TY - THES A1 - Schuster, Daniel T1 - Analyse der B-Zell-Entwicklung und -Differenzierung bei Patienten mit chronischer Immunthrombozytopenie T1 - Analysis of B-cell development and differentiation in patients with chronic immune thrombocytopenia N2 - Die Immunthrombozytopenie (ITP) ist eine erworbene Autoimmunerkrankung, bei der sich Autoantikörper gegen Thrombozyten bilden. Dadurch werden diese, unter anderem in der Milz, vermehrt abgebaut und es treten Blutungskomplikationen auf. Der fehlgeleiteten Immunabwehr wird versucht mit medikamentösen Therapien wie z. B. mit Glucocorticoiden und Rituximab bis hin zur Splenektomie entgegenzuwirken. Im Rahmen dieser Arbeit untersuchte ich durchflusszytometrisch die Verteilung der B-Zell-Subpopulationen bei Patienten mit chronischer, primärer ITP und Gesunden hinsichtlich einer möglichen Störung in der B-Zell-Entwicklung und -Differenzierung. Dabei wurden 7 Knochenmark-, 28 Blut- und 12 Milzproben von ITP-Patienten sowie 5 Knochenmark- und 10 Milzproben von Gesunden aufbereitet. Anschließend wurden die B-Zell-Subpopulationen mittels immunphänotypischer Marker gefärbt um die Proben danach durchflusszytometrisch zu vermessen und zu charakterisieren. Zusätzlich erfolgte der Vergleich zu laboreigenen, bereits etablierten Referenzwerten von 220 Blutproben von Gesunden. Bei den Knochenmarkproben konnten keine signifikanten Unterschiede in der Verteilung von Vorläufer-B-Zellen zwischen den ITP-Patienten und den Gesunden beobachtet werden, d. h. die frühe B-Zell-Entwicklung im Knochenmark erscheint bei der ITP auf zellulärer Ebene nicht beeinträchtigt. Die Analyse der Blutproben zeigte, dass auch keine signifikanten Unterschiede in der Verteilung von naiven B-Zellen zwischen den ITP-Patienten und den Gesunden vorzufinden sind. Dies bekräftigt, dass bei der ITP auf zellulärer Ebene keine Abweichungen in der frühen pre-immunen B-Zell-Entwicklung vorzuliegen scheinen und eine intakte B-Zell-Reifung bis hin zur naiven B-Zelle stattfindet. Es zeigte sich jedoch bei den ITP-Patienten ein erhöhter Anteil an anergen B-Zellen und atypischen Gedächtnis-B-Zellen, von denen allgemein angenommen wird, dass sie aus einer chronischen bzw. dysregulierten antigen-abhängigen B-Zell-Aktivierung entstammen. Aus der Untersuchung der Milzproben zeigte sich zudem, dass bei den ITP-Patienten der Anteil der antikörperproduzierenden Plasmablasten im Vergleich zu den Gesunden erhöht ist. Folglich lassen sich bei der ITP auf zellulärer Ebene vor allem Abweichungen in der späten Phase der B-Zell-Differenzierung nachweisen. Es kann somit angenommen werden, dass Störungen der B-Zell-Entwicklung, wie sie auf zellulärer Ebene bei verschiedenen mit sekundärer ITP einhergehenden Erkrankungen (systemischer Lupus erythematodes, variables Immundefektsyndrom) beschrieben wurden, bei der primären ITP nicht für die Produktion von antithrombozytären Antikörpern notwendig sind. Eine weitere detaillierte Aufarbeitung, auf welcher Ebene der B-Zell-Differenzierung der Toleranzverlust gegenüber thrombozytären Antigenen auftritt, ist entscheidend für die zukünftige Entwicklung spezifischer, zellgerichteter Therapien. N2 - Immune thrombocytopenia (ITP) is an acquired autoimmune disease in which autoantibodies against platelets are produced. As a result, the platelets are increasingly reduced in the spleen, and bleeding disorders occur. The misdirected immune defense is tried to counteract with drug therapies such as glucocorticoids and rituximab up to surgery with splenectomy. In this study, I used flow cytometry to investigate the distribution of B-cell subpopulations in patients with chronic, primary ITP and healthy individuals regarding possible disruptions in B-cell development and differentiation. 