RV) account for a significant number of asthma exacerbations, and RV species C may be associated with a severe course in vulnerable patient groups. Despite important evidence on the role of RV reported by clinicians and life scientists, there are still unanswered questions regarding their influence on asthma exacerbation in young patients. Thus, we measured the RVspecies-specific IgG titers in our German pediatric exacerbation cohort using a microarray-based technology. For this approach, human sera of patients with exacerbated asthma and wheeze, as well as healthy control subjects (n = 136) were included, and correlation analyses were performed. Concordantly with previously published results, we observed significantly higher cumulative levels of RV species A-specific IgG (p = 0.011) and RV-C-specific IgG (p = 0.051) in exacerbated asthma group compared to age-matched controls. Moreover, atopic wheezers had increased RV-specific IgG levels for species A (p = 0.0011) and species C (p = 0.0009) compared to non-atopic wheezers. Hypothesizing that bacterial infection positively correlates with immune memory against RV, we included nasopharyngeal swab results in our analyses and detected limited correlations. Interestingly, the eosinophil blood titer positively correlated with RV-specific IgG levels. With these observations, we add important observations to the existing data regarding exacerbation in pediatric and adolescent medicine. We propose that scientists and clinicians should pay more attention to the relevance of RV species in susceptible pediatric patients.
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- 2022
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11. The Rhinobiome of Exacerbated Wheezers and Asthmatics: Insights From a German Pediatric Exacerbation Network
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Malik Aydin, Cornelius Weisser, Olivier Rué, Mahendra Mariadassou, Sandra Maaß, Ann-Kathrin Behrendt, Yan Jaszczyszyn, Tatje Heilker, Maximilian Spaeth, Silvia Vogel, Sören Lutz, Parviz Ahmad-Nejad, Viktoria Graf, Aliyah Bellm, Christoph Weisser, Ella A. Naumova, Wolfgang H. Arnold, Anja Ehrhardt, Almut Meyer-Bahlburg, Dörte Becher, Jan Postberg, Beniam Ghebremedhin, and Stefan Wirth
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nasal microbiome ,proteomics ,metagenomics ,bioinformatics ,bacteria ,Moraxella catarrhalis ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Although the nose, as a gateway for organism–environment interactions, may have a key role in asthmatic exacerbation, the rhinobiome of exacerbated children with asthma was widely neglected to date. The aim of this study is to understand the microbiome, the microbial immunology, and the proteome of exacerbated children and adolescents with wheeze and asthma. Considering that a certain proportion of wheezers may show a progression to asthma, the comparison of both groups provides important information regarding clinical and phenotype stratification. Thus, deep nasopharyngeal swab specimens, nasal epithelial spheroid (NAEsp) cultures, and blood samples of acute exacerbated wheezers (WH), asthmatics (AB), and healthy controls (HC) were used for culture (n = 146), 16 S-rRNA gene amplicon sequencing (n = 64), and proteomic and cytokine analyses. Interestingly, Proteobacteria were over-represented in WH, whereas Firmicutes and Bacteroidetes were associated with AB. In contrast, Actinobacteria commonly colonized HCs. Moreover, Staphylococcaceae, Enterobacteriaceae, Burkholderiaceae, Xanthobacteraceae, and Sphingomonadaceae were significantly more abundant in AB compared to WH and HC. The α-diversity analyses demonstrated an increase of bacterial abundance levels in atopic AB and a decrease in WH samples. Microbiome profiles of atopic WH differed significantly from atopic AB, whereby atopic samples of WH were more homogeneous than those of non-atopic subjects. The NAEsp bacterial exposure experiments provided a disrupted epithelial cell integrity, a cytokine release, and cohort-specific proteomic differences especially for Moraxella catarrhalis cultures. This comprehensive dataset contributes to a deeper insight into the poorly understood plasticity of the nasal microbiota, and, in particular, may enforce our understanding in the pathogenesis of asthma exacerbation in childhood.
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- 2021
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12. Ombitasvir/Paritaprevir/Ritonavir With or Without Dasabuvir and With or Without Ribavirin for Adolescents With HCV Genotype 1 or 4
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Daniel H. Leung, Stefan Wirth, Betty B. Yao, Rolando M. Viani, Regino P. Gonzalez‐Peralta, Maureen M. Jonas, Steven J. Lobritto, Michael R. Narkewicz, Etienne Sokal, Clàudia Fortuny, Evelyn K. Hsu, Antonio Del Valle‐Segarra, Jiuhong Zha, Lois Larsen, Li Liu, Diana L. Shuster, Daniel E. Cohen, and Philip Rosenthal
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
In adults, treatment of hepatitis C virus (HCV) infection with ombitasvir (OBV)/paritaprevir (PTV)/ritonavir (r) with or without dasabuvir (DSV) and ±ribavirin (RBV) results in high rates of sustained virologic response (SVR). However, these regimens have not been investigated in adolescents. This ongoing, open‐label, phase 2/3 study evaluated the pharmacokinetics, safety, and efficacy of OBV/PTV/r+DSV±RBV treatment for 12 weeks in adolescents infected with HCV genotype (GT) 1 without cirrhosis (part 1) and the safety and efficacy of OBV/PTV/r±DSV±RBV treatment for 12 or 24 weeks in adolescents infected with GT1 or GT4 without cirrhosis or with compensated cirrhosis (parts 1 and 2). Patients were 12‐17 years of age and treatment naive or interferon experienced. Treatment regimens were based on HCV GT and cirrhosis status. Endpoints were SVR at posttreatment week 12 (SVR12), adverse events (AEs), and pharmacokinetic parameters. Thirty‐eight adolescents were enrolled, 66% were female patients, and 76% were White; 42%, 40%, and 18% of patients had HCV GT1a, GT1b, and GT4 infections, respectively. Median age was 15 years (range, 12‐17 years), and 1 patient had cirrhosis. The SVR12 rate was 100% (38/38; 95% confidence interval [CI], 90.8%‐100%). No treatment‐emergent grade 3 or 4 laboratory abnormalities were reported. No serious AEs occurred on treatment, and no AEs led to study drug discontinuation. The most common AEs were headache (21%), fatigue (18%), nasopharyngitis (13%), pruritus (13%), and upper respiratory tract infection (11%). Intensive pharmacokinetic results showed OBV, PTV, DSV, and ritonavir drug exposures were comparable to those seen in adults. Conclusion: Treatment with OBV/PTV/r±DSV±RBV was well tolerated and highly efficacious in adolescents with HCV GT1 or GT4 infection.
