@article{SchusterJohannsenRoewer2013, author = {Schuster, Frank and Johannsen, Stephan and Roewer, Norbert}, title = {A Minimal-Invasive Metabolic Test Detects Malignant Hyperthermia Susceptibility in a Patient after Sevoflurane-Induced Metabolic Crisis}, series = {Case Reports in Anesthesiology}, journal = {Case Reports in Anesthesiology}, doi = {10.1155/2013/953859}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-97080}, year = {2013}, abstract = {Malignant hyperthermia is a rare but life-threatening complication of general anesthesia in predisposed patients usually triggered by potent inhalation anesthetics and/or the depolarizing muscle relaxant succinylcholine. The authors present a case of delayed sevoflurane-induced malignant hyperthermia in a 21-year-old male patient that was sufficiently treated by discontinuation of trigger agent application and dantrolene infusion. After surviving an MH episode diagnostic procedures are indicated to increase patient safety. In the presented case, the use of a novel minimal-invasive metabolic test with intramuscular injection of halothane and caffeine successfully confirmed MH susceptibility and hence might be an alternative for invasive in vitro contracture testing in selected cases.}, language = {en} } @article{SchusterJohannsenSchneiderbangeretal.2013, author = {Schuster, Frank and Johannsen, Stephan and Schneiderbanger, Daniel and Roewer, Norbert}, title = {Evaluation of suspected malignant hyperthermia events during anesthesia}, series = {BMC Anesthesiology}, journal = {BMC Anesthesiology}, doi = {10.1186/1471-2253-13-24}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-96231}, year = {2013}, abstract = {Background Malignant hyperthermia (MH), a metabolic myopathy triggered by volatile anesthetics and depolarizing muscle relaxants, is a potentially lethal complication of general anesthesia in susceptible patients. The implementation of modern inhalation anesthetics that research indicates as less potent trigger substances and the recommended limitations of succinylcholine use, suggests there may be considerable decline of fulminant MH cases. In the presented study, the authors analyzed suspected MH episodes during general anesthesia of patients that were referred to the Wuerzburg MH unit between 2007 and 2011, assuming that MH is still a relevant anesthetic problem in our days. Methods With approval of the local ethics committee data of patients that underwent muscle biopsy and in vitro contracture test (IVCT) between 2007 and 2011 were analyzed. Only patients with a history of suspected MH crisis were included in the study. The incidents were evaluated retrospectively using anesthetic documentation and medical records. Results Between 2007 and 2011 a total of 124 patients were tested. 19 of them were referred because of suspected MH events; 7 patients were diagnosed MH-susceptible, 4 MH-equivocal and 8 MH-non-susceptible by IVCT. In a majority of cases masseter spasm after succinylcholine had been the primary symptom. Cardiac arrhythmias and hypercapnia frequently occurred early in the course of events. Interestingly, dantrolene treatment was initiated in a few cases only. Conclusions MH is still an important anesthetic complication. Every anesthetist must be aware of this life-threatening syndrome at any time. The rapid onset of adequate therapy is crucial to avoid major harm and possibly lethal outcome. Dantrolene must be readily available wherever MH triggering agents are used for anesthesia.}, language = {en} } @article{SalvadorShityakovFoerster2013, author = {Salvador, Ellaine and Shityakov, Sergey and F{\"o}rster, Carola}, title = {Glucocorticoids and endothelial cell barrier function}, series = {Cell and Tissue Research}, volume = {355}, journal = {Cell and Tissue Research}, number = {3}, doi = {10.1007/s00441-013-1762-z}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-132091}, pages = {597-605}, year = {2013}, abstract = {Glucocorticoids (GCs) are steroid hormones that have inflammatory and immunosuppressive effects on a wide variety of cells. They are used as therapy for inflammatory disease and as a common agent against edema. The blood brain barrier (BBB), comprising microvascular endothelial cells, serves as a permeability screen between the blood and the brain. As such, it maintains homeostasis of