7 bone marrow, 28 blood and 12 spleen samples from ITP patients as well as 5 bone marrow and 10 spleen samples from healthy individuals were processed. The B-cell subpopulations were stained using immunophenotypic markers to measure and characterize the samples by flow cytometry. In addition, the results were compared with the laboratory's own established reference values of 220 blood samples from healthy individuals. No significant differences in the distribution of precursor B cells between the ITP patients and the healthy subjects could be observed in the bone marrow samples. Therefore, the early B-cell development in the bone marrow does not appear to be impaired in ITP at the cellular level. The analysis of the blood samples showed that there were no significant differences in the distribution of naive B cells between the ITP patients and the healthy individuals. This confirms that in ITP at the cellular level there seem to be no deviations in the early pre-immune B-cell development and that intact B-cell maturation takes place up to naive B-cells. However, ITP patients revealed an increased proportion of anergic B-cells and atypical memory B-cells, which are generally assumed to originate from chronic or dysregulated antigen-dependent B-cell activation. The examination of the spleen samples also displayed that the proportion of antibody-producing plasmablasts in ITP patients is higher than in healthy individuals. Consequently, in ITP at the cellular level especially deviations in the late phase of B-cell differentiation can be detected. It can thus be assumed that disorders of B-cell development, as described at the cellular level in various diseases associated with secondary ITP (systemic lupus erythematosus, variable immunodeficiency syndrome), are not necessary for the production of anti-platelet antibodies in primary ITP. A further detailed investigation at which stage of the B-cell differentiation a loss of tolerance to platelet antigens occurs is crucial for the future development of specific, cell-directed therapies. KW - Essenzielle Thrombozytopenie KW - B-Zelle KW - B-Lymphozyt KW - Durchflusscytometrie KW - Immunthrombozytopenie KW - ITP KW - B-Zelle KW - Durchflusszytometrie KW - immune thrombocytopenia KW - b-cell KW - b-lymphocyte KW - flow cytometry Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-215854 ER - TY - JOUR A1 - Schuster, Frank A1 - Johannsen, Stephan A1 - Schneiderbanger, Daniel A1 - Roewer, Norbert T1 - Evaluation of suspected malignant hyperthermia events during anesthesia JF - BMC Anesthesiology N2 - 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. KW - Malignant hyperthermia KW - In vitro contracture test KW - Succinylcholine KW - Volatile anesthetics Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-96231 UR - http://www.biomedcentral.com/1471-2253/13/24 ER - TY - THES A1 - Schuster, Daniel T1 - „Da schleicht hinein ein böser Gast“ - Körper- und Krankheitsmetaphern in der medizinischen Ratgeberliteratur des 16. und 17. Jahrhunderts T1 - "An Evil Guest Is Creeping In" - Metaphors for Illness and the Body in 16th and 17th Century Health Guides N2 - Metaphern prägen unser Verständnis des Körpers und seiner Krankheiten. Die Kommunikation zwischen Heilkundigen und Kranken basiert daher maßgeblich auf Metaphern. Dieser Beitrag untersucht deutschsprachige Gesundheitsratgeber des 16. und 17. Jahrhunderts, die von gelehrten Ärzten für ein Laienpublikum verfasst wurden. Mit den Methoden der qualitativen Metaphernanalyse soll das Bild einer kommunikativen Praxis vor dem Hintergrund ihrer kulturhistorischen Rahmenbedingungen gezeichnet werden. Metaphern erweisen sich als wichtiges Werkzeug, um die sprachliche und intellektuelle Kluft zwischen Laien- und Gelehrtenwelt zu überbrücken. Geschickt