TY - THES A1 - Haas, Katrin T1 - Charakterisierung der Versorgungsqualität beim akuten ST-Hebungsmyokardinfarkt im Herzinfarktnetz Mainfranken zu Beginn der Netzwerkbildung T1 - Characterization of quality of care in patients with acute ST-elevation myocardial infarction treated in the newly formed myocardial infarction network in Mainfranken N2 - Ziele: Evaluierung der Versorgungslage von Patienten mit akutem ST-Hebungsinfarkt im 2007 neu gegründeten Herzinfarktnetz Mainfranken und Vergleich von Ist-Zustand und Leitlinienempfehlungen. Analyse der Behandlungszeiten und Identifizierung von Verbesserungsmöglichkeiten im Netzwerk. Darüber hinaus sollte untersucht werden, ob Feedbackveranstaltungen als Qualitätsmanagement-Intervention die Behandlungszeiten im Laufe des Untersuchungszeitraumes verbessern. Methoden: Von Oktober 2007 bis Dezember 2008 wurden verschiedene Basisdaten sowie die Daten der Rettungs- und Therapiekette von Patienten mit akutem ST-Hebungsinfarkt (Symptomdauer <12h), die in der Medizinischen Klinik und Poliklinik I des Universitätsklinikums Würzburg mit dem Ziel einer PCI akut-koronarangiographiert wurden, im Rahmen der multizentrischen FiTT-STEMI-Studie prospektiv erfasst. Im Untersuchungszeitraum wurden die analysierten Daten alle drei Monate im Rahmen einer Feedbackveranstaltung allen Beteiligten der Rettungs- und Therapiekette demonstriert. Ergebnisse: Im genannten Zeitraum konnten 188 Patienten in die Studie eingeschlossen werden (19% weiblich, 81% männlich), wovon 85% eine PCI im Anschluss an die Koronarangiographie erhielten. Das mittlere Alter betrug 62±12 Jahre, 15% der Patienten waren über 75 Jahre. Der mittlere TIMI-Risk-Score lag bei 3,7 Punkten. Die intrahospitale Letalität lag bei 6,9%. Die Prähospitalzeit betrug im Median 120min; es ergab sich keine signifikante Veränderung über die Quartale. Ein Sekundärtransport bzw. ein prähospitaler Kontakt zum Hausarzt verlängerten die Prähospitalzeit im Median um 173 bzw. 57min. Die Door-to-balloon(D2B)-Zeit betrug im Gesamtuntersuchungszeitraum im Median 76min, nur 33% der Patienten erreichten eine leitliniengerechte D2B-Zeit von <60min. Die meiste Zeit innerhalb der D2B-Zeit entfiel auf die Zeit vom Erreichen der PCI-Klinik bis zum Herzkatheterlabor (Door-to-cath-Zeit). Die Verkürzung der D2B-Zeit von 80min im ersten auf 70min im fünften Quartal war statistisch nicht signifikant. Die Contact-to-balloon(C2B)-Zeit betrug im Gesamtuntersuchungszeitraum im Median 139min und konnte innerhalb des Untersuchungszeitraums statistisch signifikant von 164min im ersten auf 112min im fünften Quartal gesenkt werden. Dadurch konnte die Anzahl der leitliniengerecht behandelten Patienten (C2B-Zeit<120min) von 15 auf 58% im Gesamtkollektiv bzw. 24 auf 63% bei Patienten mit Primärtransport erhöht werden. Schlussfolgerung: Das Patientenkollektiv des Herzinfarktnetzes Mainfranken entsprach bezüglich der Basischarakteristika dem anderer nationaler und internationaler Register. Da eine PCI innerhalb von 120min nach medizinischem Erstkontakt als bestmögliche Therapie beim ST-Hebungsinfarkt angesehen wird und trotz der Verbesserung im Untersuchungszeitraum im fünften Quartal nur 58% der Patienten eine PCI in diesem Zeitintervall erhielten, sollten alle Anstrengungen unternommen werden die D2B- und C2B-Zeiten im Herzinfarktnetz weiter zu verkürzen. Hierfür sollte eine Direktübergabe im Herzkatheterlabor ermöglicht werden, da die Door-to-cath-Zeit in Würzburg im Median 36 bis 48min in Anspruch nahm. Darüber hinaus sollte durch Aufklärungs- und Informationsarbeit sowie Schulungen für Rettungspersonal und Patienten versucht werden einen Sekundärtransport oder Hausarztkontakt sowie ein verzögertes Alarmieren des Rettungsdienstes zu vermeiden, da sich hierdurch die Prähospitalzeit massiv verlängerte. Inwieweit die im Untersuchungszeitraum gezeigte Verkürzung der Zeiten mit den durchgeführten Feedbackveranstaltungen zusammenhängt bleibt ungewiss, da die Veränderung auch durch die Etablierung des neu gegründeten Netzwerks an sich bedingt sein kann. N2 - Objectives: The aim was to analyze the quality of care in patients with acute myocardial infarction treated in the newly formed myocardial infarction network Mainfranken, to compare the as-is state with the guideline-recommendations and to identify improvement opportunities to shorten the treatment times. Furthermore the effect of data feedback on treatment times was assessed. Methods: As a part of the FiTT-STEMI-project the