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  • 1
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2020
    In:  Journal of Neurology Vol. 267, No. 4 ( 2020-04), p. 1004-1011
    In: Journal of Neurology, Springer Science and Business Media LLC, Vol. 267, No. 4 ( 2020-04), p. 1004-1011
    Abstract: To investigate the frequency and characterize the clinical features of treatment-refractory myasthenia gravis in an Austrian cohort. Methods Patient charts of 126 patients with generalized myasthenia gravis and onset between 2000 and 2016 were analyzed retrospectively. Patients were classified as treatment-refractory according to strict, predefined criteria. These mandated patients being at least moderately symptomatic (i.e., MGFA class III) or needing either maintenance immunoglobulins or plasma exchange therapy for at least 1 year in spite of two adequately dosed immunosuppressive drugs. Clinical features and outcome at last follow-up were compared to treatment-responsive patients. Results 14 out of 126 patients (11.1%) met these criteria of treatment-refractory myasthenia gravis. Treatment-refractory patients had more frequent clinical exacerbations and more often received rescue treatments or a further escalation of immunosuppressive therapies. They also remained more severely affected at last follow-up. An early onset of myasthenia gravis was associated with a higher risk for a refractory course. Conclusion A small subgroup of patients with generalized myasthenia gravis do not respond sufficiently to standard therapies. Refractory disease has considerable implications for both patients and health care providers and highlights an unmet need for new treatment options.
    Type of Medium: Online Resource
    ISSN: 0340-5354 , 1432-1459
    RVK:
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 1421299-7
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  • 2
    Online Resource
    Online Resource
    SAGE Publications ; 2011
    In:  Neurorehabilitation and Neural Repair Vol. 25, No. 6 ( 2011-07), p. 577-579
    In: Neurorehabilitation and Neural Repair, SAGE Publications, Vol. 25, No. 6 ( 2011-07), p. 577-579
    Abstract: Final outcome after surgical repair of peripheral nerve transections varies. Here, we present the first longitudinal functional magnetic resonance imaging (fMRI) obserof cortical somatosensory reorganization patterns after surgery. A 43-year-old man presented with isolated complete transecof the right median nerve and underwent immediate epineural end-to-end coaptation. Applying standardized vibrotactile median nerve stimulation, 3 T brain activation maps were evaluated at 1, 7, 15 weeks and 1 year after surgery. Initially, the affected hemisphere showed no primary activation but increased frontoparietal activity. After 1 year, primary activation had recovered, and frontoparietal activity was decreased relative to the nonaffected hemisphere. Based on these longitudinal fMRI patterns, we propose a new marker for restoration of somatosensory function, which may not be provided by electrophysiological methods.
    Type of Medium: Online Resource
    ISSN: 1545-9683 , 1552-6844
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2011
    detail.hit.zdb_id: 2100545-X
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  • 3
    Online Resource
    Online Resource
    American Medical Association (AMA) ; 2008
    In:  Archives of Neurology Vol. 65, No. 12 ( 2008-12-01)
    In: Archives of Neurology, American Medical Association (AMA), Vol. 65, No. 12 ( 2008-12-01)
    Type of Medium: Online Resource
    ISSN: 0003-9942
    RVK:
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2008
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  • 4
    In: Arteriosclerosis, Thrombosis, and Vascular Biology, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 3 ( 2015-03), p. 547-557
    Abstract: Atherosclerosis, an inflammatory disease of arterial vessel walls, requires migration and matrix metalloproteinase (MMP)-9–dependent invasion of monocytes/macrophages into the vascular wall. MMP-9 expression is stimulated by transcription factor nuclear factor-κB, which is regulated by inhibitor κB (IκB) and thus IκB kinase. Regulators of nuclear factor-κB include serum- and glucocorticoid-inducible kinase 1 (SGK1). The present study explored involvement of SGK1 in vascular inflammation and atherogenesis. Approach and Results— Gene-targeted apolipoprotein E (ApoE)–deficient mice without ( apoe −/− sgk1 +/+ ) or with ( apoe −/− sgk1 −/− ) additional SGK1 knockout received 16-week cholesterol-rich diet. According to immunohistochemistry atherosclerotic lesions in aorta and carotid artery, vascular CD45 + leukocyte infiltration, Mac-3 + macrophage infiltration, vascular smooth muscle cell content, MMP-2, and MMP-9 positive areas in atherosclerotic tissue were significantly less in apoe −/− sgk1 −/− mice than in apoe −/− sgk1 +/+ mice. As determined by Boyden chamber, thioglycollate-induced peritonitis and air pouch model, migration of SGK1-deficient CD11b + F4/80 + macrophages was significantly diminished in vitro and in vivo. Zymographic MMP-2 and MMP-9 production, MMP-9 activity and invasion through matrigel in vitro were significantly less in sgk1 −/− than in sgk1 +/+ macrophages and in control plasmid–transfected or inactive K127N SGK1-transfected than in constitutively active S422D SGK1-transfected THP-1 cells. Confocal microscopy revealed reduced macrophage number and macrophage MMP-9 content in plaques of apoe −/− sgk1 −/− mice. In THP-1 cells, MMP-inhibitor GM6001 (25 μmol/L) abrogated S422D SGK1-induced MMP-9 production and invasion. According to reverse transcription polymerase chain reaction, MMP-9 transcript levels were significantly reduced in sgk1 −/− macrophages and strongly upregulated in S422D SGK1-transfected THP-1 cells compared with control plasmid–transfected or K127N SGK1-transfected THP-1 cells. According to immunoblotting and confocal microscopy, phosphorylation of IκB kinase and inhibitor κB and nuclear translocation of p50 were significantly lower in sgk1 −/− macrophages than in sgk1 +/+ macrophages and significantly higher in S422D SGK1-transfected THP-1 cells than in control plasmid–transfected or K127N SGK1-transfected THP-1 cells. Treatment of S422D SGK1-transfected THP-1 cells with IκB kinase-inhibitor BMS-345541 (10 μmol/L) abolished S422D SGK1-induced increase of MMP-9 transcription and gelatinase activity. Conclusions— SGK1 plays a pivotal role in vascular inflammation during atherogenesis. SGK1 participates in the regulation of monocyte/macrophage migration and MMP-9 transcription via regulation of nuclear factor-κB.
