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  • 1
    In: Thrombosis and Haemostasis, Georg Thieme Verlag KG, Vol. 119, No. 08 ( 2019-08), p. 1332-1346
    Abstract: Background Inflammation and incomplete thrombus resolution leading to obstructive fibrotic remodelling are considered critical mechanisms for the development of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE). Osteopontin (OPN) is involved in a variety of biological processes including inflammation and tissue fibrosis. Methods OPN plasma concentrations were measured in 70 CTEPH and 119 PE patients. Tissue material from 6 CTEPH patients removed during pulmonary endarterectomy and murine venous thrombi induced by subtotal ligation of the inferior vena cava in C57BL/6 mice were analysed by (immuno)histochemistry. Results CTEPH patients had higher OPN plasma concentrations (median, 106.9 [interquartile range, 75.6–155.9]) compared to PE patients (90.4 [53.3–123.9] ng/mL, p = 0.001). OPN- and matrix metalloproteinase (MMP)-9-positive cells were predominantly present in myofibroblast-rich and profibrotic areas of CTEPH tissue material. Early stages of murine thrombus resolution were characterised by high numbers of OPN- and MMP-2-positive cells while OPN was almost absent in fresh thrombi of CTEPH tissue material. PE patients with OPN plasma concentrations of  〈  55 ng/mL had a 15.2-fold (95% confidence interval, 1.7–135.5, p = 0.015) increased risk for a diagnosis of CTEPH during follow-up. Conclusion The results of the present observational translational study point to a possible involvement of OPN in the pathogenesis of CTEPH by affecting early inflammatory and late fibrotic processes.
    Type of Medium: Online Resource
    ISSN: 0340-6245 , 2567-689X
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2019
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  • 2
    In: Thrombosis and Haemostasis, Georg Thieme Verlag KG, Vol. 92, No. 11 ( 2004), p. 980-985
    Abstract: Ultrasound of 2 MHz frequency and 1.2 W/cm2 acoustic intensity was applied to examine the effect of sonication on recombinant tissue-type plasminogen activator (rt-PA)-induced thrombolysis as well as on the distribution of plasminogen and t-PA within whole blood clots in vitro. Thrombolysis was evaluated quantitatively by measuring clot weight reduction and the level of fibrin degradation product D-dimer (FDP-DD) in the supernatant. Weight reduction in the group of clots treated both with ultrasound and rt-PA was 35.2% ± 6.9% which is significantly higher (p 〈 0.0001) than in the group of clots treated with rt-PA only (19.9% ± 4.3%). FDP-DD level in the supernatants of the group treated with ultrasound and rt-PA increased sevenfold compared to the group treated with rt-PA alone, (14895 ± 2513 ng/ml vs. 2364 ± 725 ng/ml). Localization of fibrinolytic components within the clots was accomplished by using gel-entrapping technique and immunohistochemistry. Spatial distributions of t-PA and plasminogen showed clearly that ultrasound promoted the penetration of rt-PA into thrombi significantly (p 〈 0.0001), and broadened the zone of lysis from 8.9 ± 2.6 µm to 21.2 ± 7.2 µm. We speculate that ultrasound enhances thrombolysis by affecting the distribution of rt-PA within the clot.
