Magdeburg, Germany
Magdeburg, Germany

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Scharnholz B.,University of Heidelberg | Gilles M.,University of Heidelberg | Marzina A.,University of Mannheim | Kommer M.,University of Mannheim | And 9 more authors.
Psychoneuroendocrinology | Year: 2014

This study compared features of the metabolic syndrome between healthy controls and depressed patients without activation of the hypothalamus-pituitary-adrenal (HPA) system. After exclusion of non-suppressors to 1. mg dexamethasone, we included 20 depressed inpatients and 34 healthy controls in the analyses. We assessed HPA system activity (diurnal saliva cortisol profile, cortisol excretion), normetanephrine excretion as well as fasting glucose, lipid profile and blood pressure. With regard to body composition, we measured waist circumference as well as visceral fat and adrenal volume by magnetic resonance (MR) imaging. Five depressed patients (25%) and five healthy controls (15%) fulfilled the criteria of the metabolic syndrome according NCEP-ATP-III. Depression was significantly related with fasting glucose and negatively associated with mean blood pressure (BP) and, by trend, with low HDL-cholesterol. We conclude that depressed patients may have modest metabolic disturbances even in the complete absence of activation of stress-responsive systems. Hence some metabolic disturbances in depressed patients may not be explicable by HPA activation. Additional factors are required to mediate the link between affective and metabolic disorders. © 2013 Elsevier Ltd.


Heinz J.,Institute of Clinical Chemistry | Westphal S.,Institute of Clinical Chemistry | Borucki K.,Institute of Clinical Chemistry | Luley C.,Magdeburg University Hospital | Dierkes J.,Institute of Clinical Chemistry
Circulation | Year: 2010

Background-In observational studies, hyperhomocysteinemia has been found to be a risk factor for total mortality and cardiovascular events in patients with end-stage renal disease. These patients have grossly elevated homocysteine levels that can be lowered by supplementation with folic acid and vitamin B12. We conducted a randomized clinical trial with B vitamins to reduce homocysteine levels and therefore cardiovascular events and total mortality. Methods and Results-This randomized, double-blind multicenter study was conducted in 33 dialysis centers in north and east Germany between July 2002 and July 2008. We randomly assigned 650 patients with end-stage renal disease who were undergoing hemodialysis to 2 postdialysis treatments: 5 mg folic acid, 50 μg vitamin B12, and 20 mg vitamin B6 (active treatment) or 0.2 mg folic acid, 4 μg vitamin B12, and 1.0 mg vitamin B6 (placebo) given 3 times per week for an average of 2 years. The primary outcome was total mortality; the secondary outcome was fatal and nonfatal cardiovascular events. The primary outcome occurred in 102 patients (31%) receiving the active treatment and in 92 (28%) receiving placebo (hazard ratio, 1.13; 95% confidence interval, 0.85 to 1.50; P=0.51). The secondary outcome occurred in 83 patients (25%) receiving the active treatment and in 98 (30%) receiving placebo (hazard ratio, 0.80; 95% confidence interval, 0.60 to 1.07; P=0.13). Conclusions-Increased intake of folic acid, vitamin B12, and vitamin B6 did not reduce total mortality and had no significant effect on the risk of cardiovascular events in patients with end-stage renal disease. © 2010 American Heart Association, Inc.


PubMed | University of Tübingen, Praxisklinik, St Johannes Hospital, St Getrauden Breast Center and 16 more.
Type: Clinical Trial, Phase III | Journal: International journal of cancer | Year: 2015

Studies assessing the effect of bevacizumab (BEV) on breast cancer (BC) outcome have shown different effects on progression-free and overall survival, suggesting that a subgroup of patients may benefit from this treatment. Unfortunately, no biomarkers exist to identify these patients. Here, we investigate whether single nucleotide polymorphisms (SNPs) in VEGF pathway genes correlate with pathological complete response (pCR) in the neoadjuvant GeparQuinto trial. HER2-negative patients were randomized into treatment arms receiving either BEV combined with standard chemotherapy or chemotherapy alone. In a pre-planned biomarker study, DNA was collected from 729 and 724 patients, respectively from both treatment arms, and genotyped for 125 SNPs. Logistic regression assessed interaction between individual SNPs and both treatment arms to predict pCR. Five SNPs may be associated with a better response to BEV, but none of them remained significant after correction for multiple testing. The two SNPs most strongly associated, rs833058 and rs699947, were located upstream of the VEGF-A promoter. Odds ratios for the homozygous common, heterozygous and homozygous rare rs833058 genotypes were 2.36 (95% CI, 1.49-3.75), 1.20 (95% CI, 0.88-1.64) and 0.61 (95% CI, 0.34-1.12). Notably, some SNPs in VEGF-A exhibited a more pronounced effect in the triple-negative subgroup. Several SNPs in VEGF-A may be associated with improved pCR when receiving BEV in the neoadjuvant setting. Although none of the observed effects survived correction for multiple testing, our observations are consistent with previous studies on BEV efficacy in BC. Further research is warranted to clarify the predictive value of these markers.


