Medizinische Hochschule Research Articles

Global Research Trends and Future Direction in Peripartum Cardiomyopathy: A Bibliometric Analysis.

Peripartum cardiomyopathy (PPCM) is a pregnancy-related myocardial disease. PPCM has a high morbidity and mortality rate, but neither partial nor complete recovery is highly probable. To analyze global scientific production and identify research hotspots related to PPCM. The keyword "peripartum cardiomyopathy" was used to retrieved articles from Scopus database. A total of 509 articles were extracted. We used Scopus database analysis report and VOSviewer (version 1.6.18) to analyze annual publication number, country, citation and H-index, authors, institution, source journal, reference, and research hotspot. The trend of annual publication numbers has increased significantly, with the United States leading the amounts of publication and H-index in PPCM study. Hilfiker-Kleiner, D. contributed the most publications and the most active institution was Medizinische Hochschule Hannover MHH. By employing an overlay visualization, we shed light on the evolving research emphases, wherein prominent topics such as "diagnostic imaging" and "practical guidelines" have emerged as major areas of focus in recent years. From 1971 to 2022, numbers of publications in PPCM research have increased gradually, and this trend is predicted to keep arising. Recent studies are becoming more focused on diagnostic imaging and practical guidelines. In the future, expanding global collaboration and conducting more in-depth studies are needed.

8.C. Round table: Round table: COVID-19: What have we learned? What are the public health challenges?

If there ever was a public health problem where we could learn a lot about public health research, practice, policy and communication, it is the COVID-19 pandemic. With increased knowledge about the spread, the prevention measures, treatment and vaccination, a lot of research on COVID-19 has been and is being published. Looking for COVID-19 articles on google scholar leads to over 3.6 million articles found. Nearly all research published on COVID-19 has been made publicly accessible to allow the latest research to be available for politicians, policymakers, practitioners and laymen.The quality of the research is sometimes good, sometimes less good (see our recent viewpoints https://academic.oup.com/eurpub/issue/30/5?browseBy=volume). But with the increase in research, it becomes more difficult to find which research is old, outdated and which is new.Furthermore, all sorts of media have covered the pandemic extensively, in many journals one can find very good reviews and articles by serious journalists, but in many cases, also rumours, guesses and fake news. On top of becoming tired of information overload, it is also more and more difficult to keep track of the development of the research. EUPHA - therefore - decided to publish a supplement to the European Journal of Public Health looking at specific health issues and specific groups that were affected by the pandemic. The supplement aims to present short summaries and updates on some key issues of public health relevance. Topics included range from environment, mental health, legal and ethical issues, health workforce, health inequalities, accountability, opening up the economy and such.In this Round Table, we will have a number of authors from the EJPH supplement to discuss their findings and find some common grounds on what we have learned from COVID-19 and how to move forward.Speakers/Panelists Martin McKee LSHTM, London, UK Elena Petelos Clinic of Social and Family Medicine, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece Julian Mamo Public Health Department, University of Malta, Valletta, Malta Ellen Kuhlmann Medizinische Hochschule Hannover, Hannover, Germany Els Maeckelberghe Wenckebach Institute for Medical Education and Training, University Medical Center Groningen, Groningen, Netherlands Key messages Learning from this pandemic for future planning is essential.Touching all fields affected by COVID-19 to plan for the future is necessary.