    Type of Medium: Online Resource
    ISSN: 0340-6245 , 2567-689X
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2004
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  • 3
    Online Resource
    Online Resource
    Georg Thieme Verlag KG ; 2018
    In:  Handchirurgie · Mikrochirurgie · Plastische Chirurgie Vol. 50, No. 03 ( 2018-06), p. 184-189
    In: Handchirurgie · Mikrochirurgie · Plastische Chirurgie, Georg Thieme Verlag KG, Vol. 50, No. 03 ( 2018-06), p. 184-189
    Abstract: Hintergrund: Mixed Martial Arts (MMA) ist eine Kombination verschiedener Kampfsportarten. Akute Verletzungen sind bekannt und in der Literatur allgemein beschrieben. Nichtsdestotrotz gibt es kaum Erkenntnisse über degenerative Veränderungen am muskuloskelettalen System. Das Ziel dieser Studie war die Bestimmung des Einflusses von beim MMA genutzten Techniken auf das Auftreten degenerativer Veränderungen im Vergleich zum klassischen Boxen. Methoden: Hierzu wurden 11 MMA-Kämpfer und 10 Boxer mit chronischen Handgelenkschmerzen klinisch untersucht. Alter, Gewicht, Erfahrung, Anzahl der Kämpfe und wöchentliche Trainingsstunden wurden erfragt. Um die degenerativen Veränderungen zu bestimmen, wurde ein MRT der schmerzhaften Hand ausgewertet. Ergebnisse: Erfahrung, Niveau des Wettbewerbs und Anzahl der Kämpfe waren nicht signifikant unterschiedlich in beiden Sportgruppen (p  〈  0,05), jedoch trainierten die MMA-Kämpfer signifikant mehr Stunden pro Woche (19,5 vs. 8,5 h/w; p  〈  0,001). Allerdings hatten die MMA-Kämpfer öfter und schwerwiegendere degenerative Veränderungen an allen untersuchten Strukturen (Knochen, Faserknorpel, Bänder und Sehnen). In der Kategorie „Knochen“ waren die Unterschiede signifikant (p = 0,002). Schlussfolgerung: MMA-Kämpfer zeigen eine höhere Inzidenz und einen höheren Grad an degenerativen Veränderungen an Hand und Handgelenk. Genaue Erklärungen sind noch nicht bekannt. Weitere Forschung wird benötigt, um den Einfluss der Techniken auf die Schwere der degenerativen Veränderungen an Hand und Handgelenk zu bestimmen.
    Type of Medium: Online Resource
    ISSN: 0722-1819 , 1439-3980
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2018
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  • 4
    In: The Thoracic and Cardiovascular Surgeon, Georg Thieme Verlag KG
    Abstract: Background Balloon pulmonary angioplasty (BPA) is a promising interventional treatment for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Evidence in favor of BPA is growing, but long-term data remain scarce. The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) is validated for the assessment of patients with pulmonary hypertension within three domains: symptoms, activity, and quality of life (QoL). The aim of the present study was to evaluate the long-term effects of BPA on these domains in patients with inoperable CTEPH. Methods Between March 2014 and August 2019, technically inoperable patients with target lesions for BPA were included in this prospective, observational study. CAMPHOR scores were compared between baseline (before the first BPA) and 6 months after the last intervention and also for scores assessed at annual follow-ups. Results A total of 152 patients had completed a full series of BPA interventions and a 28 (interquartile range [IQR]: 26–32) week follow-up. Further follow-up assessments including the CAMPHOR score were performed 96 (IQR: 70–117) weeks, 178 (IQR: 156–200) weeks, and 250 (IQR: 237–275) weeks after the last intervention. From baseline to the last follow-up, CAMPHOR scores for symptoms, activity, and QoL improved from 9 (IQR: 6–14) to 3 (IQR: 0–9) (p  〈  0.001), 8 (IQR: 5–12) to 4 (IQR: 2–8) (p  〈  0.001), and 5 (IQR: 2–9) to 1 (IQR: 0–5) (p  〈  0.001). Conclusion BPA leads to long-lasting, significant improvement of symptoms, physical capacity, and QoL in inoperable CTEPH patients.
    Type of Medium: Online Resource
    ISSN: 0171-6425 , 1439-1902
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
    detail.hit.zdb_id: 2056554-9
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  • 5
    In: The Thoracic and Cardiovascular Surgeon, Georg Thieme Verlag KG, Vol. 70, No. 08 ( 2022-12), p. 663-670
    Abstract: Background The gold standard treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). Little is known about the influence of advanced age on surgical outcome. Therefore, the aim of this study was to investigate the impact of patient's age on postoperative morbidity, mortality, and quality of life in a German referral center. Methods Prospectively collected data from 386 consecutive patients undergoing PEA between 01/2014 and 12/2016 were analyzed. Patients were divided into three groups according to their age: group 1: ≤ 50 years, group 2:  〉  50 ≤ 70 years, group 3:  〉  70 years. Results After PEA, distinct improvements in pulmonary hemodynamics, physical capacity (World Health Organization [WHO] functional class and 6-minute walking distance) and quality of life were found in all groups. There were more complications in elderly patients with longer time of invasive ventilation, intensive care, and in-hospital stay. However, the in-hospital mortality was comparable (0% in group 1, 2.6% in group 2, and 2.1% in group 3 [p = 0.326] ). Furthermore, the all-cause mortality at 1 year was 1.1% in group 1, 3.2% in group 2, and 6.3% in group 3 (p = 0.122). Conclusions PEA is an effective treatment for CTEPH patients of all ages accompanied by low perioperative and 1-year mortality. CTEPH patients in advanced age carefully selected by thorough preoperative evaluation should be offered PEA in expert centers to improve quality of life, symptoms, and pulmonary hemodynamics.