Westphal S.,Magdeburg University Hospital | Luley C.,Magdeburg University Hospital
Heart and Vessels | Year: 2011

Consumption of flavanols improves chronic endothelial dysfunction. We investigated whether it can also improve acute lipemia-induced endothelial dysfunction. In this randomized, placebo-controlled, double-blind, crossover trial, 18 healthy subjects received a fatty meal with cocoa either rich in flavanols (918 mg) or flavanol-poor. Flow-mediated dilation (FMD), triglycerides, and free fatty acids were then determined over 6 h. After the flavanol-poor fat loading, the FMD deteriorated over 4 h. The consumption of flavanol-rich cocoa, in contrast, improved this deterioration in hours 2, 3, and 4 without abolishing it completely. Flavanols did not have any influence on triglycerides or on free fatty acids. Flavanol-rich cocoa can alleviate the lipemia-induced endothelial dysfunction, probably through an improvement in endothelial NO synthase. © Springer 2010.


Paslakis G.,University of Heidelberg | Westphal S.,Magdeburg University Hospital | Hamann B.,University of Heidelberg | Gilles M.,University of Heidelberg | And 2 more authors.
Journal of Psychopharmacology | Year: 2014

Introduction: The neuropeptide ghrelin stimulates hunger and weight gain. Ghrelin actions have been associated with depression in a number of preclinical and clinical studies, although some studies comparing basal peripheral ghrelin levels between depressed patients and controls found no differences between the groups. Methods: Twenty patients with a melancholic depressive episode and 15 controls received a 75 g glucose load and ghrelin levels were measured at 0, 30, 60 and 90 min after the beginning of the test. The patients were then either treated with mirtazapine (n=10) or venlafaxine (n=10) and underwent the same procedure (glucose load and ghrelin assessment) after four weeks of treatment Results: Basal ghrelin concentrations did not differ between patients and controls, although the ghrelin responses following the glucose load were lower in patients and differed significantly to the controls responses. After treatment, the patients ghrelin responses to the glucose load increased by trend and approximated those in the control group. Conclusion: Ghrelin is involved in appetite-regulating pathways during depression. For the first time we show that a functional test procedure using a standardised glucose load is more suitable than the assessment of basal peripheral ghrelin levels to detect differences between diagnostic groups. © The Author(s) 2014 Reprints and permissions:.


Hamrick I.,University of Wisconsin - Madison | Meyer F.,Magdeburg University Hospital
Langenbeck's Archives of Surgery | Year: 2013

Background: Older adults undergo operations as our population ages. Increasing life expectancy and disease burden, along with decreased functional status and organ reserve, place the elderly surgical patient at higher general risk in the perioperative state. In particular, these patients have more diseases including dementia and medications that put them specifically at higher risk of delirium. Purpose: This overview describes the diagnosis, pathophysiology, and treatment of delirium and its interface with depression and dementia, and explains aging changes based on the picture of perioperative management in surgical interventions. Conclusions: Today, surgeons must be equipped to attend the geriatric patient's needs. Early recognition of comorbidities such as dementia and delirium as well as speedy and competent therapeutic treatment can limit consequences and impact. © 2013 Springer-Verlag Berlin Heidelberg.


Paslakis G.,University of Heidelberg | Buchmann A.F.,University of Heidelberg | Westphal S.,Magdeburg University Hospital | Banaschewski T.,University of Heidelberg | And 5 more authors.
Neuroendocrinology | Year: 2014