Welcome Address

Welcome Address

The intricate microchannel structure of the human femoral head

Purpose: The presence of a subchondral channel-like microstructure that provides a direct link between articular cartilage (AC) and deeper trabecular bone has been confirmed in a handful of classic literature. Referred to as "defects” or "breaks", they are not yet three-dimensionally visualized or characterized, despite their potential importance in understanding osteoarthritis (OA) progression/initiation. Here, we demonstrate the intricate 3D microstructure of the subchondral bone (SCB) channels in healthy human femoral head, and their region-dependent pattern. The microchannels are quantified in terms of average number (Ch.N), thickness (Ch.Th), as well as their correlation to the subchondral bone plate, and cartilage thicknesses. Methods: Human femurs from the anatomical gift program of the Medizinische Hochschule Hannover (MHH) were kindly provided to us. They were independently graded by three orthopaedic surgeons according to the Outerbridge classification system, and subsequently, five healthy female joints were selected. 44 measuring points were systematically defined on each sample. They were the intersections of two sets of geometrical features that were drawn on the femoral heads: 1) Twelve concentric lines, each separated by a 30°-angle interval, starting from the center (C) of the femoral head and ending on the neck junction. 2) four parallel parasagittal planes, which divided the arc between the C and the neck junctions into four equally-spaced regions. The location of each set of measuring points was standardized using a template grid, taking into account the normalized size of each femoral head. Cylindrical specimens (n=220, D=2.00 mm) were then drilled out from each sample and scanned using a high-definition micro-CT system (μCT 50, SCANCO Medical AG, Switzerland; voxel size=1.2 μm, source voltage=90 kVp, intensity=88 μA). The SCB channels were segmented and analyzed using appropriate evaluation scripts and threshold setting. 5-m thick sagittal sections of hip joint were cut and processed for toluidine blue and hematoxylin and eosin (H&E) staining. Sections were also incubated with primary antibodies against CD31 (ab28364, Abcam, 1:100), von Willebrand Factor (vWF, Dako, 1:200), calcitonin receptor (ab11042, Abcam, 1:75), and collagen type I (ab34710, Abcam, 1:200), and then processed for immunohistochemical staining using standard protocols. Statistical evaluation was carried out using SPSS package (IBM SPSS, version 25.0). Results: The data were categorized into three groups based on the contact area of the femoral head with the acetabulum: load-bearing region (LBR), non-load-bearing region (NLBR), and partial contact (PC). The microchannels showed a strong region-dependent architecture. They were abundant and small (Ch.N = 34.2 ± 11.3 1/mm; Ch.Th = 26 ± 16 μm) on the LBR, perpendicularly connecting SCB's surface to deeper trabecular spacing, while scarce and relatively thick (Ch.N = 3.7 ± 1.3 1/mm; Ch.Th = 168 ± 82 μm) on the NLBR of the femoral head. The area where the femoral head and acetabulum were only partially in contact (PC) showed a combination of thick and small channels (Ch.N = 19.6 ± 7.7 1/mm; Ch.Th = 75 ± 53 μm). The mean AC thickness was positively correlated (Pearson’s r = 0.43) with the number of microchannels (LBR: 696 ± 209 μm, PC: 575 ± 162 μm, NLBR: 315 ± 124 μm). H&E staining of the subchondral zone showed that articular cartilage was occasionally extended through the calcified cartilage and marrow spaces. Likewise, immunohistochemistry results demonstrated positive expression for vWF inside microchannels, a specific marker for endothelial cells. Conclusions: Our results demonstrate that an intricate microchannel structure exists in the subchondral bone of the human femoral head. The number, width, and distribution pattern of the channels is strongly region-dependent. The positive correlation of microchannel numbers with AC thickness in healthy femurs shows that they might play a dynamic role in the nutrition of AC.

