Mainz, Germany
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Non-allergic rhinitis with eosinophilia syndrome (NARES) is an eosinophilic inflammation of the nasal mucosa without evidence of an allergy or other nasal pathologies. Beside the exclusion of other reasons for a non-allergic rhinitis evidence of an nasal eosinophilic inflammation is essenttial. Symptoms can be effectifly treated by topical administration of steroids and antihistamines.


Goetz M.,Universitatsmedizin Mainz | Watson A.,University of East Anglia | Kiesslich R.,Universitatsmedizin Mainz
Journal of Biophotonics | Year: 2011

Confocal laser endomicroscopy (CLE) is a novel endoscopic technique permitting in vivo microscopy (optical biopsies) of the gastrointestinal mucosa. CLE has been studied in a multitude of diseases of the upper and lower gastrointestinal tract, including Barrett's esophagus, gastric inflammation and cancer, celiac disease, colorectal adenoma and carcinoma, and inflammatory bowel diseases. CLE has recently evolved and been studied for bile duct and liver imaging. CLE has shown overall high accuracy and enabled smart, targeted biopsies rather than untargeted sampling. Furthermore, the availability of real time microscopic information during endoscopy has immediate impact on therapeutic decisions and guides endoscopic interventions. CLE is also a unique tool for observation of (patho-)physiologic events in their natural environment (functional imaging) and has been linked to molecular imaging of gastrointestinal neoplasia in vivo, thereby broadening our understanding of mucosal pathology in clinical and basic science. © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.


Medication safety in hospitals might not be completely guaranteed. However, hospital pharmacists are in charge to increase those safety issues. Therefore it is necessary to carefully analyze the medication process, to identify potential medication errors and to uncover where they appear. Based on such analyses, targeted strategies are needed to reduce medication errors. Risks for the patient safety are often caused at transition sites between different sectors and departments, as well as between different health care professionals. Especially at those sites at higher risk, where several people are involved, a hospital pharmacist should be included as the expert considering medication issues. Frequent causes for medication errors are inadequate knowledge of the patient or the drug, inadequate communication between health care professionals, lack of attention and inadequate awareness of guidelines, ignoring of standard regulations, work overload as well as social issues. All those causes should be reduced together by all health care professionals. Strategies may include the setup of particular guidelines and regulations, trainings conducted by the hospital pharmacist, and an increase of information and adequate communication. One of the most important among such strategies is to increase the awareness and sensitivity for medication errors.


Goetz M.,Universitatsmedizin Mainz | Wang T.D.,University of Michigan
Gastroenterology | Year: 2010

Molecular imaging is a rapidly growing new discipline in gastrointestinal endoscopy. It uses the molecular signature of cells for minimally-invasive, targeted imaging of gastrointestinal pathologies. Molecular imaging comprises wide field techniques for the detection of lesions and microscopic techniques for in vivo characterization. Exogenous fluorescent agents serve as molecular beacons and include labeled peptides and antibodies, and probes with tumor-specific activation. Most applications have aimed at improving the detection of gastrointestinal neoplasia with either prototype fluorescence endoscopy or confocal endomicroscopy, and first studies have translated encouraging results from rodent and tissue models to endoscopy in humans. Even with the limitations of the currently used approaches, molecular imaging has the potential to greatly impact on future endoscopy in gastroenterology. © 2010 AGA Institute.


Goetz M.,Universitatsmedizin Mainz | Kiesslich R.,Universitatsmedizin Mainz
American Journal of Physiology - Gastrointestinal and Liver Physiology | Year: 2010

Confocal endomicroscopy is a novel technique that permits in vivo microscopy of the human gastrointestinal mucosa during ongoing endoscopy, thereby providing optical virtual biopsies. Endomicroscopy has been demonstrated to reveal histological information in a multitude of diseases in the upper and lower gastrointestinal tract in vivo. Most studies have focused on inflammation and neoplasia, such as Barrett's esophagus, gastric cancer, celiac disease, Crohn's disease and ulcerative colitis, or colorectal neoplasias. Endomicroscopy allows obtainment of "smart," targeted biopsies from regions with microscopic alterations rather than having to rely on random untargeted tissue sampling. This reduces the number of biopsies while increasing the diagnostic yield. In addition, immediate histological information is available, enabling immediate therapy. Apart from morphological visualization, endomicroscopy offers a unique possibility to study pathophysiological events in their natural environment (functional imaging). Molecular imaging with endomicroscopy applied in clinical and basic science will permit advances in understanding of the cellular basis of gastrointestinal physiology and pathophysiology. Copyright © 2010 the American Physiological Society.


The term integrating the healthcare enterprise (IHE) has been known for more than 10 years and provides an innovative approach to ensure interoperability based on a synthesis of different standards for defined scenarios. Acceptance and deployment are, however limited in Germany compared with other countries. In this article the basic principles and the potential of IHE are described. © 2013 Springer-Verlag Berlin Heidelberg.