lenken die ärztlichen Autoren mit Hilfe von Metaphern den Blick des Lesers. Dabei bieten sie ihm auch sinnstiftende Erkenntnisse und Ansätze zur Teilhabe am therapeutischen Prozess. N2 - Metaphors can shape our conception of the body and our understanding of its diseases. Communication between medical practitioners and patients, therefore, has often relied on metaphors. This study examines 16th and 17th century health guides written in German vernacular by university-trained medical practitioners. Using qualitative metaphor analysis, a communications practice and its historical background are explored [for insights into patient-practitioner communications]. Metaphors emerge to create a linguistic and intellectual common ground between experts in medicine and the lay reading public. They could serve to manipulate the patient but also to facilitate participation in the therapeutic process and to satisfy the patients’ need for understanding. KW - Metaphernanalyse KW - Ratgeber KW - Medizin KW - Frühe Neuzeit KW - Volkssprache KW - Gesundheitsratgeber KW - Gout KW - Early Modern KW - Vernakularisierung KW - Gicht KW - Podagra KW - Pest KW - health guide KW - metaphor analysis KW - vernacular medicine Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-286477 ER - TY - JOUR A1 - Farmer, Adam D. A1 - Strzelczyk, Adam A1 - Finisguerra, Alessandra A1 - Gourine, Alexander V. A1 - Gharabaghi, Alireza A1 - Hasan, Alkomiet A1 - Burger, Andreas M. A1 - Jaramillo, Andrés M. A1 - Mertens, Ann A1 - Majid, Arshad A1 - Verkuil, Bart A1 - Badran, Bashar W. A1 - Ventura-Bort, Carlos A1 - Gaul, Charly A1 - Beste, Christian A1 - Warren, Christopher M. A1 - Quintana, Daniel S. A1 - Hämmerer, Dorothea A1 - Freri, Elena A1 - Frangos, Eleni A1 - Tobaldini, Eleonora A1 - Kaniusas, Eugenijus A1 - Rosenow, Felix A1 - Capone, Fioravante A1 - Panetsos, Fivos A1 - Ackland, Gareth L. A1 - Kaithwas, Gaurav A1 - O'Leary, Georgia H. A1 - Genheimer, Hannah A1 - Jacobs, Heidi I. L. A1 - Van Diest, Ilse A1 - Schoenen, Jean A1 - Redgrave, Jessica A1 - Fang, Jiliang A1 - Deuchars, Jim A1 - Széles, Jozsef C. A1 - Thayer, Julian F. A1 - More, Kaushik A1 - Vonck, Kristl A1 - Steenbergen, Laura A1 - Vianna, Lauro C. A1 - McTeague, Lisa M. A1 - Ludwig, Mareike A1 - Veldhuizen, Maria G. A1 - De Couck, Marijke A1 - Casazza, Marina A1 - Keute, Marius A1 - Bikson, Marom A1 - Andreatta, Marta A1 - D'Agostini, Martina A1 - Weymar, Mathias A1 - Betts, Matthew A1 - Prigge, Matthias A1 - Kaess, Michael A1 - Roden, Michael A1 - Thai, Michelle A1 - Schuster, Nathaniel M. A1 - Montano, Nicola A1 - Hansen, Niels A1 - Kroemer, Nils B. A1 - Rong, Peijing A1 - Fischer, Rico A1 - Howland, Robert H. A1 - Sclocco, Roberta A1 - Sellaro, Roberta A1 - Garcia, Ronald G. A1 - Bauer, Sebastian A1 - Gancheva, Sofiya A1 - Stavrakis, Stavros A1 - Kampusch, Stefan A1 - Deuchars, Susan A. A1 - Wehner, Sven A1 - Laborde, Sylvain A1 - Usichenko, Taras A1 - Polak, Thomas A1 - Zaehle, Tino A1 - Borges, Uirassu A1 - Teckentrup, Vanessa A1 - Jandackova, Vera K. A1 - Napadow, Vitaly A1 - Koenig, Julian T1 - International Consensus Based Review and Recommendations for Minimum Reporting Standards in Research on Transcutaneous Vagus Nerve Stimulation (Version 2020) JF - Frontiers in Human Neuroscience N2 - Given its non-invasive nature, there is increasing interest in the use of transcutaneous vagus nerve stimulation (tVNS) across basic, translational and clinical research. Contemporaneously, tVNS can be achieved by stimulating either the auricular branch or the cervical bundle of the vagus nerve, referred to as transcutaneous auricular vagus nerve stimulation(VNS) and transcutaneous cervical VNS, respectively. In order to advance the field in a systematic manner, studies using these