the central nervous system (CNS). In many CNS disorders, BBB integrity is compromised. GC treatment has been demonstrated to improve the tightness of the BBB. The responses and effects of GCs are mediated by the ubiquitous GC receptor (GR). Ligand-bound GR recognizes and binds to the GC response element located within the promoter region of target genes. Transactivation of certain target genes leads to improved barrier properties of endothelial cells. In this review, we deal with the role of GCs in endothelial cell barrier function. First, we describe the mechanisms of GC action at the molecular level. Next, we discuss the regulation of the BBB by GCs, with emphasis on genes targeted by GCs such as occludin, claudins and VE-cadherin. Finally, we present currently available GC therapeutic strategies and their limitations.}, language = {en} } @article{ShityakovBroscheitFoerster2013, author = {Shityakov, Sergey and Broscheit, Jens and F{\"o}rster, Carola}, title = {Multidrug resistance protein P-gp interaction with nanoparticles (fullerenes and carbon nanotube) to assess their drug delivery potential: a theoretical molecular docking study.}, series = {International journal of computational biology and drug design}, volume = {6}, journal = {International journal of computational biology and drug design}, number = {4}, doi = {10.1504/IJCBDD.2013.056801}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-132089}, pages = {343-357}, year = {2013}, abstract = {P-glycoprotein (P-gp)-mediated efflux system plays an important role to maintain chemical balance in mammalian cells for endogenous and exogenous chemical compounds. However, despite the extensive characterisation of P-gp potential interaction with drug-like molecules, the interaction of carbon nanoparticles with this type of protein molecule is poorly understood. Thus, carbon nanoparticles were analysed, such as buckminsterfullerenes (C20, C60, C70), capped armchair single-walled carbon nanotube (SWCNT or C168), and P-gp interactions using different molecular docking techniques, such as gradient optimisation algorithm (ADVina), Lamarckian genetic algorithm (FastDock), and shape-based approach (PatchDock) to estimate the binding affinities between these structures. The theoretical results represented in this work show that fullerenes might be P-gp binders because of low levels of Gibbs free energy of binding (ΔG) and potential of mean force (PMF) values. Furthermore, the SWCNT binding is energetically unfavourable, leading to a total decrease in binding affinity by elevation of the residual area (Ares), which also affects the π-π stacking mechanisms. Further, the obtained data could potentially call experimental studies using carbon nanostructures, such as SWCNT for development of drug delivery vehicles, to administer and assess drug-like chemical compounds to the target cells since organisms probably did not develop molecular sensing elements to detect these types of carbon molecules.}, language = {en} } @article{KrankeGirardLavand’hommeetal.2013, author = {Kranke, Peter and Girard, Thierry and Lavand'homme, Patricia and Melber, Andrea and Jokinen, Johanna and Muellenbach, Ralf M. and Wirbelauer, Johannes and H{\"o}nig, Arnd}, title = {Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a "poor man's epidural"}, series = {BMC Pregnancy and Childbirth}, journal = {BMC Pregnancy and Childbirth}, doi = {10.1186/1471-2393-13-139}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-96262}, year = {2013}, abstract = {Background The epidural route is still considered the gold standard for labour analgesia, although it is not without serious consequences when incorrect placement goes unrecognized, e.g. in case of intravascular, intrathecal and subdural placements. Until now there has not been a viable alternative to epidural analgesia especially in view of the neonatal outcome and the need for respiratory support when long-acting opioids are used via the parenteral route. Pethidine and meptazinol are far from ideal having been described as providing rather sedation than analgesia, affecting the cardiotocograph (CTG), causing fetal acidosis and having active metabolites with prolonged half-lives especially in the neonate. Despite these obvious shortcomings, intramuscular and intravenously administered pethidine and comparable substances