    Type of Medium: Online Resource
    ISSN: 0171-6425 , 1439-1902
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2022
    detail.hit.zdb_id: 2056554-9
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  • 6
    In: Thrombosis and Haemostasis, Georg Thieme Verlag KG, Vol. 117, No. 04 ( 2017), p. 769-783
    Abstract: The pathomechanisms underlying the development of thrombofibrotic pulmonary artery occlusions in Chronic Thromboembolic Pulmonary Hypertension (CTEPH) are largely unknown. The aim of this study was to allocate distinct cellular processes playing a role in thrombus resolution, such as inflammation, hypoxia, proliferation, apoptosis and angiogenesis, to different stages of thrombofibrotic remodelling. A total of 182 pulmonary endarterectomy (PEA) specimens were collected from 31 CTEPH patients. To facilitate co-localisation, Tissue MicroArrays were prepared and processed for (immuno)-histochemistry and confocal fluorescence microscopy. Murine venous thrombus formation and resolution was examined after inferior vena cava ligation. PEA tissues exhibited five morphologically distinct regions predominantly consisting of either fibrin-, erythrocyte- or extracellular matrix-rich thrombus, myofibroblasts, vessels or fibrotic tissue, and were found to resemble chronological stages of thrombus resolution in mice. Cellularity was highest in vessel-rich regions, and numerous cells were strongly positive for HIF1α or HIF2α as well as markers of activated VEGF signalling, including endothelial nitric oxide synthase. On the other hand, negative regulators of angiogenic growth factor signalling and reactive oxygen species were also highly expressed. Immune cells, primarily macrophages of the M2 subtype and CD117 haematopoietic progenitors were detected and highest in vascularised regions. Our findings demonstrate the simultaneous presence of different stages of thrombus organisation and suggest that hypoxia-induced endothelial, mesenchymal and immune cell activation may contribute to thrombofibrosis in CTEPH. This systematic histological characterisation of the material obstructing pulmonary vessels in CTEPH may provide a valuable basis for further studies aimed at determining causal factors underlying this disease. Supplementary Material to this article is available online at www.thrombosis-online.com.
    Type of Medium: Online Resource
    ISSN: 0340-6245 , 2567-689X
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2017
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  • 7
    In: Aktuelle Neurologie, Georg Thieme Verlag KG, Vol. 45, No. 07 ( 2018-09), p. 513-533
    Abstract: Epilepsien zählen zu den häufigsten neurologischen Erkrankungen mit etwa 600 000 Betroffenen in Deutschland. Symptome epileptischer Anfälle, die Vielzahl möglicher Epilepsieursachen und die unterschiedlichen Krankheitsverläufe erschweren sowohl die korrekte Diagnosestellung als auch die Auswahl einer geeigneten Therapie (Antikonvulsiva, epilepsiechirurgische Eingriffe, Neurostimulationsverfahren, ketogene Ernährungstherapien, Verhaltensstrategien u. a.). Zudem haben krankheitsspezifische Risiken sowie häufig auftretende Komorbiditäten nicht selten gravierende psychosoziale Konsequenzen. Daher wird bei der Versorgung von Menschen mit Epilepsie neben der vollständigen Anfallskontrolle ohne Nebenwirkungen und der Lebensqualität auch die Kontrolle bzw. Linderung typischer Begleiterkrankungen und Risiken angestrebt. Um diese Behandlungsziele zu erreichen, sind spezifische Fachkenntnisse und Untersuchungsmöglichkeiten erforderlich, die von spezialisierten Zentren vorgehalten werden. Epilepsiezentren sind als überregionale Kompetenzzentren definiert, die über spezielle Expertise und eine besondere Ausstattung zur ambulanten und stationären Versorgung von Patienten mit Epilepsien und verwandten Erkrankungen verfügen. Zu ihren Aufgaben zählen u. a. die umfassende Diagnostik, Differenzialdiagnostik und Therapie von Epilepsiepatienten sowie die multiprofessionelle und interdisziplinäre Beratung von Angehörigen und Eltern. Dieser Artikel fasst die diagnostischen und therapeutischen Herausforderungen bei der Versorgung von Menschen mit Epilepsien zusammen, beschreibt die personellen, apparativen und institutionellen Voraussetzungen von Epilepsiezentren und gibt eine Übersicht über die Vergütung epileptologischer Spezialleistungen nach G-DRG. Darüber hinaus werden Merkmale einzelner Epilepsiezentren in Deutschland skizziert sowie Perspektiven und Möglichkeiten zur Verbesserung der Versorgung von Epilepsiepatienten diskutiert.