data of patients with acute myocardial infarction (symptom onset <12h) undergoing coronary angiography with the intention to perform primary PCI in the Department of Internal Medicine I of the University Hospital Würzburg were collected from October 2007 until December 2008. Quarterly feedback was performed for all participants of the hospital and the rescue services. Results: 188 patients were included (19% female, 81% male). In 85% PCI was performed after coronary angiography. The mean age was 62±12 years, 15% were older than 75 years. The average TIMI-Risk-Score was 3,7 points and the in-hospital mortality 6,9%. Median 120min passed by until a patient reached a PCI-capable hospital and there was no significant decrease in that time during the study period. Secondary transport and a consultation of a general practicioner extended this time for about 173 and 57min respectively. Median door-to-balloon(D2B)-time was 76min for the whole period, only 33% of all patients were treated within the guideline-recommended time of <60min. Within the D2B-time the largest time component was the door-to-cath time (=time interval from arrival in a PCI-capable hospital to arrival at the catheterization laboratory). There was a non-significant decrease in D2B-time from 80min in the first quarter to 70min in the fifth quarter. The median contact-to-balloon(C2B)-time was 139min and decreased signficantly from 164min in the first quarter to 112min in the fifth quarter. Thereby the proportion of patients who were treated within the recommended C2B-Zeit<120min increased from 15 to 58% regarding all patients and from 24 to 63% regarding only patients with primary transport. Conclusions: Primary PCI <120min after first medical contact is the preferred therapy in acute myocardial infarction and despite the improvements during the study period only 58% of our patients were treated within this time interval. So all efforts should be made to continue reducing treatment times in the STEMI-network in Mainfranken. Bypassing the emergency department could save 36 to 48min (median door-to-cath-time). Because secondary transport, consultation of a general practicioner and a delayed information of the emergency medical sevices clearly extended the time from symtpom onset to presentation at the PCI-centre, there should be education and information sessions to reduce these times. To which extend our improvements in treatment times are due to the feedback intervention remains hard to tell. The improvements could be due to the newly formed network itself. KW - Herzinfarkt KW - Netzwerk KW - Stemi KW - FiTT-STEMI KW - feedback KW - Contact-to-balloon KW - FiTT-STEMI KW - feedback KW - Contact-to-balloon KW - myocardial infarction Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-80388 ER - TY - JOUR A1 - Peters, Marcell K. A1 - Hemp, Andreas A1 - Appelhans, Tim A1 - Behler, Christina A1 - Classen, Alice A1 - Detsch, Florian A1 - Ensslin, Andreas A1 - Ferger, Stefan W. A1 - Frederiksen, Sara B. A1 - Gebert, Frederike A1 - Haas, Michael A1 - Helbig-Bonitz, Maria A1 - Hemp, Claudia A1 - Kindeketa, William J. A1 - Mwangomo, Ephraim A1 - Ngereza, Christine A1 - Otte, Insa A1 - Röder, Juliane A1 - Rutten, Gemma A1 - Costa, David Schellenberger A1 - Tardanico, Joseph A1 - Zancolli, Giulia A1 - Deckert, Jürgen A1 - Eardley, Connal D. A1 - Peters, Ralph S. A1 - Rödel, Mark-Oliver A1 - Schleuning, Matthias A1 - Ssymank, Axel A1 - Kakengi, Victor A1 - Zhang, Jie A1 - Böhning-Gaese, Katrin A1 - Brandl, Roland A1 - Kalko, Elisabeth K.V. A1 - Kleyer, Michael A1 - Nauss, Thomas A1 - Tschapka, Marco A1 - Fischer, Markus A1 - Steffan-Dewenter, Ingolf T1 - Predictors of elevational biodiversity gradients change from single taxa to the multi-taxa community level JF - Nature Communications N2 - The factors determining gradients of biodiversity are a fundamental yet unresolved topic in ecology. While diversity gradients have been analysed for numerous single taxa, progress towards general explanatory models has been hampered by limitations in the phylogenetic coverage of past studies. By parallel sampling of 25 major plant and animal taxa along a 3.7 km elevational gradient on Mt. Kilimanjaro, we quantify cross-taxon consensus in diversity gradients and evaluate predictors of diversity from single taxa to a multi-taxa community level. While single taxa show complex distribution patterns and respond to different environmental factors, scaling up diversity to the community