Editorial introductions

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Gernot MarxGernot MarxDr Gernot Marx, MD, FRCA, is full Professor of Anesthesiology and Critical Care Medicine and Chair at the University RWTH Aachen, Germany. He is Head of the Department of Intensive Care Medicine and Intermediate Care at the University Hospital RWTH Aachen. He is Chairman of the Board of the German Society of Telemedicine. He is full Board Member of the German Society of Anaesthesia and Intensive Care and full Board Member of the German Interdisciplinary Society of Intensive Care and Emergency Medicine. He graduated and took his residency at the Medizinische Hochschule Hannover, Germany. He was Senior Lecturer in Anaesthesia and Intensive Care Medicine at the University of Liverpool, UK, and full Professor for Anaesthesiology, Intensive Care and Emergency Medicine at the Friedrich-Schiller-Universität Jena, Germany. He received the Fellowship by election of the Royal College of Anaesthetists. His research interest is focused on sepsis, fluid therapy and telemedicine. He is Editor of two books, Checklist Intensive Care Medicine and The Intensive Care Medicine. He is Editor in Chief of intensivup2date, Editor of AINS (Anaesthesiologie Intensivmedizin Notfallmedizin Schmerztherapie) and Associate Editor of British Journal of Anaesthesia. Stanley H. RosenbaumStanley H. RosenbaumStanley H. Rosenbaum, MA, MD, is Professor of Anesthesiology, Internal Medicine and Surgery at Yale University School of Medicine, USA. He is the Vice Chairman for Academic Affairs and the Director of the Division of Perioperative and Adult Anesthesia in the Department of Anesthesiology. Dr Rosenbaum has had a long career doing research and publishing numerous papers, monographs and textbooks on various aspects of anesthesiology, critical care medicine and medical ethics. In 2011 he was awarded the Lifetime Achievement Award of the Society of Critical Care Anesthesiologists. Kai ZacharowskiKai ZacharowskiProfessor Kai Zacharowski, MD, PhD, ML, FRCA, holds the position of the Ordinarius and is the Director of the Department of Anesthesia, Intensive Care Medicine and Pain Therapy at the University Hospital Frankfurt, Germany, since 2009. From 2006 until 2008 he was the Chair of Anesthesia and Intensive Care Medicine at the University Hospital Bristol, UK. His research, teaching, and consulting interests are in both clinical and basic aspects of patient safety, transfusion and clotting, innate immunity, cardiovascular and critical care medicine. Professor Zacharowski received his MD from the German University of Mainz, Germany, and his PhD from Queen Mary, University of London, UK, where he was working with the Nobel laureate Prof Sir John Vane who discovered how aspirin works. His scientific contributions have been published in peer-reviewed journals such as Nature Medicine, Lancet, NEJM and Proceedings of the National Academy of Science and were awarded with numerous awards for Innovative Clinical Research. He is serving as Editor-in-Chief for the Journal of Anesthesia & Intensive Care Medicine as well as an Editorial Board member of numerous journals in Critical Care Medicine, Emergency Medicine and Anesthesia and is the CEO of the Lohfert Foundation. He is practicing Anesthesia and Critical Care Medicine in Frankfurt.

Promoting Hand Hygiene Compliance: PSYGIENE—a Cluster-Randomized Controlled Trial of Tailored Interventions

The German "Clean Hands Campaign" (an adaptation of the WHO "Clean Care is Safer Care" programme) to promote hand hygiene among hospital personnel at Hannover Medical School (MHH, Medizinische Hochschule Hannover), known as Aktion Saubere Hände (ASH), met with initial success. By 2013, however, compliance rates with hygienic hand disinfection in the hospital's ten intensive care units (ICUs) and two hematopoietic stem cell transplantation units (HSCTUs) had relapsed to their initial levels (physicians: 48%; nurses: 56%). The cluster- randomized controlled trial PSYGIENE was conducted to investigate whether interventions tai - lored in ways suggested by research in behavioral psychology might bring about more sustainable improvements than the ASH. The "Health Action Process Approach" (HAPA) compliance model specifies key psychological determinants of compliance. These determinants were assessed among health care workers in the ICUs and HSCTUs of the MHH by questionnaire (response rates: physicians: 71%; nurses: 63%) and by interviews of the responsible ward physicians and head nurses (100%). In 2013, 29 tailored behavior change techniques were implemented in educational training sessions and feedback discussions in the six wards that constituted the intervention arm of the trial, while ASH training sessions were provided in the control arm. The compliance rates for 2014 and 2015 (the primary outcomes of the trial) were determined by nonparticipating observation of hygienic hand disinfection, in accordance with the World Health Organization's gold standard. The two groups did not differ in their baseline compliance rates in 2013 (intervention: 54%, control: 55%, p = 0.581). The tailored interventions led to increased compliance in each of the two follow-up years (2014: 64%, p<0.001; 2015: 70%, p = 0.001), while the compliance in the control arm increased to 68% in 2014 (p<0.001) but fell back to 64% in 2015 (p = 0.007). The compliance increases from 2013-2015 and the compliance rate in 2015 were higher in the intervention arm (p<0.005). This was mainly attributable to the nurses' behavior, as the corresponding parameters for physicians did not differ significantly between the two study arms in stratified analysis. Tailored interventions based on behavioral psychology principles led to more sustainable increases in compliance with hand hygiene guidelines than ASH training sessions did. This was true among nurses, and thus also for hospital ward personnel as a whole (i.e., nurses and physicians combined). Further studies are needed to identify more target group-specific interventions that may improve compliance among physicians.