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- 2018
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13. Do Current Asthma-Preventive Measures Appropriately Face the World Health Organization's Concerns: A Study Presentation of a New Clinical, Prospective, Multicentric Pediatric Asthma Exacerbation Cohort in Germany
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Malik Aydin, Ella A. Naumova, Soeren Lutz, Almut Meyer-Bahlburg, Wolfgang H. Arnold, Florian Kreppel, Anja Ehrhardt, Jan Postberg, and Stefan Wirth
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asthma ,allergy ,childhood ,exacerbation ,epigenome ,biomarker ,Pediatrics ,RJ1-570 - Abstract
In summer 2017, the World Health Organization published 10 facts on asthma, which is known as a major non-communicable disease of high clinical and scientific importance with currently several hundred million people—with many children among them—suffering from air passages inflammation and narrowing. Importantly, the World Health Organization sees asthma as being underdiagnosed and undertreated. Consequently, much more efforts in clinical disease management and research need to be spent on reducing the asthma-related health burden. Particularly, for young approximately 6 months aged patients presenting recurrent bronchitic respiratory symptoms, many parents anxiously ask the doctors for risk prognosis for their children's future life. Therefore, we urgently need to reevaluate if the current diagnostic and treatment measures are in concordance with our yet incomplete knowledge of pathomechanisms on exacerbation. To contribute to this increasing concern worldwide, we established a multicentric pediatric exacerbation study network, still recruiting acute exacerbated asthmatics (children >6 years) and preschool asthmatics/wheezers (children
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- 2020
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14. The Relevance of the Bacterial Microbiome, Archaeome and Mycobiome in Pediatric Asthma and Respiratory Disorders
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Carolin Baehren, Eleni Buedding, Aliyah Bellm, Frank Schult, Anton Pembaur, Stefan Wirth, Anja Ehrhardt, Friedrich Paulsen, Jan Postberg, and Malik Aydin
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microbiome ,archaea ,fungi ,nasopharynx ,oropharynx ,asthma ,Cytology ,QH573-671 - Abstract
Bacteria, as well as eukaryotes, principally fungi, of the upper respiratory tract play key roles in the etiopathogenesis of respiratory diseases, whereas the potential role of archaea remains poorly understood. In this review, we discuss the contribution of all three domains of cellular life to human naso- and oropharyngeal microbiomes, i.e., bacterial microbiota, eukaryotes (mostly fungi), as well as the archaeome and their relation to respiratory and atopic disorders in infancy and adolescence. With this review, we aim to summarize state-of-the-art contributions to the field published in the last decade. In particular, we intend to build bridges between basic and clinical science.
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- 2022
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15. Viral Infection and Respiratory Exacerbation in Children: Results from a Local German Pediatric Exacerbation Cohort
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Erwan Sallard, Frank Schult, Carolin Baehren, Eleni Buedding, Olivier Mboma, Parviz Ahmad-Nejad, Beniam Ghebremedhin, Anja Ehrhardt, Stefan Wirth, and Malik Aydin
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human rhinovirus ,respiratory syncytial virus ,virus ,infection ,asthma ,bronchitis ,Microbiology ,QR1-502 - Abstract
Respiratory viruses play an important role in asthma exacerbation, and early exposure can be involved in recurrent bronchitis and the development of asthma. The exact mechanism is not fully clarified, and pathogen-to-host interaction studies are warranted to identify biomarkers of exacerbation in the early phase. Only a limited number of international exacerbation cohorts were studied. Here, we have established a local pediatric exacerbation study in Germany consisting of children with asthma or chronic, recurrent bronchitis and analyzed the viriome within the nasopharyngeal swab specimens derived from the entire cohort (n = 141). Interestingly, 41% of exacerbated children had a positive test result for human rhinovirus (HRV)/human enterovirus (HEV), and 14% were positive for respiratory syncytial virus (RSV). HRV was particularly prevalent in asthmatics (56%), wheezers (50%), and atopic (66%) patients. Lymphocytes were decreased in asthmatics and in HRV-infected subjects, and patients allergic to house dust mites were more susceptible to HRV infection. Our study thus confirms HRV infection as a strong ‘biomarker’ of exacerbated asthma. Further longitudinal studies will show the clinical progress of those children with a history of an RSV or HRV infection. Vaccination strategies and novel treatment guidelines against HRV are urgently needed to protect those high-risk children from a serious course of disease.
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- 2022
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16. Increased Antibiotic Resistance in Children with Helicobacter pylori Infection: A Retrospective Study
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Luca Helmbold, Beniam Ghebremedhin, Aliyah Bellm, Marc A. Hopkins, Stefan Wirth, and Malik Aydin
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abdominal pain ,children ,multiple drug resistance ,antibiotic resistance ,histopathology ,gastritis ,Medicine - Abstract
Children with recurrent abdominal pain may be suffering from a Helicobacterpylori (HP) infection. The gold standard for confirming HP gastritis is histological evaluation and microbiological tests performed on specimens collected by esophagogastroduodenoscopy (EGD). The aim of this study was to analyze HP positive cultures and antibiograms with regard to clinical and histopathological correlates. The data of 124 subjects with frequent gastrointestinal symptoms who underwent an EGD were retrospectively collected and analyzed. The mean age of the patients was 13 ± 3.6 years. The most frequent complaints were epigastric pain (84%; n = 100/119) and dyspepsia (79%; n = 94/119). HP gastritis was diagnosed in 54% (n = 67). Interestingly, 40% (n = 49) of the isolates were resistant to at least one antibiotic: amoxicillin (20%; n = 10/49), clarithromycin (45%; n = 22/49), or metronidazole (59%; n = 29/49). Isolates were resistant to two or more antibiotics in 16% (n = 20) of cases. In conclusion, we revealed remarkably high resistance rates to amoxicillin, metronidazole, and clarithromycin in our cohort. The presence of antibiotic resistance to more than one antibiotic was substantially increased in our HP-infected patients and this may negatively affect eradication treatment.
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- 2022
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17. Episomal HBV persistence within transcribed host nuclear chromatin compartments involves HBx
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Kai O. Hensel, Franziska Cantner, Felix Bangert, Stefan Wirth, and Jan Postberg
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Epigenome ,Episome ,Host–pathogen interaction ,Supranucleosomal structure ,X-protein ,HBxAg ,Genetics ,QH426-470 - Abstract
Abstract Background In hepatocyte nuclei, hepatitis B virus (HBV) genomes occur episomally as covalently closed circular DNA (cccDNA). The HBV X protein (HBx) is required to initiate and maintain HBV replication. The functional nuclear localization of cccDNA and HBx remains unexplored. Results To identify virus–host genome interactions and the underlying nuclear landscape for the first time, we combined circular chromosome conformation capture (4C) with RNA-seq and ChIP-seq. Moreover, we studied HBx-binding to HBV episomes. In HBV-positive HepaRG hepatocytes, we observed preferential association of HBV episomes and HBx with actively transcribed nuclear domains on the host genome correlating in size with constrained topological units of chromatin. Interestingly, HBx alone occupied transcribed chromatin domains. Silencing of native HBx caused reduced episomal HBV stability. Conclusions As part of the HBV episome, HBx might stabilize HBV episomal nuclear localization. Our observations may contribute to the understanding of long-term episomal stability and the facilitation of viral persistence. The exact mechanism by which HBx contributes to HBV nuclear persistence warrants further investigations.
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- 2018
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18. The Risk of Nonsteroidal Anti-Inflammatory Drugs in Pediatric Medicine: Listen Carefully to Children with Pain
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Olivier Mboma, Stefan Wirth, and Malik Aydin
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ibuprofen ,nonsteroidal anti-inflammatory drugs ,acute kidney injury ,pediatric ,Pediatrics ,RJ1-570 - Abstract
Over the last decades, the use of over-the-counter analgesics in the general population has increased in Germany. Ibuprofen is one of the most commonly used nonsteroidal anti-inflammatory drug (NSAID) and is frequently prescribed to children as an analgesic and/or antipyretic. Besides having a well-established safety and efficacy profile when used in appropriate doses, cases of NSAID-induced acute kidney injury (AKI) have been described in the pediatric population, particularly in the context of dehydration and in combination with other drugs. The ingestion of more than 400 mg/kg is associated with severe or life-threatening toxicity. This report is about two previously healthy adolescents, who developed AKI after taking high daily dose of ibuprofen as a pain reliever without any appropriate medical supervision. With these case reports, in addition to the side effect profiles of this analgesic, we would also like to present a certain therapeutic recommendation that we applied in these patients, and furthermore appeal to pediatricians to strictly set the indications for ibuprofen intake.