level leads to an unambiguous support for temperature as the main predictor of species richness in both plants and animals. Our findings illuminate the influence of taxonomic coverage for models of diversity gradients and point to the importance of temperature for diversification and species coexistence in plant and animal communities. KW - community ecology KW - macroecology KW - tropical ecology KW - biodiversity Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-169374 VL - 7 ER - TY - JOUR A1 - Sedaghat-Hamedani, Farbod A1 - Rebs, Sabine A1 - Kayvanpour, Elham A1 - Zhu, Chenchen A1 - Amr, Ali A1 - Müller, Marion A1 - Haas, Jan A1 - Wu, Jingyan A1 - Steinmetz, Lars M. A1 - Ehlermann, Philipp A1 - Streckfuss-Bömeke, Katrin A1 - Frey, Norbert A1 - Meder, Benjamin T1 - Genotype complements the phenotype: identification of the pathogenicity of an LMNA splice variant by nanopore long-read sequencing in a large DCM family JF - International Journal of Molecular Sciences N2 - Dilated cardiomyopathy (DCM) is a common cause of heart failure (HF) and is of familial origin in 20–40% of cases. Genetic testing by next-generation sequencing (NGS) has yielded a definite diagnosis in many cases; however, some remain elusive. In this study, we used a combination of NGS, human-induced pluripotent-stem-cell-derived cardiomyocytes (iPSC-CMs) and nanopore long-read sequencing to identify the causal variant in a multi-generational pedigree of DCM. A four-generation family with familial DCM was investigated. Next-generation sequencing (NGS) was performed on 22 family members. Skin biopsies from two affected family members were used to generate iPSCs, which were then differentiated into iPSC-CMs. Short-read RNA sequencing was used for the evaluation of the target gene expression, and long-read RNA nanopore sequencing was used to evaluate the relevance of the splice variants. The pedigree suggested a highly penetrant, autosomal dominant mode of inheritance. The phenotype of the family was suggestive of laminopathy, but previous genetic testing using both Sanger and panel sequencing only yielded conflicting evidence for LMNA p.R644C (rs142000963), which was not fully segregated. By re-sequencing four additional affected family members, further non-coding LMNA variants could be detected: rs149339264, rs199686967, rs201379016, and rs794728589. To explore the roles of these variants, iPSC-CMs were generated. RNA sequencing showed the LMNA expression levels to be significantly lower in the iPSC-CMs of the LMNA variant carriers. We demonstrated a dysregulated sarcomeric structure and altered calcium homeostasis in the iPSC-CMs of the LMNA variant carriers. Using targeted nanopore long-read sequencing, we revealed the biological significance of the variant c.356+1G>A, which generates a novel 5′ splice site in exon 1 of the cardiac isomer of LMNA, causing a nonsense mRNA product with almost complete RNA decay and haploinsufficiency. Using novel molecular analysis and nanopore technology, we demonstrated the pathogenesis of the rs794728589 (c.356+1G>A) splice variant in LMNA. This study highlights the importance of precise diagnostics in the clinical management and workup of cardiomyopathies. KW - familial DCM KW - laminopathy KW - long-read sequencing KW - nanopore KW - induced pluripotent stem cell cardiomyocytes Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-290415 SN - 1422-0067 VL - 23 IS - 20 ER - TY - JOUR A1 - Sedaghat-Hamedani, Farbod A1 - Rebs, Sabine A1 - El-Battrawy, Ibrahim A1 - Chasan, Safak A1 - Krause, Tobias A1 - Haas, Jan A1 - Zhong, Rujia A1 - Liao, Zhenxing A1 - Xu, Qiang A1 - Zhou, Xiaobo A1 - Akin, Ibrahim A1 - Zitron, Edgar A1 - Frey, Norbert A1 - Streckfuss-Bömeke, Katrin A1 - Kayvanpour, Elham T1 - Identification of SCN5a p.C335R variant in a large family with dilated cardiomyopathy and conduction disease JF - International Journal of Molecular Sciences N2 - Introduction: Familial dilated cardiomyopathy (DCM) is clinically variable and has been associated with mutations in more than 50 genes. Rapid improvements in DNA sequencing have led to the identification of diverse rare variants with unknown significance (VUS), which underlines the importance of functional analyses. In this study, by investigating human-induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs), we evaluated the pathogenicity of the p.C335R sodium voltage-gated channel alpha subunit 5 (SCN5a) variant in a large family with familial DCM and