    Type of Medium: Online Resource
    ISSN: 1079-5642 , 1524-4636
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1494427-3
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  • 5
    Online Resource
    Online Resource
    Georg Thieme Verlag KG ; 2019
    In:  Handchirurgie · Mikrochirurgie · Plastische Chirurgie Vol. 51, No. 02 ( 2019-04), p. 94-101
    In: Handchirurgie · Mikrochirurgie · Plastische Chirurgie, Georg Thieme Verlag KG, Vol. 51, No. 02 ( 2019-04), p. 94-101
    Abstract: Einleitung Das thermische Trauma im Kindes- und Jugendalter ist weiterhin von hoher sozioökonomischer Relevanz, da es seit Jahren zu keiner Reduktion der jährlich stationär behandelten Patienten/innen gekommen ist. Die Therapie des pädiatrischen Verbrennungspatienten stellt besondere Anforderungen an das medizinische Personal, die verwendeten Verbandsmaterialien und die angewandten Operationstechniken. Ziel dieser Studie war es einen aktuellen Überblick über das stationäre Management und die Therapie des thermischen Traumas bei pädiatrischen Patienten/innen an einer spezialisierten Klinik zu geben. Patienten/Material und Methode Kinder und Jugendliche, die zwischen 2012 und 2016 an der Kinderstation der chirurgischen Fächer der Medizinischen Universität Wien von der klinischen Abteilung für Plastische und Rekonstruktive Chirurgie bei thermischen Trauma behandelt wurden, wurden identifiziert und ihr Therapieverlauf retrospektiv analysiert. Ergebnisse 115 Patienten/innen wurden auf Grund eines akuten thermischen Traumas stationär behandelt. Das mediane Alter lag bei 2 Jahren (0–18). Die Verbrühung stellte mit 74 % den häufigsten Verletzungsmechanismus dar. Im Median zeigten sich 5 % (1–40) der Körperoberfläche betroffen. Konservatives Wundmanagement bei 2a°igem Trauma (62 %) wurde in 98 % mit MepilexAg durchgeführt und dauerte im Median 11 Tage (4–34) bis zur Abheilung. In 38 % (n = 44) lag eine 2b°ige oder 3°ige Verbrennung vor. Die Verwendung von Suprathel nach tangentialer Nekrosektomie bzw. Bürstendebridement bei oberflächlichen 2b°igen Verletzungen zeigte zufriedenstellende Heilungsverläufe. Schlussfolgerung Durch den Einsatzvon modernen Wundverbänden in der konservativen Therapie 2a°iger Wunden kann eine schnelle und unkomplizierte Abheilung mit atraumatischen Verbandswechseln erfolgen. Bei oberflächlichen 2b°igen Wunden bietet Suprathel eine gute Alternative zur klassischen Hauttransplantation, welche jedoch bei tieferen 2b°igen Verbrennungen immer noch als Therapiestandard gelten sollte. Narbenprophylaxe und regelmäßige Nachkontrollen sind wichtig um sekundäre Funktionseinschränkungen durch Narbenstränge zu vermeiden. Um zukünftig die Inzidenz des thermischen Traumas im Kindesalter zu senken ist die prophylaktische Aufklärung und Sensibilisierung der Eltern von großer Wichtigkeit.