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- 2021
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19. The Communication between Ocular Surface and Nasal Epithelia in 3D Cell Culture Technology for Translational Research: A Narrative Review
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Malik Aydin, Jana Dietrich, Joana Witt, Maximiliane S. C. Finkbeiner, Jonas J.-H. Park, Stefan Wirth, Christine E. Engeland, Friedrich Paulsen, and Anja Ehrhardt
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ocular surface epithelium ,goblet cells ,nasal epithelium ,3D cell culture ,infection ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
There is a lack of knowledge regarding the connection between the ocular and nasal epithelia. This narrative review focuses on conjunctival, corneal, ultrastructural corneal stroma, and nasal epithelia as well as an introduction into their interconnections. We describe in detail the morphology and physiology of the ocular surface, the nasolacrimal ducts, and the nasal cavity. This knowledge provides a basis for functional studies and the development of relevant cell culture models that can be used to investigate the pathogenesis of diseases related to these complex structures. Moreover, we also provide a state-of-the-art overview regarding the development of 3D culture models, which allow for addressing research questions in models resembling the in vivo situation. In particular, we give an overview of the current developments of corneal 3D and organoid models, as well as 3D cell culture models of epithelia with goblet cells (conjunctiva and nasal cavity). The benefits and shortcomings of these cell culture models are discussed. As examples for pathogens related to ocular and nasal epithelia, we discuss infections caused by adenovirus and measles virus. In addition to pathogens, also external triggers such as allergens can cause rhinoconjunctivitis. These diseases exemplify the interconnections between the ocular surface and nasal epithelia in a molecular and clinical context. With a final translational section on optical coherence tomography (OCT), we provide an overview about the applicability of this technique in basic research and clinical ophthalmology. The techniques presented herein will be instrumental in further elucidating the functional interrelations and crosstalk between ocular and nasal epithelia.
- Published
- 2021
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20. Diagnostic Performance of SARS-CoV-2 Rapid Antigen Test in a Large, German Cohort
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Olivier Mboma, Elmar Rieke, Parviz Ahmad-Nejad, Stefan Wirth, and Malik Aydin
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COVID-19 ,SARS-CoV-2 early diagnosis ,rapid antigen detection test ,primary healthcare center ,Pediatrics ,RJ1-570 - Abstract
We assessed the performance of a rapid antigen test (RAT) in everyday clinical practice. Between 1 November 2020 until 1 April 2021 all in-patients at the Helios University Hospital Wuppertal, Germany, as well as the accompanying relatives at the Children’s Hospital received a SARS-CoV-2 RAT and a SARS-CoV-2 RT-PCR prior to admission. Out of 3686 patients, 22 (0.6%) subjects were tested positive by RT-PCR and RAT, and 3591 (97.4%) were negative by both methods, showing discordant results: RT-PCR+/RAT− in 58 (1.6%) and RT-PCR−/RAT+ in 15 patients (0.4%). Overall sensitivity and specificity of RAT was 27.5% (95%CI 18.1–38.6%) and 99.6% (95%CI 99.3–99.8%), respectively. The sensitivity was slightly higher in adults (30.4%, 95%CI 18.8–90.9%) than in pediatric subjects (20.8%, 95%CI 7.1–42.2%). False negative RAT had a statistically higher Ct-value (p < 0.001) compared to true positive values, and overall sensitivity increased to 80% [59.3–93.2%] with Ct value < 30. While the sensitivity of the RAT was poor compared with the RT-PCR, the specificity was excellent. However, the sensitivity increased with lower Ct value, and with the right anamnesis the RAT can be a quick and easy approach to distinguish people who are infectious with SARS-CoV-2 from noninfectious people, enabling appropriate triage in clinical practice while waiting for the RT-PCR result.
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- 2021
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21. Human Species D Adenoviruses Isolated from Diarrheal Feces Show Low Infection Rates in Primary Nasal Epithelial Cells
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Malik Aydin, Sebastian Schellhorn, Stefan Wirth, Wenli Zhang, and Anja Ehrhardt
- Subjects
adenovirus ,virus ,infection ,nasal epithelial cells ,transduction ,CAR ,Pediatrics ,RJ1-570 - Abstract
The importance of adenovirus (Ad) research is significantly increasing with respect to virotherapy for vaccine development, tumor, and gene therapy. Due to the different species and subtypes of this virus, the characterization of the biological significance of especially rare Ad is necessary. Previously, rare Ad types 70, 73, and 74 were originally isolated from fecal samples of immunocompromised patients and they represent recombinants of other Ad types. Here we investigated transduction experiments of these reporter gene tagged Ad types in primary cells exemplified by subject-derived primary nasal epithelial cells (NAEPCs). To analyze the transduction rates, we performed flow cytometry, quantitative polymerase chain reaction (PCR), and cytokine analyses 25 h post-infection. We found that, in contrast to Ad type 5 (as a positive control), the transduction rates of NAEPCs with Ad types 70, 73, and 74 were interestingly low. The major Ad receptor (coxsackievirus-adenovirus receptor and CD46) expression levels showed no significant change after infection with Ad types 70, 73 and 74. Moreover, Interleukin 6 (IL-6) was not released after in vitro Ad transduction. Due to the high risk of developing life-threatening complications in immunocompromised patients by these human species D Ads, even more attention needs to be investigated into the development of diagnostic and therapeutic concepts to prevent and treat those opportunistic infections in susceptible patients.
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- 2021
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22. Speckle Tracking Stress Echocardiography Uncovers Early Subclinical Cardiac Involvement in Pediatric Patients with Inflammatory Bowel Diseases
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Kai O. Hensel, Francisca E. Abellan Schneyder, Lucia Wilke, Andreas Heusch, Stefan Wirth, and Andreas C. Jenke
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Medicine ,Science - Abstract
Abstract Inflammatory bowel disease (IBD) is an established risk factor for cardiovascular disease (CVD). However, whether cardiac consequences present early in IBD is unknown. This is the first study in children aiming to unmask altered myocardial mechanics in IBD. We enrolled 50 consecutive normotensive children with Crohn’s disease (CD) (n = 28) or ulcerative colitis (UC) (n = 22). The study groups consisted of 18 patients with active inflammatory disease (mean age 14.6 ± 2.5 years) and 32 children with IBD in remission (14.3 ± 2.3 years). 60 age- and gender-matched children served as healthy controls. Speckle tracking stress echocardiography (STE) was used to assess left ventricular (LV) myocardial strain and strain rate. Circumferential strain rate was significantly decreased in children with active IBD (−1.55 ± 0.26 s−1) and IBD in remission (−1.49 ± 0.26 s−1) versus healthy controls (1.8 ± 0.4 s−1) both at rest (p
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- 2017
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23. From Submerged Cultures to 3D Cell Culture Models: Evolution of Nasal Epithelial Cells in Asthma Research and Virus Infection
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Malik Aydin, Ella A. Naumova, Aliyah Bellm, Ann-Kathrin Behrendt, Federica Giachero, Nora Bahlmann, Wenli Zhang, Stefan Wirth, Friedrich Paulsen, Wolfgang H. Arnold, and Anja Ehrhardt
- Subjects
epithelial cells ,nasal epithelial cells ,bronchial epithelial cells ,submerged ,3D cell culture ,spheroids ,Microbiology ,QR1-502 - Abstract
Understanding the response to viral infection in the context of respiratory diseases is of significant importance. Recently, there has been more focus on the role of the nasal epithelium in disease modeling. Here, we provide an overview of different submerged, organotypic 3D and spheroid cell culture models of nasal epithelial cells, which were used to study asthma and allergy with a special focus on virus infection. In detail, this review summarizes the importance, benefits, and disadvantages of patient-derived cell culture models of nasal- and bronchial epithelial cells, including a comparison of these cell culture models and a discussion on why investigators should consider using nasal epithelial cells in their research. Exposure experiments, simple virus transduction analyses as well as genetic studies can be performed in these models, which may provide first insights into the complexity of molecular signatures and may open new doors for drug discovery and biomarker research.