Kroller-Schon S.,Universitatsmedizin Mainz
Arteriosclerosis, thrombosis, and vascular biology | Year: 2012

We investigated whether AMP-activated protein kinase (AMPK) may be involved in the signaling processes leading to exercise-mediated vascular protection. The effects of voluntary exercise on AMPK activity, endothelial NO synthase expression and phosphorylation, vascular reactive oxygen species formation, and cell senescence were tested in α1AMPK knockout and corresponding wild-type mice. Exercise significantly improved endothelial function, and increased plasma nitrite production in wild-type mice, associated with an activation of aortic AMPK assessed by its phosphorylation at threonine 172. In addition, regular physical activity resulted in an upregulation of endothelial NO synthase protein, serine 1177 endothelial NO synthase phosphorylation, and an increase of circulating Tie-2(+)Sca-1(+)Flk-1(+) myeloid progenitor cells. All these changes were absent after α1AMPK deletion. In addition, exercise increased the expression of important regulators of the antioxidative defense including heme oxygenase-1 and peroxisome proliferator-activated receptor γ coactivator 1α, decreased aortic reactive oxygen species levels, and prevented endothelial cell senescence in an α1AMPK-dependent manner. Intact α1AMPK signaling is required for the signaling events leading to the manifestation of vascular protective effects during exercise. Pharmacological AMPK activation might be a novel approach in the near future to simulate the beneficial vascular effects of physical activity.


Langer F.,Universitatsklinikum Eppendorf | Ruf W.,Scripps Research Institute | Ruf W.,Universitatsmedizin Mainz
Thrombosis and Haemostasis | Year: 2014

Tissue factor (TF), the cellular receptor and cofactor for factor VII/VIIa, initiates haemostasis and thrombosis. Initial tissue distribution studies suggested that TF was sequestered from the circulation and only present at perivascular sites. However, there is now clear evidence that TF also exists as a blood-borne form with critical contributions not only to arterial thrombosis following plaque rupture and to venous thrombosis following endothelial perturbation, but also to various other clotting abnormalities associated with trauma, infection, or cancer. Because thrombin generation, fibrin deposition, and platelet aggregation in the contexts of haemostasis, thrombosis, and pathogen defence frequently occur without TF de novo synthesis, considerable efforts are still directed to understanding the molecular events underlying the conversion of predominantly non-coagulant or cryptic TF on the surface of haematopoietic cells to a highly procoagulant molecule following cellular injury or stimulation. This article will review some of the still controversial mechanisms implicated in cellular TF activation or decryption with particular focus on the coordinated effects of outer leaflet phosphatidylserine exposure and thiol-disulfide exchange pathways involving protein disulfide isomerase (PDI). In this regard, our recent findings of ATP-triggered stimulation of the purinergic P2X7 receptor on myeloid and smooth muscle cells resulting in potent TF activation and shedding of procoagulant microparticles as well as of rapid monocyte TF decryption following antithymocyte globulin-dependent membrane complement fixation have delineated specific PDIdependent pathways of cellular TF activation and thus illustrated additional and novel links in the coupling of inflammation and coagulation. © Schattauer 2014.


Rosbach J.,Universitatsmedizin Mainz
Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft | Year: 2013

In refractory glaucoma, surgical intervention is required which in most cases aims at artificially increasing the drainage of aqueous humor from the eye. One surgical option used with increasing frequency is the implantation of episcleral glaucoma drainage devices (GDD). The clinical success of such devices is often limited by excessive wound healing and scar formation around the base plate of the implant. In severe cases, which seem to occur most frequently in pediatric patients, the rapid formation of a thick, water-impervious fibrotic capsule within months after initial implantation leads to diminished aqueous resorption and an increase in intraocular pressure to presurgical values. Often additional surgical interventions become necessary. Excision of the fibrotic tissue around the implant may help to salvage function and might be an alternative to the more commonly practiced implantation of an additional GDD. In the case series presented here the surgical method of capsular revision is described and the clinical outcome in 11 eyes from 10 patients is reported.


An analysis of literature results reveals differences concerning the need for rescue breathing in lay-rescuer cardiopulmonary-resuscitation (CPR). Observational studies on large registries have shown improved survival rates with standard CPR (chest compressions and rescue breathing) compared to continuous chest compressions (CCC). This applies especially for cardiac arrests of non-cardiac origin or prolonged EMS-arrival times. In contrast a public program for lay-rescuers focusing on CCC lead to improved success rates of bystander-CPR, followed by improved survival rates. The 2010 ERC guidelines have resolved this controversy by integrating both aspects. CCC is recommended for everyone. Trained bystanders should use standard-CPR as method of choice. For dispatcher-assisted CPR the results are clear. Giving instructions for mouth-to-mouth ventilation is too complicated and time consuming, thus impairing survival rates. Therefore CCC is recommended for dispatcher-assisted CPR. © Georg Thieme Verlag KG Stuttgart · New York.

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