conduction disease. Methods: A four-generation family with autosomal dominant familial DCM was investigated. Next-generation sequencing (NGS) was performed in all 16 family members. Clinical deep phenotyping, including endomyocardial biopsy, was performed. Skin biopsies from two patients and one healthy family member were used to generate human-induced pluripotent stem cells (iPSCs), which were then differentiated into cardiomyocytes. Patch-clamp analysis with Xenopus oocytes and iPSC-CMs were performed. Results: A SCN5a variant (c.1003T>C; p.C335R) could be detected in all family members with DCM or conduction disease. A novel truncating TTN variant (p.Ser24998LysfsTer28) could also be identified in two family members with DCM. Family members with the SCN5a variant (p.C335R) showed significantly longer PQ and QRS intervals and lower left ventricular ejection fractions (LV-EF). All four patients who received CRT-D were non-responders. Electrophysiological analysis with Xenopus oocytes showed a loss of function in SCN5a p.C335R. Na\(^+\) channel currents were also reduced in iPSC-CMs from DCM patients. Furthermore, iPSC-CM with compound heterozygosity (SCN5a p.C335R and TTNtv) showed significant dysregulation of sarcomere structures, which may be contributed to the severity of the disease and earlier onset of DCM. Conclusion: The SCN5a p.C335R variant is causing a loss of function of peak INa in patients with DCM and cardiac conduction disease. The co-existence of genetic variants in channels and structural genes (e.g., SCN5a p.C335R and TTNtv) increases the severity of the DCM phenotype. KW - familial DCM KW - conduction disease KW - SCN5a Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-284442 SN - 1422-0067 VL - 22 IS - 23 ER - TY - JOUR A1 - Ziegler, Alice A1 - Meyer, Hanna A1 - Otte, Insa A1 - Peters, Marcell K. A1 - Appelhans, Tim A1 - Behler, Christina A1 - Böhning-Gaese, Katrin A1 - Classen, Alice A1 - Detsch, Florian A1 - Deckert, Jürgen A1 - Eardley, Connal D. A1 - Ferger, Stefan W. A1 - Fischer, Markus A1 - Gebert, Friederike A1 - Haas, Michael A1 - Helbig-Bonitz, Maria A1 - Hemp, Andreas A1 - Hemp, Claudia A1 - Kakengi, Victor A1 - Mayr, Antonia V. A1 - Ngereza, Christine A1 - Reudenbach, Christoph A1 - Röder, Juliane A1 - Rutten, Gemma A1 - Schellenberger Costa, David A1 - Schleuning, Matthias A1 - Ssymank, Axel A1 - Steffan-Dewenter, Ingolf A1 - Tardanico, Joseph A1 - Tschapka, Marco A1 - Vollstädt, Maximilian G. R. A1 - Wöllauer, Stephan A1 - Zhang, Jie A1 - Brandl, Roland A1 - Nauss, Thomas T1 - Potential of airborne LiDAR derived vegetation structure for the prediction of animal species richness at Mount Kilimanjaro JF - Remote Sensing N2 - The monitoring of species and functional diversity is of increasing relevance for the development of strategies for the conservation and management of biodiversity. Therefore, reliable estimates of the performance of monitoring techniques across taxa become important. Using a unique dataset, this study investigates the potential of airborne LiDAR-derived variables characterizing vegetation structure as predictors for animal species richness at the southern slopes of Mount Kilimanjaro. To disentangle the structural LiDAR information from co-factors related to elevational vegetation zones, LiDAR-based models were compared to the predictive power of elevation models. 17 taxa and 4 feeding guilds were modeled and the standardized study design allowed for a comparison across the assemblages. Results show that most taxa (14) and feeding guilds (3) can be predicted best by elevation with normalized RMSE values but only for three of those taxa and two of those feeding guilds the difference to other models is significant. Generally, modeling performances between different models vary only slightly for each assemblage. For the remaining, structural information at most showed little additional contribution to the performance. In summary, LiDAR observations can be used for animal species prediction. However, the effort and cost of aerial surveys are not always in proportion with the prediction quality, especially when the species distribution follows zonal patterns, and elevation information yields similar results. KW - biodiversity KW - species richness KW - LiDAR KW - elevation KW - partial least square regression KW - arthropods KW - birds KW - bats KW - predictive modeling Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-262251 SN - 2072-4292 VL - 14 IS - 3 ER -