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- 2021
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24. House Dust Mite Exposure Causes Increased Susceptibility of Nasal Epithelial Cells to Adenovirus Infection
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Malik Aydin, Ella A. Naumova, Friedrich Paulsen, Wenli Zhang, Felix Gopon, Christian Theis, Sören Lutz, Eric Ehrke-Schulz, Wolfgang H. Arnold, Stefan Wirth, and Anja Ehrhardt
- Subjects
adenovirus ,house dust mite ,CAR ,CD46 ,allergy ,asthma ,Microbiology ,QR1-502 - Abstract
Adenovirus (AdV) infections in the respiratory tract may cause asthma exacerbation and allergic predisposition, and the house dust mite (HDM) may aggravate virus-induced asthma exacerbations. However, the underlying mechanisms of whether and how AdV affects asthmatic patients remains unclear. To address this question, we investigated nasal epithelial cells (NAEPCs) derived from a pediatric exacerbation study cohort for experimental analyses. We analyzed twenty-one different green-fluorescent protein- and luciferase-tagged AdV types in submerged 2D and organotypic 3D cell culture models. Transduction experiments revealed robust transduction of AdV type 5 (AdV5) in NAEPCs, which was associated with an increased uptake of AdV5 in the presence of HDM. In healthy and asthmatic NAEPCs exposed to HDM before infection, we observed a time- and dose-dependent increase of AdV5 uptake associated with upregulation of entry receptors for AdV5. Furthermore, electron microscopic and histologic analyses of 3D cell cultures revealed an impairment of the respiratory cilia after HDM exposition. This ex vivo pilot study shows the impact of AdV infection and HDM exposition in a primary cell culture model for asthma.
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- 2020
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25. CT mapping of the vertebral level of right adrenal vein
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Christoph Degenhart, Hanna Strube, Matthias J. Betz, Anna Pallauf, Martin Bidlingmaier, Evelyn Fischer, Martin Reincke, Maximilian F. Reiser, and Stefan Wirth
- Subjects
Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
PURPOSEWe aimed to evaluate the accuracy of multidetector computed tomography (MDCT) venous mapping for the localization of the right adrenal veins (RAV) in patients suffering from primary aldosteronism.METHODSMDCT scans of 75 patients with primary aldosteronism between March 2008 and November 2011 were evaluated by two readers (a junior [R1] and a senior [R2] radiologist) according to the following criteria: quality of RAV depiction (scale, 1–5), localization of the RAV confluence with regard to the inferior vena cava, and depiction of anatomical variants. Results were compared with RAV venograms obtained during adrenal vein sampling and corroborated by laboratory testing of cortisol in selective RAV blood samples. Kappa statistics were calculated for interobserver agreement and for concordance of MDCT mapping with the gold standard.RESULTSSuccessful RAV sampling was achieved in 69 of 75 patients (92%). Using MDCT mapping, adrenal veins could be visualized in 78% (R1, 54/69) and 77% (R2, 53/69) of patients. MDCT mapping led to correct identification of RAV in 70% (R1, 48/69) and 88% (R2, 61/69) of patients. Venograms revealed five cases of anatomical variants, which were correctly identified in 60% (R1, R2). MDCT-based localizations were false or misleading in 16% (R1, 11/69) and 7% (R2, 5/69) of cases.CONCLUSIONPreinterventional MDCT mapping may facilitate successful catheterization in adrenal vein sampling.
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- 2015
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26. Subclinical Alterations of Cardiac Mechanics Present Early in the Course of Pediatric Type 1 Diabetes Mellitus: A Prospective Blinded Speckle Tracking Stress Echocardiography Study
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Kai O. Hensel, Franziska Grimmer, Markus Roskopf, Andreas C. Jenke, Stefan Wirth, and Andreas Heusch
- Subjects
Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Diabetic cardiomyopathy substantially accounts for mortality in diabetes mellitus. The pathophysiological mechanism underlying diabetes-associated nonischemic heart failure is poorly understood and clinical data on myocardial mechanics in early stages of diabetes are lacking. In this study we utilize speckle tracking echocardiography combined with physical stress testing in order to evaluate whether left ventricular (LV) myocardial performance is altered early in the course of uncomplicated type 1 diabetes mellitus (T1DM). 40 consecutive asymptomatic normotensive children and adolescents with T1DM (mean age 11.5±3.1 years and mean disease duration 4.3±3.5 years) and 44 age- and gender-matched healthy controls were assessed using conventional and quantitative echocardiography (strain and strain rate) during bicycle ergometer stress testing. Strikingly, T1DM patients had increased LV longitudinal (p=0.019) and circumferential (p=0.016) strain rate both at rest and during exercise (p=0.021). This was more pronounced in T1DM patients with a longer disease duration (p=0.038). T1DM patients with serum HbA1c>9% showed impaired longitudinal (p=0.008) and circumferential strain (p=0.005) and a reduced E/A-ratio (p=0.018). In conclusion, asymptomatic T1DM patients have signs of hyperdynamic LV contractility early in the course of the disease. Moreover, poor glycemic control is associated with early subclinical LV systolic and diastolic impairment.
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- 2016
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27. Is loss of fixation following locked plating of proximal humeral fractures related to the number of screws and their positions in the humeral head?
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Mohammad Maddah, Wolf C. Prall, Lucas Geyer, Stefan Wirth, Wolf Mutschler, and Ben Ockert
- Subjects
proximal humeral fracture, angular stable plating, screw cutout, secondary fracture displacement, loss of fixation ,Orthopedic surgery ,RD701-811 - Abstract
The aim of the study was to examine the correlation between the chosen position of screws and the complications observed in patients who underwent locked plating of proximal humeral fractures. We evaluated radiographs of 367 patients treated by locked-plating for proximal humeral fractures. Radiographs were taken at one day, 6 weeks, 3 months and 6 months after surgery, and were analyzed for secondary fracture displacement, loss of fixation, cutting out of screws and necrosis of the humeral head. Secondary loss of fixation occurred in 58 cases (15.8%) and among those cutting out of screws was observed in 25 cases (6.8%). In cases of secondary loss of fixation a mean of 6.7 screws were used to fix the fracture (vs 6.6, P=0.425). There was neither significant correlation between position of screws and the occurrence of postoperative loss of fixation in Spearman correlation nor relationship from backward logistic regression analysis. Loss of fixation following locked plating of proximal humeral fractures does not relate to the number of screws and their positions in the humeral head. In consequence, anatomic fracture reduction and restoration of the humeral head-shaft angle are still important factors and should not be disregarded.