technologies need to adequately report sufficient methodological detail to enable comparison of results between studies, replication of studies, as well as enhancing study participant safety. We systematically reviewed the existing tVNS literature to evaluate current reporting practices. Based on this review, and consensus among participating authors, we propose a set of minimal reporting items to guide future tVNS studies. The suggested items address specific technical aspects of the device and stimulation parameters. We also cover general recommendations including inclusion and exclusion criteria for participants, outcome parameters and the detailed reporting of side effects. Furthermore, we review strategies used to identify the optimal stimulation parameters for a given research setting and summarize ongoing developments in animal research with potential implications for the application of tVNS in humans. Finally, we discuss the potential of tVNS in future research as well as the associated challenges across several disciplines in research and clinical practice. KW - transcutaneous vagus nerve stimulation KW - minimum reporting standards KW - guidelines & recommendations KW - transcutaneous auricular vagus nerve stimulation KW - transcutaneous cervical vagus nerve stimulation Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-234346 SN - 1662-5161 VL - 14 ER - TY - JOUR A1 - Herrmann, Johannes A1 - Adam, Elisabeth Hannah A1 - Notz, Quirin A1 - Helmer, Philipp A1 - Sonntagbauer, Michael A1 - Ungemach-Papenberg, Peter A1 - Sanns, Andreas A1 - Zausig, York A1 - Steinfeldt, Thorsten A1 - Torje, Iuliu A1 - Schmid, Benedikt A1 - Schlesinger, Tobias A1 - Rolfes, Caroline A1 - Reyher, Christian A1 - Kredel, Markus A1 - Stumpner, Jan A1 - Brack, Alexander A1 - Wurmb, Thomas A1 - Gill-Schuster, Daniel A1 - Kranke, Peter A1 - Weismann, Dirk A1 - Klinker, Hartwig A1 - Heuschmann, Peter A1 - Rücker, Viktoria A1 - Frantz, Stefan A1 - Ertl, Georg A1 - Muellenbach, Ralf Michael A1 - Mutlak, Haitham A1 - Meybohm, Patrick A1 - Zacharowski, Kai A1 - Lotz, Christopher T1 - COVID-19 Induced Acute Respiratory Distress Syndrome — A Multicenter Observational Study JF - Frontiers in Medicine N2 - Background: Proportions of patients dying from the coronavirus disease-19 (COVID-19) vary between different countries. We report the characteristics; clinical course and outcome of patients requiring intensive care due to COVID-19 induced acute respiratory distress syndrome (ARDS). Methods: This is a retrospective, observational multicentre study in five German secondary or tertiary care hospitals. All patients consecutively admitted to the intensive care unit (ICU) in any of the participating hospitals between March 12 and May 4, 2020 with a COVID-19 induced ARDS were included. Results: A total of 106 ICU patients were treated for COVID-19 induced ARDS, whereas severe ARDS was present in the majority of cases. Survival of ICU treatment was 65.0%. Median duration of ICU treatment was 11 days; median duration of mechanical ventilation was 9 days. The majority of ICU treated patients (75.5%) did not receive any antiviral or anti-inflammatory therapies. Venovenous (vv) ECMO was utilized in 16.3%. ICU triage with population-level decision making was not necessary at any time. Univariate analysis associated older age, diabetes mellitus or a higher SOFA score on admission with non-survival during ICU stay. Conclusions: A high level of care adhering to standard ARDS treatments lead to a good outcome in critically ill COVID-19 patients. KW - COVID-19 KW - ARDS (acute respiratory distress syndrome) KW - intensive care medicine KW - pandemia KW - Germany Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-219834 SN - 2296-858X VL - 7 ER -