    Type of Medium: Online Resource
    ISSN: 0722-1819 , 1439-3980
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2019
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  • 6
    In: European Journal of Neurology, Wiley, Vol. 29, No. 6 ( 2022-06), p. 1815-1824
    Abstract: Hereditary myopathies with limb‐girdle muscular weakness (LGW) are a genetically heterogeneous group of disorders, in which molecular diagnosis remains challenging. Our aim was to present a detailed clinical and genetic characterization of a large cohort of patients with LGW. Methods This nationwide cohort study included patients with LGW suspected to be associated with hereditary myopathies. Parameters associated with specific genetic aetiologies were evaluated, and we further assessed how they predicted the detection of causative variants by conducting genetic analyses. Results Molecular diagnoses were identified in 62.0% (75/121) of the cohort, with a higher proportion of patients diagnosed by next‐generation sequencing (NGS) than by single‐gene testing (77.3% vs. 22.7% of solved cases). The median (interquartile range) time from onset to genetic diagnosis was 8.9 (3.7–19.9) and 17.8 (7.9–27.8) years for single‐gene testing and NGS, respectively. The most common diagnoses were myopathies associated with variants in CAPN3 ( n  = 9), FKRP ( n  = 9), ANO5 ( n  = 8), DYSF ( n  = 8) and SGCA ( n  = 5), which together accounted for 32.2% of the cohort. Younger age at disease onset ( p  = 0.043), 〉 10× elevated creatine kinase activity levels ( p  = 0.024) and myopathic electromyography findings ( p  = 0.007) were significantly associated with the detection of causative variants. Conclusions Our findings suggest that an earlier use of NGS in patients with LGW is needed to avoid long diagnostic delays. We further present parameters predictive of a molecular diagnosis that may help to select patients for genetic analyses, especially in centres with limited access to sequencing.
    Type of Medium: Online Resource
    ISSN: 1351-5101 , 1468-1331
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2020241-6
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  • 7
    In: European Journal of Neurology, Wiley, Vol. 29, No. 8 ( 2022-08), p. 2453-2462
    Abstract: This study was undertaken to investigate short‐ and long‐term outcome following thymectomy in patients with acetylcholine receptor antibody (AChR‐Ab)‐positive myasthenia gravis (MG). Methods Rates of clinical response (defined as minimal manifestation, pharmacological remission, or complete stable remission) lasting for at least 1 year were retrospectively analyzed using Cox proportional hazard models. The occurrence of relapses was recorded during follow‐up. Clinical factors associated with achieving an initial or a sustained response were analyzed. Results Ninety‐four patients with a median age of 33 years (interquartile range [IQR] = 22–51), 68% with nonthymomatous MG and 32% with thymoma‐associated MG, were included. An initial clinical response was reached in 72% (68/94). Neither sex, age at onset, thymus histology, delay to surgery after disease onset, surgical approach, corticosteroid treatment, nor clinical severity before thymectomy was significantly associated with achieving this endpoint. During long‐term follow‐up (median = 89.5 months, IQR = 46–189.5), only half of the patients with an initial response (34/68) had a sustained response without relapses. No clinical factors predicted whether the response would become sustained. In patients without immunosuppressive treatment before thymectomy ( n  = 24), a high AChR‐Ab reduction rate after thymectomy was associated with a higher likelihood of achieving an initial response ( p  = 0.03). Conclusions Sustained long‐term clinical response of MG patients after thymectomy is significantly lower than the initial response rates would suggest. The observation that none of the evaluated clinical factors was associated with a worse outcome supports the current clinical practice of patient selection for thymectomy. The relative decline of AChR‐Abs after surgery appears to be a promising prognostic marker.
    Type of Medium: Online Resource
    ISSN: 1351-5101 , 1468-1331
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2020241-6
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  • 8
    In: Parkinsonism & Related Disorders, Elsevier BV, Vol. 21, No. 3 ( 2015-03), p. 259-265
    Type of Medium: Online Resource
    ISSN: 1353-8020
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2015
    detail.hit.zdb_id: 2027635-7
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  • 9
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2023-02-20)
    Abstract: Repetitive nerve stimulation (RNS) is a standard test for the diagnosis of myasthenia gravis (MG), where decrement of compound muscle action potentials (CMAP) corresponds to clinical muscle fatigability. Our aim was to ascertain the diagnostic and prognostic utility of RNS in MG patients. This study included MG patients treated between 01/2000 and 12/2016, with an observational period of at least one year and a minimum of two neurological examinations. Clinical and electrophysiological data were retrospectively gathered from patient records, and CMAP decrement was correlated with autoantibody titers and clinical disease severity at different time points. Ninety-four patients were included, with 88.3% of the cohort testing positive for acetylcholine receptor autoantibodies (AChR-Abs). RNS sensitivity was higher in patients with generalized disease (71.6%) than in purely ocular MG (38.5%). CMAP decrement did not significantly correlate with AChR-Ab titers, nor with clinical symptom severity at the time of testing or last follow up. However, there was a significant correlation between CMAP decrement and the worst recorded clinical status on a group level. RNS testing is more sensitive in generalized disease and AChR-Ab positive patients, but our data do not support RNS as a tool for long-term outcome prediction. Future studies with a prospective study design could help to overcome a number of limiting factors discussed in our study.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2615211-3
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  • 10
    In: Frontiers in Molecular Neuroscience, Frontiers Media SA, Vol. 13 ( 2020-8-14)
    Type of Medium: Online Resource
    ISSN: 1662-5099
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2020
    detail.hit.zdb_id: 2452967-9
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