Adherence of Pseudomonas aeruginosa to cystic fibrosis buccal epithelial cells.

Pseudomonas aeruginosa cystic fibrosis buccal adherence assay http://ow.ly/lPtB306VKIQ

Asistencia ventricular izquierda para terapia de destino: primera experiencia en septuagenarios

ObjectivesThe number of elderly patients suffering from congestive heart failure has increased dramatically in recent years. In the context of global stagnation of heart transplantation, comes the need for an alternative definitive therapy for these patients. Recently left ventricular assist devices (LVAD) have increased significantly, surpassing even the number of transplants worldwide. The technological development of new devices and the emergence of new surgical techniques arising from minimally invasive cardiac surgery have been part of this development. The purpose of this study was to review the first series of minimally invasive LVAD implants in septuagenarian patients. MethodsA prospective single-centre clinical trial was conducted on all patients greater than or equal to 70 years that required an LVAD implant (HVAD, HeartWare Inc.) as destination therapy for the years 2013 to 2015 in the Medizinische Hochschule Clinic in Hannover. The monitoring ended after two years. All patients were operated by a minimally invasive technique consisting of a “J” mini-sternotomy and a left lateral thoracotomy. ResultsA total of 14 patients were included (age 71.8 ± 1.5 years, all (100%) males, and 64.3% with ischaemic heart disease). It was a second operation for 50% of the cases, and 7.1% received a prior mechanical circulatory assist device (MCAD). All patients were operated on using extracorporeal circulation (ECC) for a mean time of 51 ± 8 min). The mean length of stay in ICU was 6.4 ± 5.2 days. Adverse events during the early post-operative period included, surgical re-intervention due to bleeding (7.1%), right ventricular failure (14.3%), and dialysis (14.3%). Survival rates were: 30 days: 85.7% 1 year: 78.6% 2 years: 70.7%. ConclusionsThe initial results show that minimally invasive implantation of LVAD can be performed effectively, safely, and with good results in septuagenarian patients as destination therapy. There were low levels of adverse events during a two year follow-up, showing that destination therapy can be performed even in patients in their seventies.

Editorial introductions

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Gernot MarxFigureDr Gernot Marx, MD, FRCA is full Professor of Anesthesiology and Critical Care Medicine and Chair at the University RWTH Aachen, Germany. He is Head of the Department of Intensive Care Medicine and Intermediate Care at the University Hospital RWTH Aachen. He is full board member of the German Society of Anaesthesia and Intensive Care and full board member of the interdisciplinary German Society of Intensive Care and Emergency Medicine. He graduated and took his residency at the Medizinische Hochschule Hannover in Germany. He was Senior Lecturer in Anaesthesia and Intensive Care Medicine at the University of Liverpool, UK and full Professor for Anaesthesiology, Intensive Care and Emergency Medicine at the Friedrich-Schiller-Universität Jena, Germany. He received the Fellowship by election of the Royal College of Anaesthetists. His research interest is focused on sepsis, fluid therapy and telemedicine. He is Editor of two books, Checklist Intensive Care Medicine and The Intensive Care Medicine. He is Editor of AINS (Anaesthesiologie Intensivmedizin Notfallmedizin Schmerztherapie) and Associate Editor of British Journal of Anaesthesia. Hartmut BürkleFigureHartmut Bürkle, MD, PhD is full Professor of Anesthesiology and Critical Care Medicine, and Chair of the Department of Anesthesiology and Intensive Care Medicine at the University Medical Center Freiburg, Germany. After his residency in Anesthesiology in Hamburg and a postdoctoral fellowship at the UCSD, San Diego (Prof T. L. Yaksh) he joined Prof Hugo Van Aken[Combining Acute Accent]s anesthesia and intensive care medicine group in Muenster, Germany. His research interests are centered on regional anesthesia techniques, perioperative pain therapy and perioperative rehabilitation, highlighting patient's outcome. During the last decade, he has also focused on the development of safe anesthesia strategies, the economical and ethical issues of modern health systems related to anesthesia and intensive care medicine, as well as on implementing peer reviewed quality care in anesthesiology and intensive care medicine. He has published more than 120 studies and acted as reviewer for most of the national and international journals of anesthesiology and intensive care medicine. Kai ZacharowskiFigureProfessor Kai Zacharowski holds the position of the Ordinarius and is the Director of the Department of Anesthesia, Intensive Care Medicine and Pain Therapy at the University Hospital Frankfurt. His research, teaching, and consulting interests are in both clinical and basic aspects of patient safety, transfusion and clotting, innate immunity, cardiovascular and critical care medicine. Professor Zacharowski received his MD from the German University of Mainz and his PhD from Queen Mary, University of London (where he was working with the Nobel laureate Prof Sir John Vane → discovered how aspirin works). His scientific contributions are published in peer-reviewed journals such as Nature Medicine, Lancet, NEJM and Proceedings of the National Academy of Science and were awarded with numerous awards for Innovative Clinical Research. He is serving as Editor-in-Chief for the Journal of Anesthesia & Intensive Care Medicine as well as an Editorial Board member of numerous journals in Critical Care Medicine, Emergency Medicine and Anesthesia. He obtained 2 clinical specializations (Anesthesia/Intensive Care Medicine and Clinical Pharmacology) and is practicing Anesthesia and Critical Care Medicine in Frankfurt.