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- 2014
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28. DNA methylation analysis in the intestinal epithelium-effect of cell separation on gene expression and methylation profile.
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Andreas C Jenke, Jan Postberg, Timothy Raine, Komal M Nayak, Malte Molitor, Stefan Wirth, Arthur Kaser, Miles Parkes, Robert B Heuschkel, Valerie Orth, and Matthias Zilbauer
- Subjects
Medicine ,Science - Abstract
Epigenetic signatures are highly cell type specific. Separation of distinct cell populations is therefore desirable for all epigenetic studies. However, to date little information is available on whether separation protocols might influence epigenetic and/or gene expression signatures and hence might be less beneficial. We investigated the influence of two frequently used protocols to isolate intestinal epithelium cells (IECs) from 6 healthy individuals.Epithelial cells were isolated from small bowel (i.e. terminal ileum) biopsies using EDTA/DTT and enzymatic release followed by magnetic bead sorting via EPCAM labeled microbeads. Effects on gene/mRNA expression were analyzed using a real time PCR based expression array. DNA methylation was assessed by pyrosequencing of bisulfite converted DNA and methylated DNA immunoprecipitation (MeDIP).While cell purity was >95% using both cell separation approaches, gene expression analysis revealed significantly higher mRNA levels of several inflammatory genes in EDTA/DTT when compared to enzymatically released cells. In contrast, DNA methylation of selected genes was less variable and only revealed subtle differences. Comparison of DNA methylation of the epithelial cell marker EPCAM in unseparated whole biopsy samples with separated epithelium (i.e. EPCAM positive and negative fraction) demonstrated significant differences in DNA methylation between all three tissue fractions indicating cell type specific methylation patterns can be masked in unseparated tissue samples.Taken together, our data highlight the importance of considering the potential effect of cell separation on gene expression as well as DNA methylation signatures. The decision to separate tissue samples will therefore depend on study design and specific separation protocols.
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- 2013
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29. Expression of human beta-defensins in children with chronic inflammatory bowel disease.
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Matthias Zilbauer, Andreas Jenke, Gundula Wenzel, Jan Postberg, Andreas Heusch, Alan D Phillips, Gabriele Noble-Jamieson, Franco Torrente, Camilla Salvestrini, Robert Heuschkel, and Stefan Wirth
- Subjects
Medicine ,Science - Abstract
BACKGROUND: Human beta-defensins (hBDs) are antimicrobial peptides known to play a major role in intestinal innate host defence. Altered mucosal expression of hBDs has been suggested to be implicated in chronic inflammatory bowel disease pathogenesis. However, little is known about expression of these peptides in children. METHODS: Intestinal biopsies were obtained from the duodenum (n = 88), terminal ileum (n = 90) and ascending colon (n = 105) of children with Crohn's disease (n = 26), ulcerative colitis (n = 11) and healthy controls (n = 16). Quantitative real-time (RT) PCR was performed and absolute mRNA copy numbers analyzed for hBD1-3 as well as inflammatory cytokines IL-8 and TNF-alpha. RESULTS: Significant induction of hBD2 and hBD3 was observed in the inflamed terminal ileum and ascending colon of IBD children. In the ascending colon induction of hBD2 was found to be significantly lower in children with Crohn's disease compared to ulcerative colitis. A strong correlation was found between inducible defensins hBD2 and 3 and the inflammatory cytokines IL-8 and TNF-alpha, both in the terminal ileum and ascending colon. CONCLUSION: Our study demonstrates distinct changes in hBD expression throughout the intestinal tract of children with IBD, lending further support for their potential role in disease pathogenesis.
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- 2010
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30. 12/m mit Bauchschmerzen, weichen Stuhlgängen und Leistungsabfall
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Stefan Wirth, Olivier Mboma, and Matthias Preuße
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Pediatrics, Perinatology and Child Health ,Surgery - Published
- 2022
31. 7/w mit Blähungen, Müdigkeit, Bauchschmerzen und wechselnden Stuhlgängen
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Stefan Wirth, Olivier Mboma, and Matthias Preuße
- Subjects
Pediatrics, Perinatology and Child Health ,Surgery - Published
- 2022
32. Handlungsempfehlung nach der S1-Leitlinie Invagination
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Karen Brückner and Stefan Wirth
- Subjects
Pediatrics, Perinatology and Child Health ,Surgery - Published
- 2022
33. Aufklärung über Organspende in der Hausarztpraxis
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Zoë Fehring, Philip Boehme, Stefan Wirth, Christian Prinz, and Leonard Fehring
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General Medicine - Published
- 2022
34. 14/w mit anhaltenden Oberbauchschmerzen
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Olivier Mboma, Matthias Preuße, and Stefan Wirth
- Subjects
Pediatrics, Perinatology and Child Health ,Surgery - Published
- 2022
35. Schockraumdiagnostik
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Alexander Gäble, Muhammad AlMatter, Marco Armbruster, Maria Berndt, Florian Fischer, Adisa Kuršumovic, Marc Mühlmann, Hubert Kimmig, Bernhard Kumle, Oliver Peschel, Rainer Ritz, Sebastian Russo, Frank Schmid, Guido Wanner, Birgit Zieger, and Stefan Wirth
- Published
- 2023
36. Uncovering the gastrointestinal passage, intestinal epithelial cellular uptake, and AGO2 loading of milk miRNAs in neonates using xenomiRs as tracers
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Patrick Philipp Weil, Susanna Reincke, Christian Alexander Hirsch, Federica Giachero, Malik Aydin, Jonas Scholz, Franziska Jönsson, Claudia Hagedorn, Duc Ninh Nguyen, Thomas Thymann, Anton Pembaur, Valerie Orth, Victoria Wünsche, Ping-Ping Jiang, Stefan Wirth, Andreas C.W. Jenke, Per Torp Sangild, Florian Kreppel, and Jan Postberg
- Subjects
intestinal maturation ,Nutrition and Dietetics ,necrotizing enterocolitis ,fetal human intestinal epithelial cells ,miRNA target ,Medicine (miscellaneous) ,enteral feeding ,preterm delivery ,preterm piglet - Abstract
Background: Human breast milk has a high microRNA (miRNA) content. It remains unknown whether and how milk miRNAs might affect intestinal gene regulation and homeostasis of the developing microbiome after initiating enteral nutrition. However, this requires that relevant milk miRNA amounts survive the gastrointestinal (GI) passage, are taken up by cells, and become available to the RNA interference machinery. It seems important to dissect the fate of these miRNAs after oral ingestion and GI passage. Objectives: Our goal was to analyze the potential transmissibility of milk miRNAs via the gastrointestinal system in neonate humans and a porcine model in vivo to contribute to the discussion of whether milk miRNAs could influence gene regulation in neonates and thus might vertically transmit developmental relevant signals. Methods: We performed cross-species profiling of miRNAs via deep sequencing and utilized dietary xenobiotic taxon-specific milk miRNA (xenomiRs) as tracers in human and porcine neonates, followed by functional studies in primary human fetal intestinal epithelial cells using adenovirus-type 5-mediated miRNA gene transfer. Results: Mammals share many milk miRNAs yet exhibit taxon-specific miRNA fingerprints. We traced bovine-specific miRNAs from formula nutrition in human preterm stool and 9 d after the onset of enteral feeding in intestinal cells (ICs) of preterm piglets. Thereafter, several xenomiRs accumulated in the ICs. Moreover, a few hours after introducing enteral feeding in preterm piglets with supplemented reporter miRNAs (cel-miR-39-5p/-3p), we observed their enrichment in blood serum and in argonaute RISC catalytic component 2 (AGO2)-immunocomplexes from intestinal biopsies. Conclusions: Milk-derived miRNAs survived GI passage in human and porcine neonates. Bovine-specific miRNAs accumulated in ICs of preterm piglets after enteral feeding with bovine colostrum/formula. In piglets, colostrum supplementation with cel-miR-39-5p/-3p resulted in increased blood concentrations of cel-miR-39-3p and argonaute RISC catalytic component 2 (AGO2) loading in ICs. This suggests the possibility of vertical transmission of miRNA signaling from milk through the neonatal digestive tract. Am J Clin Nutr 2023;xx:xx–xx.