    Type of Medium: Online Resource
    ISSN: 0302-4350 , 1438-9428
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2018
    detail.hit.zdb_id: 2056721-2
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  • 8
    In: Klinische Monatsblätter für Augenheilkunde, Georg Thieme Verlag KG, Vol. 238, No. 05 ( 2021-05), p. 550-553
    Type of Medium: Online Resource
    ISSN: 0023-2165 , 1439-3999
    RVK:
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2021
    detail.hit.zdb_id: 2039754-9
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  • 9
    Online Resource
    Online Resource
    Georg Thieme Verlag KG ; 2007
    In:  Synthesis Vol. 2007, No. 23 ( 2007-12), p. 3620-3626
    In: Synthesis, Georg Thieme Verlag KG, Vol. 2007, No. 23 ( 2007-12), p. 3620-3626
    Type of Medium: Online Resource
    ISSN: 0039-7881 , 1437-210X
    RVK:
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2007
    detail.hit.zdb_id: 204080-3
    detail.hit.zdb_id: 2033062-5
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  • 10
    In: Sportverletzung · Sportschaden, Georg Thieme Verlag KG, Vol. 34, No. 02 ( 2020-06), p. 72-78
    Abstract: Background Cold-water immersion (CWI) has become a popular preventive, regenerative and performance-enhancing intervention in various sports. However, its effects on soft tissue, including changes of intramuscular stiffness, are poorly understood. The purpose of this study was to investigate the effect of CWI on muscle stiffness. Patients/Material and Methods Thirty healthy participants were included and divided into the three following groups (n = 10): 1) post-ESU group: exercise and CWI (post-exercise set-up); 2) control group: exercise without CWI (control condition); 3) pre-ESU group: CWI alone (pre-exercise set-up). Acoustic radiation force impulse (ARFI) elastography was conducted to assess tissue stiffness (shear wave velocity, SWV). Values obtained at resting conditions (baseline, t0) were compared to values post-exercise (t1, for post-ESU group and control group), post-CWI (t2, for post-ESU group and pre-ESU group; rest for control group) and to 60-min follow-up time (t3, for all groups). Data were assessed in superficial and deep muscle tissue (rectus femoris muscle, RF; vastus intermedius muscle, VI). Results For the post-ESU group (CWI post-exercise), there was no significant difference between the time points of measurements: exercise (t1: RF: 1.63 m/s; VI: 1.54 m/s), CWI (t2: RF: 1.63 m/s; VI: 1.53 m/s) and at 60-min follow-up (t3: RF: 1.72 m/s; VI: 1.61 m/s). In the control group, a significant decrease of SWV was found between baseline conditions at t0 and post-exercise (t1) at VI (VI: 1.37 m/s; p = 0.004; RF: 1.59 m/s; p = 0.084). For t2 and t3, no further significant changes were detected. Regarding the pre-exercise set-up (pre-ESU group), a significant decrease in SWV from baseline to t2 in VI (1.60 m/s to 1.49 m/s; VI: p = 0.027) was found. Conclusion This study shows varying influences of CWI on muscle stiffness. Overall, we did not detect any significant effects of CWI on muscle stiffness post-exercise. Muscle stiffness-related effects of CWI differ in the context of a pre- or post-exercise condition and have to be considered in the implementation of CWI to ensure its potential preventive and regenerative benefits.
    Type of Medium: Online Resource
    ISSN: 0932-0555 , 1439-1236
    RVK:
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
    detail.hit.zdb_id: 639120-5
    detail.hit.zdb_id: 2041799-8
    SSG: 31
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