are still frequently used in delivery units. Since the end of the 90ths remifentanil administered in a patient-controlled mode (PCA) had been reported as a useful alternative for labour analgesia in those women who either don't want, can't have or don't need epidural analgesia. Discussion In view of the need for conversion to central neuraxial blocks and the analgesic effect remifentanil has been demonstrated to be superior to pethidine. Despite being less effective in terms of the resulting pain scores, clinical studies suggest that the satisfaction with analgesia may be comparable to that obtained with epidural analgesia. Owing to this fact, remifentanil has gained a place in modern labour analgesia in many institutions. However, the fact that remifentanil may cause harm should not be forgotten when the use of this potent mu-agonist is considered for the use in labouring women. In the setting of one-to-one midwifery care, appropriate monitoring and providing that enough experience exists with this potent opioid and the treatment of potential complications, remifentanil PCA is a useful option in addition to epidural analgesia and other central neuraxial blocks. Already described serious consequences should remind us not refer to remifentanil PCA as a "poor man's epidural" and to safely administer remifentanil with an appropriate indication. Summary Therefore, the authors conclude that economic considerations and potential cost-savings in conjunction with remifentanil PCA may not be appropriate main endpoints when studying this valuable method for labour analgesia.}, language = {en} } @article{vonRuedenWoltmannRoeseetal.2013, author = {von R{\"u}den, Christian and Woltmann, Alexander and R{\"o}se, Marc and Wurm, Simone and R{\"u}ger, Matthias and Hierholzer, Christian and B{\"u}hren, Volker}, title = {Outcome after severe multiple trauma: a retrospective analysis}, series = {Journal of Trauma Management \& Outcomes}, volume = {7}, journal = {Journal of Trauma Management \& Outcomes}, number = {4}, doi = {10.1186/1752-2897-7-4}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-132249}, year = {2013}, abstract = {Background Aim of this study was to evaluate prognosis of severely injured patients. Methods All severely injured patients with an Injury Severity Score (ISS) ≥ 50 were identified in a 6-year-period between 2000 and 2005 in German Level 1 Trauma Center Murnau. Data was evaluated from German Trauma Registry and Polytrauma Outcome Chart of the German Society for Trauma Surgery and a personal interview to assess working ability and disability and are presented as average. Results 88 out of 1435 evaluated patients after severe polytrauma demonstrated an ISS ≥ 50 (6.5\%), among them 23\% women and 77\% men. 66 patients (75\%) had an ISS of 50-60, 14 (16\%) 61-70, and 8 (9\%) ≥ 70. In 27\% of patients trauma was caused by motor bike accidents. 3.6 body regions were involved. Patients had to be operated 5.3 times and were treated 23 days in the ICU and stayed 73 days in hospital. Mortality rate was 36\% and rate of multi-organ failure 28\%. 15\% of patients demonstrated severe senso-motoric dysfunction as well as residues of severe head injury. 25\% recovered well or at least moderately. 29 out of 56 survivors answered the POLO-chart. A personal interview was performed with 13 patients. The state of health was at least moderate in 72\% of patients. In 48\% interpersonal problems and in 41\% severe pain was observed. In 57\% of patients problems with working ability regarding duration, as well as quantitative and qualitative performance were observed. Symptoms of post-traumatic stress disorder were found in 41\%. The more distal the lesions were located (foot/ankle) the more functional disability affected daily life. In only 15\%, working ability was not impaired. 8 out of 13 interviewed patients demonstrated complete work disability. Conclusions Even severely injured patients after multiple trauma have a good prognosis. The ISS is an established tool to assess severity and prognosis of trauma, whereas prediction of clinical outcome cannot be deducted from this score.