- Published
- 2023
37. Erdbebensichere Chemieanlagen
- Author
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Stefan Wirth
- Subjects
General Chemical Engineering ,General Chemistry - Published
- 2022
38. Post-mortem computed tomography is a useful tool for determining the pulmonary ventilation status in newborns
- Author
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Fabian Mück, Stefanie Lochner, Michael J. Schwerer, Jochen M. Grimm, Daniel Maxien, Stefan Wirth, Florian Fischer, and Laura Bechstein
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Radiology ,Post mortem computed tomography ,business ,Pathology and Forensic Medicine - Abstract
Introduction Lung ventilation is a standard sign of life in newborns. Post-mortem computed tomography (PMCT) is highly sensitive to the presence of gas in the body including the lungs. Current standard examinations to determine the pulmonary ventilation status in newborns are the flotation test and histology. The purpose of this study was to compare the accuracy of PMCT with the flotation test for determining the lung ventilation status with histological control as reference standard. A cut-off value as CT number in Hounsfield Units (HU) determining lung ventilation of newborns in PMCT should be established. Methods A total of 38 infant lungs were examined of which 21 lungs were from infants deceased shortly after live birth (control group) and 17 lungs belonged to infants where live birth was in question (study group). All lungs were examined using PMCT, flotation test, and histological examination. Results The control group showed an overall mean attenuation ± standard deviation of −219 HU ± 135; the study group of 45 ± 15 HU in histologically nonventilated lungs versus −192 ± 207 HU; (p Conclusion PMCT is equally well suited to determine lung ventilation as the flotation test. It provides additional information regarding pulmonary infiltration, degree of putrefaction, or signs of trauma (fractures, pneumothorax). Histology remains mandatory in ambiguous cases.
- Published
- 2021
39. Die neue Gesetzgebung zur Organspende – Wirkung, Potenzial und Grenzen aus der Sicht klinisch tätiger Ärzt:innen
- Author
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Philip Boehme, Zoë Fehring, Stefan Wirth, and Leonard Fehring
- Subjects
medicine.medical_specialty ,education.field_of_study ,business.industry ,Urology ,Population ,Legislation ,language.human_language ,German ,Public discussion ,Family medicine ,Donation ,language ,medicine ,Organizational structure ,Organ donation ,business ,education - Abstract
Zusammenfassung Hintergrund Die neuen Gesetze zur Organspende von 2019 und 2020 umfassen Regelungen zur Steigerung der Organspenderate. Dazu zählen Strukturverbesserungen, die Einführung eines Online-Registers zur Dokumentation der Entscheidung zur Organspende und die verbesserte Aufklärung der Bevölkerung. Zur Einschätzung der Maßnahmen durch unmittelbar betroffene klinisch tätige Ärzte ist bislang wenig bekannt. Methode Es wurde eine zweistufige Sequential-mixed-method-Studie durchgeführt. Im Rahmen einer Online-Umfrage nahmen deutschlandweit 1235 Ärzte von über 90 Kliniken teil. Ergebnisse Klinisch tätige Ärzte benennen größtenteils strukturelle Defizite als Ursachen für die niedrige Spenderrate in Deutschland. Weniger als die Hälfte der Ärzte, die mit Organspende in Kontakt kommen, findet sich ausreichend über Organspende ausgebildet. Ärztliche Aufklärungsgespräche haben wesentlichen Einfluss auf die Entscheidungsfindung von Patienten, werden aber kaum geführt. Da Patienten und Angehörige sich zu Lebzeiten zu wenig mit den Themen Tod und Organspende auseinandersetzten, führt die individuelle Entscheidungssituation oft zu Überforderung. Hausärzten kommt eine Schüsselrolle bei der Aufklärung zu. Von der Einführung eines Online-Registers erwarten nur wenige Befragte einen Einfluss auf die Organspenderate. Schlussfolgerung Mit der neuesten Gesetzgebung wurde ein Großteil der von Ärzten benannten strukturellen Defizite aufgegriffen. Eine zusätzliche Steigerung der Organspenderate könnte durch professionalisierte Angehörigenbetreuung erreicht werden. Eine stärkere Thematisierung von Tod und Organspende in der Gesellschaft könnte im individuellen Fall die Entscheidungsfindung von Angehörigen erleichtern.
- Published
- 2021
40. S3-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) zur Prophylaxe, Diagnostik und Therapie der Hepatitis-B-Virusinfektion – (AWMF-Register-Nr. 021-11)
- Author
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Stefan Wirth, Frank Tacke, Pia van Leeuwen, Claus Niederau, Dieter Glebe, Heiner Wedemeyer, P. Lynen-Jansen, Markus Cornberg, Ulrike Protzer, Thomas Berg, Lisa Sandmann, Jörg Petersen, W. Jilg, Christoph Höner zu Siederdissen, and CiiM, Zentrum für individualisierte Infektionsmedizin, Feodor-Lynen-Str.7, 30625 Hannover.
- Subjects
Gynecology ,Hepatitis B virus ,medicine.medical_specialty ,business.industry ,Gastroenterology ,Medicine ,Hepatitis B ,business ,medicine.disease_cause ,medicine.disease - Abstract
[No abstract available]
- Published
- 2021
41. Handlungsempfehlung zu Diagnostik und medikamentöser Behandlung von Kindern und Jugendlichen mit einer SARS-CoV-2-Infektion
- Author
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Stefan Wirth, A. Kirigin, O. Mboma, and M. Preuße
- Subjects
2019-20 coronavirus outbreak ,Action (philosophy) ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pediatrics, Perinatology and Child Health ,Handlungsempfehlungen ,Medicine ,Surgery ,business ,Virology - Published
- 2021
42. Aktuelle Therapie der chronischen Hepatitis C bei Kindern und Jugendlichen
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Dagmar Schreiber-Dietrich, Stefan Wirth, and Christoph F. Dietrich
- Subjects
Gynecology ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Medicine ,030211 gastroenterology & hepatology ,Surgery ,business - Abstract
ZusammenfassungZur Behandlung der chronischen Hepatitis C wurden in den letzten Jahren direkt wirkende antivirale Medikamente (DAA) zugelassen und sind bei Erwachsenen etabliert. Sie machten die interferonbasierten Therapien obsolet. Auch für Kinder und Jugendliche stehen seit Kurzem einige DAA zur Verfügung, die überwiegend ab dem Alter von 3 Jahren eingesetzt werden können.Die chronische Hepatitis C wird bei Kindern überwiegend vertikal übertragen und ist selten. Sie ist zwar zunächst eine wenig aktive und progrediente Erkrankung, kann aber im Erwachsenenalter in eine Leberzirrhose mit der Folge eines hepatozellulären Karzinoms übergehen. Die Diagnose ist mit der Bestimmung des Anti-HCV (IgM/IgG) und der HCV-RNA im Serum mit Genotypisierung leicht zu stellen. Die DAA werden oral appliziert und ausgesprochen gut toleriert. Drei Wirkstoffkombinationen stehen aktuell zur Verfügung, und 2021 wird eine weitere zugelassen. Die Heilungschancen sind mit über 95 % ausgesprochen gut und anhaltend.Im eigenen Krankengut wurden 25 Jungen und Mädchen überwiegend mit Genotyp 1 im Alter von 4 bis 17 Jahren mit DAA behandelt. Unabhängig von der Höhe der HCV-RNA im Serum waren alle bereits nach 4 Wochen HCV-RNA negativ und erzielten einen dauerhaften Erfolg.Die wesentliche Aufgabe ist nun, alle Kinder und Jugendlichen mit einer chronischen Hepatitis C zu identifizieren. Bei der äußerst guten Heilungschance kann davon ausgegangen werden, dass das Eradikationsziel in dieser Altersgruppe in absehbarer Zeit erreicht werden kann.