Computed tomography overexposure as a consequence of extended scan length.

This study aimed to raise awareness around the increased effective dose as scan length chosen is increased from standard protocol The Monte Carlo-based software CT-Expo (G. Stamm (Medizinische Hochschule Hannover, Hannover, Germany) and H.D. Nagel (SASCRAD, Buchholz, Germany)) was used to simulate the effective dose increase as the scanned region of the standard protocol increased. The results of this study show that for scans with a high computed tomography dose index (CTDI)vol the patient could be exposed to an extra 1 mSv within 6 cm of overscan. Protocols that investigated large scan areas may not see a significant relative dose reduction because of the use of a lower CTDIvol ; however, radiation exposure should be kept as low as reasonably achievable. There is significant dose optimisation potential when strictly adhering to appropriate scan lengths within each imaging protocol wherever possible.

Influence of time of day of blood pressure-lowering treatment on the risk of developing new-onset diabetes

Baroreflex activation therapy safely reduces blood pressure for at least five years in a large resistant hypertension cohort George Bakris,y,3 Mitra Nadim, Herman Haller, Eric Lovett, John Bisognano. CVRx, Minneapolis, MN, United States; Medizinische Hochschule Hannover, Hannover, Germany; The University of Chicago Medicine, Chicago, IL, United States; The University of Rochester, Rochester, NY, United States; University of Southern California, Los Angeles, CA, United States

Baroreflex activation therapy safely reduces blood pressure for at least five years in a large resistant hypertension cohort

Baroreflex activation therapy safely reduces blood pressure for at least five years in a large resistant hypertension cohort George Bakris,y,3 Mitra Nadim, Herman Haller, Eric Lovett, John Bisognano. CVRx, Minneapolis, MN, United States; Medizinische Hochschule Hannover, Hannover, Germany; The University of Chicago Medicine, Chicago, IL, United States; The University of Rochester, Rochester, NY, United States; University of Southern California, Los Angeles, CA, United States

Konservative Kalibrierung eines Freimesssystems für Reststoffe aus dem nuklearmedizinischen Betrieb

Clearance monitor systems are used for gross gamma measurements of waste potentially contaminated with radioactivity. These measurements are to make sure that legal requirements, e.g. clearance criteria according to the german radiation protection ordinance, are met. This means that measurement results may overestimate, but must not underestimate the true values. This paper describes a pragmatic way using a calibrated Cs-137 point source to generate a conservative calibration for the clearance monitor system used in the Medizinische Hochschule Hannover (MHH). The most important nuclides used in nuclear medicine are considered. The measurement result reliably overestimates the true value of the activity present in the waste. The calibration is compliant with the demands for conservativity and traceability to national standards.