}, language = {en} } @article{ShityakovFoerster2013, author = {Shityakov, Sergey and F{\"o}rster, Carola}, title = {Pharmacokinetic Delivery and Metabolizing Rate of Nicardipine Incorporated in Hydrophilic and Hydrophobic Cyclodextrins Using Two-Compartment Mathematical Model}, series = {The Scientific World Journal}, volume = {2013}, journal = {The Scientific World Journal}, number = {131358}, doi = {10.1155/2013/131358}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-130519}, pages = {9}, year = {2013}, abstract = {The dispersion routes of cyclodextrin complexes with nicardipine (NC), such as hydrophilic hydroxypropyl-\(\beta\)-cyclodextrin (NC/HP\(\beta\)CD) and hydrophobic triacetyl-\(\beta\)-cyclodextrin (NC/TA\(\beta\)CD), through the body for controlled drug delivery and sustained release have been examined. The two-compartment pharmacokinetic model described the mechanisms of how the human body handles with ingestion of NC-cyclodextrin complexes in gastrointestinal tract (GI), distribution in plasma, and their metabolism in the liver. The model showed that drug bioavailability was significantly improved after oral administration of cyclodextrin complexes. The mathematical significance of this study to predict nicardipine delivery using pharmacokinetic two-compartment mathematical model with linear ordinary differential equations (ODE) approach represents a valuable tool to emphasize its effectiveness and metabolizing rate and diminish the side effects.}, language = {en} } @article{MuellenbachRoewerKranke2013, author = {M{\"u}llenbach, Ralf Michael and Roewer, Norbert and Kranke, Peter}, title = {Quality Assurance Would Be Welcome}, series = {Deutsches {\"A}rzteblatt international}, volume = {110}, journal = {Deutsches {\"A}rzteblatt international}, number = {27-28}, doi = {10.3238/arztebl.2013.0485a}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-128844}, pages = {485}, year = {2013}, abstract = {No abstract available.}, language = {en} } @article{RittnerHackelPflueckeetal.2013, author = {Rittner, Heike Lydia and Hackel, Dagmar and Pfl{\"u}cke, Diana and Neumann, Annick and Viebahn, Johannes and Mousa, Shaaban and Wischmeyer, Erhard and Roewer, Norbert and Brack, Alexander}, title = {The Connection of Monocytes and Reactive Oxygen Species in Pain}, series = {PLoS ONE}, journal = {PLoS ONE}, doi = {10.1371/journal.pone.0063564}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-96669}, year = {2013}, abstract = {The interplay of specific leukocyte subpopulations, resident cells and proalgesic mediators results in pain in inflammation. Proalgesic mediators like reactive oxygen species (ROS) and downstream products elicit pain by stimulation of transient receptor potential (TRP) channels. The contribution of leukocyte subpopulations however is less clear. Local injection of neutrophilic chemokines elicits neutrophil recruitment but no hyperalgesia in rats. In meta-analyses the monocytic chemoattractant, CCL2 (monocyte chemoattractant protein-1; MCP-1), was identified as an important factor in the pathophysiology of human and animal pain. In this study, intraplantar injection of CCL2 elicited thermal and mechanical pain in Wistar but not in Dark Agouti (DA) rats, which lack p47phox, a part of the NADPH oxidase complex. Inflammatory hyperalgesia after complete Freund's adjuvant (CFA) as well as capsaicin-induced hyperalgesia and capsaicin-induced current flow in dorsal root ganglion neurons in DA were comparable to Wistar rats. Macrophages from DA expressed lower levels of CCR2 and thereby migrated less towards CCL2 and formed limited amounts of ROS in vitro and 4-hydroxynonenal (4-HNE) in the tissue in response to CCL2 compared to Wistar rats. Local adoptive transfer of peritoneal macrophages from Wistar but not from DA rats reconstituted CCL2-triggered hyperalgesia in leukocyte-depleted DA and Wistar rats. A pharmacological stimulator of ROS production (phytol) restored CCL2-induced hyperalgesia in vivo in DA rats. In Wistar rats, CCL2-induced hyperalgesia was completely blocked by superoxide dismutase (SOD), catalase or tempol. Likewise, inhibition of NADPH oxidase by apocynin reduced CCL2-elicited hyperalgesia but not CFA-induced inflammatory hyperalgesia. In summary, we provide a link between CCL2, CCR2 expression on macrophages, NADPH oxidase, ROS and the development CCL2-triggered hyperalgesia, which is different from CFA-induced hyperalgesia. The study further supports the impact of CCL2 and ROS as potential targets in pain therapy.}, language = {en} }