Background: The appetite-stimulating hormone ghrelin is a fundamental regulator of human energy metabolism. A series of studies support the notion that long-term appetite and weight regulation may be already programmed in early life and it could be demonstrated that the intrauterine environment affects the ghrelin system of the offspring. Animal studies have also shown that intrauterine programming of orexigenic systems persists even until adolescence/adulthood. Methods: We hypothesized that plasma ghrelin concentrations in adulthood may be associated with the intrauterine exposure to cigarette smoke. We examined this hypothesis in a sample of 19-year-olds followed up since birth in the framework of the Mannheim Study of Children at Risk, an ongoing epidemiological cohort study of the long-term outcome of early risk factors. Results: As a main finding, we found that ghrelin plasma concentrations in young adults who had been exposed to cigarette smoke in utero were significantly higher than in those without prenatal smoke exposure. Moreover, individuals with intrauterine nicotine exposure showed a significantly higher prevalence of own smoking habits and lower educational status compared to those in the group without exposure. Conclusion: Smoking during pregnancy may be considered as an adverse intrauterine influence that may alter the endocrine-metabolic status of the offspring even until early adulthood. © 2014 S. Karger AG, Basel.


Zardo P.,Magdeburg University Hospital | Busk H.,Magdeburg University Hospital | Kutschka I.,Magdeburg University Hospital
Current Opinion in Anaesthesiology | Year: 2015

Purpose of Review: Chest tube protocols are still largely dictated by personal preferences and experience. A general lack of published evidence encourages individual decision-making and hinders the development of clear-cut guidelines. The aim of this review is to establish standardized procedures with recommendations for size and number of inserted tubes, ideal suction levels and duration of thoracostomy. Recent Findings: Novel digital drainage systems markedly reduce interobserver variability in air leak assessment and may thus shorten chest tube duration and overall hospital stay. Paired with a more aggressive stance that allows chest tube removal even with secretion quantities of 500ml/day, new protocols need to be established. Summary: Thoracic procedures are heterogeneous and postsurgical requirements vary in accordance. Most resections will not require more than one large bore (≥20F) catheter and will benefit from postoperative active suction. Even though only moderate-quality evidence suggests that suction reduces incidence of pneumothorax if compared to water seal and its effects on prolonged air leak are controversial, recent studies encourage application of active suction. Removal of chest tubes appears to be well tolerated even with a secretion of above 450ml/day. © 2015 Wolters Kluwer Health, Inc. All rights reserved.


PubMed | Otto Von Guericke University of Magdeburg and Magdeburg University Hospital
Type: Case Reports | Journal: Pathology, research and practice | Year: 2015

Inflammatory myofibroblastic tumors (IMTs), a rare condition of unknown etiology, have often been reported to be associated with specific infections or malignant tumors. The question of whether IMT themselves are an inflammatory or a neoplastic process is still going on.A 57-year-old female patient was transferred to our hospital with ileus caused by a mesenterial tumor. Intraoperatively, the mesenteric mass and the dependent small intestine segment, as well as a suspect hepatic lesion, were resected. The histopathological investigation revealed 8 malignant neuroendocrine tumors (NET) of the small intestine with lymphatic and hepatic metastasis and a mesenteric IMT. The postoperative course was uneventful, and the patient was discharged on the 18th postoperative day. The last follow-up after 30 months showed no recurrence of the IMT but clinical and radiological evidence of a persistent hepatic metastasis of the NETs. While plasma Chromogranin A remained suppressed by Sandostatin, the TGF 1 level was markedly elevated.Based on the current literature and our previous experiences, we can state that IPT are an aberrant secondary immunological process possibly induced by excessive TGF 1 and not a neoplasia. Nevertheless, the tumorous behavior points to a continuity between inflammation and neoplasia. Differential diagnoses and the potential molecular pathogenesis are further discussed.


PubMed | Magdeburg University Hospital
Type: Journal Article | Journal: International journal of hematology | Year: 2016

The risk of venous thromboembolism is increased in patients with lymphoma and leukemia; however, little is known about the potential underlying hereditary or acquired thrombophilia. We prospectively analyzed procoagulant markers and gene mutations in patients with lymphoma (n = 35) and leukemia (n = 10) at diagnosis and over the course of treatment. Global coagulation tests were normal in all patients, as were antithrombin and protein S. Activated protein C resistance caused by the factor V Leiden mutation was found in four patients, one patient had the G20210A mutation of the prothrombin gene, and one patient had protein C deficiency. The most striking findings were sustained very high levels of factor VIII (>150 %) in 30 patients (68 %), which correlated with high von Willebrand factor. An acute phase response in these patients was ruled out by absence of fever and normal IL-6 and -. Elevated factor VIII is an independent thrombophilic risk factor and may play an etiologic role in thromboembolic complications in patients with malignant lymphoma. Since high von Willebrand factor is most likely caused by endothelial cell injury, an additional, unknown pathophysiological association with malignant lymphoma and acute leukemia is possible.

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