Isolated acute bilateral ophthalmoplegia as a form of anti-GQ1b syndrome - a case report and differential diagnostic considerations

WCN 2013 No: 1101 Topic: 7 — Neuromuscular disorders Isolated acute bilateral ophthalmoplegia as a form of anti-GQ1b syndrome a case report and differential diagnostic considerations A. Toth, G. Aradi, I. Vastagh, K. Pozsegovits, L. Rencz, D. Bereczki, Z. Aranyi. Department of Neurology, Semmelweis University, Faculty of Medicine, Budapest, Hungary; Department of Neurology, Dr. Kenessey Albert Hospital, Balassagyarmat, Hungary Background: Isolated acute bilateral ophthalmoplegia is an uncommon occurrence, but it may cause differential diagnostic problems. It may be a manifestation of the Miller Fisher syndrome spectrum, which has been recently referred to as anti-GQ1b syndrome. Objective: To present a case with acute bilateral ophthalmoplegia associated with anti-GQ1b antibody positivity, but without other typical signs of Miller Fisher syndrome (MFS). Differential diagnostic aspects are highlighted. Patient: A 57-year-old female patient presented with an acute onset of diplopia, progressing to bilateral ophthalmoplegia within days. These symptoms were preceded by flu-like symptoms. Deep tendon reflexes were diminished, otherwise her neurological status was unremarkable, the typical triad of MFSwas not observed. MRI of the brain was normal. Cerebrospinal fluid examination revealed increased protein content with normal cell count. Electrophysiological assessment showed normal sensory nerve action potentials, whereas low amplitude or absent sensory nerve action potentials are characteristic findings in MFS. Serological testing confirmed anti-GQ1b class IgG antibody positivity, supporting the diagnosis of MFS spectrum. The patient fully recovered within 3 months, without any specific treatment, showing the benign nature of the condition. Discussion: Acute ophthalmoparesis may be a restricted form antiGQ1b syndrome. In addition to classical MFS, further variants include Bickerstaff's brainstem encephalitis, pharyngeal-cervical-brachial paresis, and acute ataxic sensory neuropathy. Although acute ophthalmoparesis as a manifestation of anti-GQ1b syndrome is a benign condition, it may cause differential diagnostic problems with potentially more serious conditions needing prompt treatment, such as Wernicke's encephalopathy, ocularmyasthenia, botulism, paraneoplastic brainstemencephalitis, or brainstem stroke. doi:10.1016/j.jns.2013.07.1569 Abstract — WCN 2013 No: 1413 Topic: 7 — Neuromuscular disorders “Reporting biomarker” development: Update in als patients treated with G-CSF -mobilized hematopoietic stem cells WCN 2013 No: 1413 Topic: 7 — Neuromuscular disorders “Reporting biomarker” development: Update in als patients treated with G-CSF -mobilized hematopoietic stem cells A.V. Khomenko, D. Baldaranov, J. Grassinger, S.W. Johannesen, I. Kobor, J. Roesl, K. Kollewe, S. Petri, R. Dengler, M. Deppe, A. Ludolph, J. Kassubek, G. Schuierer, T. Bruun, W. Schulte-Mattler, U. Bogdahn. Department of Neurology, University of Regensburg, Regensburg, Germany; Department of Haematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany; Clinic for Neurology, Medizinische Hochschule Hannover, Hannover, Germany; Department of Neurology, University of Muenster, Muenster, Germany; Neurological University Clinic, University Ulm, Ulm, Germany; Department of Neuroradiology, University of Regensburg,