- Published
- 2021
43. The practice of emergency radiology throughout Europe: a survey from the European Society of Emergency Radiology on volume, staffing, equipment, and scheduling
- Author
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Marc Zins, Douglas S. Katz, Gerd Schueller, Andrea Laghi, Andrea Delli Pizzi, Cem Calli, Vittorio Miele, Koenraad Nieboer, Mariano Scaglione, Francesca Iacobellis, Katarzyna Katulska, Maureen Dumba, Elizabeth Dick, Michael N. Patlas, Lorenzo E. Derchi, Stefan Wirth, Raffaella Basilico, Ferco H. Berger, Ana Blanco Barrio, Roberto Grassi, Richard Hartley, Mario Muto, Ulrich Linsenmaier, Refky Nicola, Medical Imaging, Radiology, and Ege Üniversitesi
- Subjects
medicine.medical_specialty ,education ,Specialty ,Staffing ,Surveys ,Subspecialty ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,medicine ,Medical imaging ,Humans ,Radiology, Nuclear Medicine and imaging ,hospital ,Neuroradiology ,medicine.diagnostic_test ,business.industry ,Major trauma ,Interventional radiology ,General Medicine ,Emergency department ,medicine.disease ,Europe ,Cross-Sectional Studies ,030220 oncology & carcinogenesis ,Workforce ,Diagnostic imaging ,diagnostic imaging ,emergencies ,emergency service ,radiology ,surveys ,Radiology ,Medical emergency ,Emergencies ,Emergency Service, Hospital ,business ,Emergency service - Abstract
OBJECTIVES: To obtain information from radiology departments throughout Europe regarding the practice of emergency radiology METHODS: A survey which comprised of 24 questions was developed and made available online. The questionnaire was sent to 1097 chairs of radiology departments throughout Europe using the ESR database. All data were collected and analyzed using IBM SPSS Statistics software, version 20 (IBM). RESULTS: A total of 1097 radiologists were asked to participate, 109 responded to our survey. The response rate was 10%. From our survey, 71.6% of the hospitals had more than 500 beds. Ninety-eight percent of hospitals have an active teaching affiliation. In large trauma centers, emergency radiology was considered a dedicated section. Fifty-three percent of institutions have dedicated emergency radiology sections. Less than 30% had all imaging modalities available. Seventy-nine percent of institutions have 24/7 coverage by staff radiologists. Emergency radiologists interpret cross-sectional body imaging, US scans, and basic CT/MRI neuroimaging in more than 50% of responding institutions. Cardiac imaging examinations/procedures are usually performed by cardiologist in 53% of institutions, while non-cardiac vascular procedures are largely performed and interpreted by interventional radiologists. Most people consider the European Diploma in Emergency Radiology an essential tool to advance the education and the dissemination of information within the specialty of emergency radiology. CONCLUSION: Emergency radiologists have an active role in the emergency medical team. Indeed, based upon our survey, they have to interact with emergency physicians and surgeons in the management of critically ill patients. A broad skillset from ultrasonography and basic neuroimaging is required. KEY POINTS: • At most major trauma centers in Europe, emergency imaging is currently performed by all radiologists in specific units who are designated in the emergency department. • Radiologists in the emergency section at present have a broad skillset, which includes cross-sectional body imaging, ultrasonography, and basic neuroimaging of the brain and spine. • A dedicated curriculum that certifies a subspecialty in emergency radiology with a diploma offered by the European Society of Emergency Radiology demonstrates a great interest by the vast majority of the respondents.
- Published
- 2020
44. C-arm based computed tomography - A comparative study.
- Author
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Stefan Wirth, Ekkehard Euler, Ulrich Linsenmaier, Clemens Rock, Dorothea Kotsianos, Roland Brandl, Wolf Mutschler, and Klaus Jürgen Pfeifer
- Published
- 2001
45. [GPs education about organ donation: what factors influence the success?]
- Author
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Zoë, Fehring, Philip, Boehme, Stefan, Wirth, Christian, Prinz, and Leonard, Fehring
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Health Knowledge, Attitudes, Practice ,Tissue and Organ Procurement ,General Practitioners ,Germany ,Surveys and Questionnaires ,Humans ,Organ Transplantation ,Tissue Donors - Abstract
According to the new legislation on organ donation in Germany, general practitioners (GPs) should regularly inform and educate their patients about organ donation from March 1, 2022. This is because of the persistently low organ donation rate in Germany. So far, there is a lack of information about the factors influencing the medical education of patients regarding organ donation provided by GPs.GPs were surveyed via a web-based questionnaire in November and December 2021. 215 data sets have been utilized.GPs see themselves in charge for educating people about organ donation (86%). However, most of them invest little time in educating patients. 75% of GPs think that there is no time available for educational talks in the daily routine and 80% perceive difficulties in raising the issue of organ donation due to social taboos. Only 24% of GPs are aware of the new legislation. Only half of the respondents feel sufficiently informed to provide information about organ donation. On average, GPs consider a reimbursement of about 40 euros to be appropriate.GPs have not dealt much with the topic of organ donation and need more comprehensive information for the education of patients. GPs require more time to accommodate education in everyday life. Younger citizens can only be reached by GPs to a limited extent. This group must be addressed by other means.Hintergrund: Laut des Gesetzes zur Stärkung der Entscheidungsbereitschaft bei der Organspende sollen Hausärzte in Deutschland ab 1. März 2022 ihre Patienten regelmäßig zur Organspende informieren und aufklären. Hintergrund sind die anhaltend niedrigen Organspendezahlen in Deutschland. Bislang ist jedoch wenig bekannt, welche Faktoren die Aufklärung durch Hausärzte beeinflussen.Es wurde eine bundesweite Online-Umfrage durchgeführt. Die Datenerhebung erfolgte im November und Dezember 2021. 215 Datensätze konnten ausgewertet werden.Ergebnisse: Hausärzte sehen sich in Verantwortung für die Aufklärung über Organspende (86%). Die meisten investieren bislang jedoch wenig Zeit in die Aufklärung von Patienten. 75% der Hausärzte geben an, im Alltag zu wenig Zeit für Aufklärungsgespräche zu haben und 80% sehen Schwierigkeiten bei der Thematisierung von Organspende durch gesellschaftliche Tabus. Die gesetzlichen Neuregelungen sind nur bei 24% der Hausärzte bekannt. Nur die Hälfte der Befragten hält sich für ausreichend informiert, um über Organspende aufzuklären. Hausärzte halten im Mittel eine Vergütung von knapp 40 Euro pro Aufklärungsgespräch für angemessen.Schlussfolgerungen: Hausärzte setzen sich bislang wenig mit dem Thema Organspende auseinander und benötigen umfassendere Informationen für die Aufklärung von Patienten. Zudem wird mehr Zeit benötigt, um der Aufklärung im Alltag gerecht zu werden. Jüngere Bürger können von Hausärzten jedoch nur eingeschränkt erreicht werden, diese Altersgruppe muss auf anderem Weg adressiert werden.Schlüsselwörter: Organspende, Transplantationsgesetz, Aufklärung, Hausarzt, OrganspendeausweisEingereicht am 17.1.2022 - Revision akzeptiert am 8.2.2022.
- Published
- 2022
46. [Patient education about organ donation - suggestions for the family doctor]
- Author
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Zoë, Fehring, Philipp, Boehme, Stefan, Wirth, Christian, Prinz, and Leonard, Fehring
- Subjects
Health Knowledge, Attitudes, Practice ,Tissue and Organ Procurement ,Patient Education as Topic ,Surveys and Questionnaires ,Humans ,Physicians, Family ,Family ,Tissue Donors - Published
- 2022
47. Are Parents Informed Well Enough About Their Child's Long-term Risks Related to Undescended Testis?
- Author
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Stephan, Degener, Maximilian, Dürbeck, Stephan, Roth, Stefan, Wirth, and Kai O, Hensel
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Male ,Parents ,Orchiopexy ,Cryptorchidism ,Testis ,Humans ,Infant ,Child ,Referral and Consultation - Abstract
Worldwide, recommendations for timely surgical repair of undescended testis (UDT) are not well translated into clinical practice, potentially due to suboptimal patient/parent education. We evaluated the frequency and content of information provided to affected parents of 310 consecutive cases of UDT undergoing orchidopexy. Parents were enquired regarding details of education provided by the attending clinician. 18% of parents were not provided with detailed information regarding any long-term consequences of untreated UDT. In the 79% who were educated, information about impaired fertility was frequent, while malignant degeneration, hypogonadism and testicular atrophy were poorly communicated. 49% of all parents searched for further information on the internet or through a second medical opinion. The frequency and level of detail of information regarding long-term complications provided to parents of children with UDT is suboptimal and needs to be improved.
- Published
- 2022
48. MirZ: an integrated microRNA expression atlas and target prediction resource.
- Author
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Jean Hausser, Philipp Berninger, Christoph Rodak, Yvonne Jantscher, Stefan Wirth, and Mihaela Zavolan
- Published
- 2009
- Full Text
- View/download PDF
49. Efficacy of conservative treatment of perianal abscesses in children and predictors for therapeutic failure
- Author
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Hubert Zirngibl, Johannes Doerner, Lars Boenicke, Mike Ralf Langenbach, and Stefan Wirth
- Subjects
Anal fistula ,perianal abscess ,medicine.medical_specialty ,recurrence ,Multivariate analysis ,conservative treatment ,General Pediatrics ,Pediatrics ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Abscess ,child ,Univariate analysis ,business.industry ,Perianal Abscess ,lcsh:RJ1-570 ,lcsh:Pediatrics ,Odds ratio ,medicine.disease ,Surgery ,Conservative treatment ,anal fistula ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Therapeutic failure ,Original Article ,030211 gastroenterology & hepatology ,business - Abstract
Background: The optimal management of perianal abscess in children is controversial.Purpose: To evaluate the efficiency of conservative treatment of perianal abscess in children and identify parameters that predict therapy failure.Methods: All cases of children younger than 14 years of age with perianal abscesses between 2001–2016 were evaluated.Results: Of the 113 enrolled patients, 64 underwent subsequent surgery for advanced disease (primary surgery group). Conservative treatment was initiated in 49 patients (primary conservative group) but was stopped because of inefficiency in 25 patients, who were referred for surgery after a median 7.03 days (range, 2 to 16 days). The other 24 patients (48%) initially achieved complete remission after conservative treatment, but 10 were readmitted after a median 34 months (range, 3 to 145 months) with recurrent disease. There were no significant differences in permanent success after conservative treatment between infants (10 of 29, 34%) and older children (4 of 20 [20%], P=0.122). Overall, conservative treatment alone was effective in only 14 of 113 patients. Recurrence after surgery occurred in 16 patients (25%) in the primary surgery group and 11 patients (22%) in the primary conservative group (P=0.75). Univariate analysis of predictors for conservative treatment failure revealed inflammatory values (C-reactive protein and white blood count, P=0.017) and abscess size (P=0.001) as significant parameters, whereas multivariate analysis demonstrated that only abscess size (odds ratio, 3.37; P=0.023) was significant.Conclusion: Conservative treatment of perianal abscess is permanently efficient in only a minority of children but is not associated with a higher recurrence rate after subsequent surgery. Abscess size is a predictor for therapy failure.
- Published
- 2020
50. Schockraumdiagnostik
- Author
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Sebastian G. Russo, Stefan Wirth, Muhammad AlMatter, Frank Schmid, Hubert Kimmig, Alexander Gäble, Marc Mühlmann, Bernhard Kumle, Marco Armbruster, Adisa Kuršumovic, Rainer Ritz, Guido Wanner, and Maria Berndt
- Subjects
Care process ,Service (systems architecture) ,business.industry ,medicine.disease ,Resuscitation room ,Polytrauma ,030218 nuclear medicine & medical imaging ,Care facility ,03 medical and health sciences ,0302 clinical medicine ,Ct examination ,030220 oncology & carcinogenesis ,Radiological weapon ,medicine ,Team leader ,Radiology, Nuclear Medicine and imaging ,Medical emergency ,business - Abstract
Clinical problem The indication for resuscitation room care is an acute (potentially) life-threatening patient condition. Typical causes for this are polytrauma, acute neurological symptoms, acute chest and abdominal pain or the cause remains unclear at first. The care is always provided in a suitably composed interdisciplinary team. This requires cause-specific standards tailored to the care facility and requires a mutual understanding of the partners involved with regard to specialist interests and care processes. Standard radiological methods Whole-body CT is established for polytrauma imaging and usually each institution has already defined an institutional standard. For the other causes, first imaging with CT is just as common, but the protocols and procedures to be used are often not as clear as in the case of polytrauma. Methodical innovation and evaluation For polytrauma service, ATLS and procedures according to ABCDE already serve as a largely standardized framework in the resuscitation room. For every other group of causes, comparable concepts should be developed and institutionally strive for objectification of continuous improvement. This refers not only to the resuscitation room stay but also to the interfaces before and after resuscitation room service. Practical recommendations After the patient has arrived, it has to be determined whether the assessment of a vital risk is retained. If so, institutionally defined care standards must be followed for the various causes. This concerns the interface logistics, the definition of a team leader including associated tasks, the supply processes including the CT examination protocols as well as the close communication.
- Published
- 2020
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