Interleukin 17 receptor A regulates renal inflammation and aggravates fibrosis

Event Abstract Back to Event Interleukin 17 receptor A regulates renal inflammation and aggravates fibrosis Shuwang Ge1, Barbara Hertel1, Hermann Haller1 and Sibylle Von Vietinghoff1* 1 Medizinische Hochschule Hannover, Germany Background: The T cell cytokine IL-17 is an important pro-inflammatory mediator. We have previously shown IL-17 receptor expression on monocytes and a role of IL-17 in macrophage accumulation in peritonitis. We here investigated the role of the IL-17 receptor on myeloid cells in chronic renal inflammation and fibrosis. Methods: Renal interstitial fibrosis was induced by unilateral urethral obstruction in mice reconstituted with Il17ra-/- or control bone marrow or a mixture of both. Renal leukocytes were assessed by flow cytometry, and kidney damage was scored by HE and sirius red staining. Results: Il17ra-/- macrophages were significantly less abundant than wt cells in in the control, and much more markedly the obstructed kidney. Obstruction increased CD11c and F4/80 expression. This phenotype was significantly less pronounced in the cells deficient in IL-17 signaling. The proportion of fibrotic tissue area was significantly lower in mice reconstituted with Il17ra-/- bone marrow than mice with wt bone marrow. Conclusion: Lack of IL-17 receptor A on the myeloid cells significantly alters inflammation and diminishes fibrosis in renal obstruction. Keywords: IL-17, Fibrosis, Monocytes, IL-17 receptor, Inflammation Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Innate immunity Citation: Ge S, Hertel B, Haller H and Von Vietinghoff S (2013). Interleukin 17 receptor A regulates renal inflammation and aggravates fibrosis. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.00015 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 08 Mar 2013; Published Online: 22 Aug 2013. * Correspondence: Dr. Sibylle Von Vietinghoff, Medizinische Hochschule Hannover, Hannover, Germany, vonvietinghoff.sibylle@mh-hannover.de Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Shuwang Ge Barbara Hertel Hermann Haller Sibylle Von Vietinghoff Google Shuwang Ge Barbara Hertel Hermann Haller Sibylle Von Vietinghoff Google Scholar Shuwang Ge Barbara Hertel Hermann Haller Sibylle Von Vietinghoff PubMed Shuwang Ge Barbara Hertel Hermann Haller Sibylle Von Vietinghoff Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Hepatitis E virus infection: Multiple faces of an underestimated problem

A major breakthrough in HEV research was the successful development of an HEV vaccine (HEV-239) which has been licensed in China in early 2012. This vaccine showed a vaccine efficacy of 94-100% in preventing acute symptomatic cases of hepatitis E [5]. However, it still needs to be determined if HEV-239 is also effective in patients with chronic liver disease or subjects receiving immunosuppressive medications Hepatitis E virus infection: Multiple faces of an underestimated problem Sven Pischke, Heiner Wedemeyer* Medizinische Hochschule Hannover, Hannover, Germany *Corresponding author. Address: Medizinische Hochschule Hannover, Hannover, Germany *E-mail address: wedemeyer.heiner@mh-hannover.de

Organ doses, effective doses, and risk indices in adult CT: Comparison of four types of reference phantoms across different examination protocols

Radiation exposure from computed tomography (CT) to the public has increased the concern among radiation protection professionals. Being able to accurately assess the radiation dose patients receive during CT procedures is a crucial step in the management of CT dose. Currently, various computational anthropomorphic phantoms are used to assess radiation dose by different research groups. It is desirable to better understand how the dose results are affected by different choices of phantoms. In this study, the authors assessed the uncertainties in CT dose and risk estimation associated with different types of computational phantoms for a selected group of representative CT protocols. Routinely used CT examinations were categorized into ten body and three neurological examination categories. Organ doses, effective doses, risk indices, and conversion coefficients to effective dose and risk index (k and q factors, respectively) were estimated for these examinations for a clinical CT system (LightSpeed VCT, GE Healthcare). Four methods were used, each employing a different type of reference phantoms. The first and second methods employed a Monte Carlo program previously developed and validated in our laboratory. In the first method, the reference male and female extended cardiac-torso (XCAT) phantoms were used, which were initially created from the Visible Human data and later adjusted to match organ masses defined in ICRP publication 89. In the second method, the reference male and female phantoms described in ICRP publication 110 were used, which were initially developed from tomographic data of two patients and later modified to match ICRP 89 organ masses. The third method employed a commercial dosimetry spreadsheet (ImPACT group, London, England) with its own hermaphrodite stylized phantom. In the fourth method, another widely used dosimetry spreadsheet (CT-Expo, Medizinische Hochschule, Hannover, Germany) was employed together with its associated male and female stylized phantoms. For fully irradiated organs, average coefficients of variation (COV) ranged from 0.07 to 0.22 across the four male phantoms and from 0.06 to 0.18 across the four female phantoms; for partially irradiated organs, average COV ranged from 0.13 to 0.30 across the four male phantoms and from 0.15 to 0.30 across the four female phantoms. Doses to the testes, breasts, and esophagus showed large variations between phantoms. COV for gender-averaged effective dose and k factor ranged from 0.03 to 0.23 and from 0.06 to 0.30, respectively. COV for male risk index and q factor ranged from 0.06 to 0.30 and from 0.05 to 0.36, respectively; COV for female risk index and q factor ranged from 0.06 to 0.49 and from 0.07 to 0.54, respectively. Despite closely matched organ mass, total body weight, and height, large differences in organ dose exist due to variation in organ location, spatial distribution, and dose approximation method. Dose differences for fully irradiated radiosensitive organs were much smaller than those for partially irradiated organs. Weighted dosimetry quantities including effective dose, male risk indices, k factors, and male q factors agreed well across phantoms. The female risk indices and q factors varied considerably across phantoms.

Multimodal and multilevel approaches: key elements in preventive interventions

The social context in which children develop is a key determinant of their health. The social background tells us something about a child’s welfare and chances of growing up healthy. Moreover, it gives us clues as to which target groups should be a particular focus of our attention when implementing preventive interventions (Marmot et al. 2010). Children from low-income families with low education levels generally have poorer health and more psychological problems than their age-matched peers from highincome families with higher education levels. Thus, education level is an important factor. There is a reciprocal relationship between education and health. A recent review of over 50 publications by the World Health Organization revealed some interesting findings (Suhrcke and de Paz 2011) — good general health during childhood has a positive effect on education background and educational attainment. Consequently, poor health has a negative effect on education for the individual child. Children in poor health spend up to one-third more time in the school system than healthy children, and healthy children complete school with higher levels of education. Furthermore, it was shown that poor nutrition and smoking in particular have a negative effect on education. Likewise, the evidence indicates that obesity and overweight are negatively associated with educational outcomes, and that frequent sleeping problems in childhood can hinder academic performance. Conversely, physical activity has a positive impact on academic performance. By comparison, the effects of anxiety and depression on education are under-researched. The authors conclude that the available data provides sufficient evidence for the influence of health on education. Their findings underline the need to invest not only in the education of children, but also in their health and in prevention chains, particularly at the local level, right from the beginning. One-dimensional models do not adequately reflect the complexity of factors involved here. Models for the prevention of overweight and obesity, the etiology of which is not completely understood, made this extremely clear. WeimerJehle, Deuschle and Rehaag, who created a causal loop model to identify key factors for prevention in socially disadvantaged children and adolescents, concluded that there is no one specific factor that can be expected to act as an effective prevention factor for every scenario. Instead, a multi-level perspective is needed which takes into account the specific characteristics of an individual’s environment. Behavioural and structural prevention strategies exist, and Pawils, Atabaki, Metzner, Nocker, Linden, Plaumann and Walter provide an overview of the German and European approaches. Other examples are shown in the different U. Walter (*) Institut fur Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany e-mail: Walter.Ulla@MH-Hannover.de

Comparison of computed tomography dose reporting software

Computed tomography (CT) dose reporting software facilitates the estimation of doses to patients undergoing CT examinations. In this study, comparison of three software packages, i.e. CT-Expo (version 1.5, Medizinische Hochschule, Hannover, Germany), ImPACT CT Patients Dosimetry Calculator (version 0.99×, Imaging Performance Assessment on Computed Tomography, www.impactscan.org) and WinDose (version 2.1a, Wellhofer Dosimetry, Schwarzenbruck, Germany), has been made in terms of their calculation algorithm and the results of calculated doses. Estimations were performed for head, chest, abdominal and pelvic examinations based on the protocols recommended by European guidelines using single-slice CT (SSCT) (Siemens Somatom Plus 4, Erlangen, Germany) and multi-slice CT (MSCT) (Siemens Sensation 16, Erlangen, Germany) for software-based female and male phantoms. The results showed that there are some differences in final dose reporting provided by these software packages. There are deviations of effective doses produced by these software packages. Percentages of coefficient of variance range from 3.3 to 23.4 % in SSCT and from 10.6 to 43.8 % in MSCT. It is important that researchers state the name of the software that is used to estimate the various CT dose quantities. Users must also understand the equivalent terminologies between the information obtained from the CT console and the software packages in order to use the software correctly.

66 Allogeneic stem-cell transplantation in chronic myelomonocytic leukemia (CMML): Factors affecting transplantation outcome. A study of the CLWP of the EBMT

66 Allogeneic stem-cell transplantation in chronic myelomonocytic leukemia (CMML): Factors affecting transplantation outcome. A study of the CLWP of the EBMT