University Clinic of Jena

Jena, Germany

University Clinic of Jena

Jena, Germany
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Erickson N.,Ludwig Maximilians University of Munich | Boscheri A.,TU Munich | Linke B.,Humboldt University of Berlin | Huebner J.,University Clinic of Jena
Medical Oncology | Year: 2017

The efficacy and benefits of ketogenic diets (KD) have recently been gaining worldwide and remain a controversial topic in oncology. This systematic review therefore presents and evaluates the clinical evidence on isocaloric KD dietary regimes and reveals that evidence supporting the effects of isocaloric ketogenic dietary regimes on tumor development and progression as well as reduction in side effects of cancer therapy is missing. Furthermore, an array of potential side effects should be carefully considered before applying KD to cancer patients. In regard to counseling cancer patients considering a KD, more robust and consistent clinical evidence is necessary before the KD can be recommended for any single cancer diagnosis or as an adjunct therapy. © 2017, Springer Science+Business Media New York.


Hamzei F.,University Clinic of Jena | Hamzei F.,Albert Ludwigs University of Freiburg | Lappchen C.H.,Albert Ludwigs University of Freiburg | Glauche V.,Albert Ludwigs University of Freiburg | And 3 more authors.
Neurorehabilitation and Neural Repair | Year: 2012

Background. Mirror therapy (MT) is a promising therapeutic approach in stroke patients with severe hand paresis. Objective. The ipsilateral (contralesional) primary sensorimotor cortex (SMC) and the mirror neuron system have been suggested to play decisive roles in the MT network. The present study investigated its underlying neural plasticity. Methods. Two groups of healthy participants (n = 13 in each group) performed standardized fine motor tasks moving pegs and marbles (20 min/d for 4 days) with their right hand with either a mirror (mirror training group, MG) or a nonreflective board (control training group, CG) positioned orthogonally in front of them. The number of items moved by each hand was tested after each training session. Functional MRI (fMRI) was acquired before and after the training procedure to investigate the mirror training (MTr)-specific network by the analysis of the factors Time and Group. Results. The hand performance test of the trained right hand did not differ between the 2 groups. The untrained left hand improved significantly more in the MG compared with the CG. fMRI analysis of action observation and imitation of grasping tasks demonstrated MTr-specific activation changes within the right dorsal and left ventral premotor cortex as well as in the left SMC (SMCleft). Analysis of functional and effective connectivity showed a MTr-specific increase of functional coupling between each premotor region and the left supplementary motor area, which in turn showed an increased functional interaction with the ipsilateral SMCleft. Conclusions. MTr remodels the motor system by functionally connecting hand movement to the ipsilateral SMC. On a system level, it leads to interference of the neural circuit related to motor programming and observation of the trained hand with the illusionary movement of the untrained hand. © The Author(s) 2012.


Laible M.,Albert Ludwigs University of Freiburg | Laible M.,University of Heidelberg | Grieshammer S.,Moritz Klinik | Seidel G.,Moritz Klinik | And 4 more authors.
Neurorehabilitation and Neural Repair | Year: 2012

Background. Previous studies demonstrated a posterior shift of activation toward the primary sensory cortex (S1) following stroke; however, any relationship between this posterior shift and clinical outcome measures for the affected hand function were unclear. Objective. The authors investigated the possible role of S1 in motor recovery. Methods. Assuming that previous studies examined inhomogeneous groups of patients, the authors selected participants with chronic stroke who had moderate hand paresis, normal sensory examination and somatosensory-evoked potentials, and no lesion within the S1, thalamus, or brain stem. Constraint-induced movement therapy (CIMT) was used to train the impaired hand. To relate fMRI (functional MRI) activation changes from baseline to post-CIMT, a correlation analysis was performed with changes of the Wolf Motor Function Test (WMFT) as a test for the hand function. Results. A close relationship was found between increases in hand function and peak changes in activation within the ipsilesional S1. With a better outcome, greater increases in activation within the S1 were evident (P <.03; r = 0.73). Conclusion. In selected patients, the sensory network influences training-induced motor gains. This predictive knowledge of plasticity when applying CIMT may suggest strategies to enhance the effect of therapy, such as the addition of electrical stimulation to enhance S1 excitability. © The Author(s) 2012.


Nawka T.,Charité - Medical University of Berlin | Sittel C.,Katharinenhospital Stuttgart | Arens C.,Otto Von Guericke University of Magdeburg | Lang-Roth R.,University of Cologne | And 7 more authors.
Laryngoscope | Year: 2015

Objectives/Hypothesis Bilateral vocal fold paralysis (BVFP) is a rare but life-threatening condition mostly caused by iatrogenic damage to the peripheral recurrent laryngeal nerve. Endoscopic enlargement techniques have been the standard treatment for decades. However, prospective studies using internationally accepted phoniatric and respiratory evaluation guidelines are rare. Study Design Prospective observational multicenter study. Methods Twelve clinical centers screened 61 patients, of whom 36 were eligible according to the study protocol. Subjects were assessed with specific phoniatric and respiratory tests preoperatively and at 1 and 6 months postoperatively. Results Important respiratory parameters improved significantly 6 months postoperatively (peak expiratory and expiratory flow), confirming that a glottal enlargement effectively reduced the obstruction. Objective parameters dealing with voice quality worsened significantly (maximum phonation time, voice range profile, hoarseness), whereas subjective voice assessment (VHI-12) did not change significantly. Conclusion Endoscopic glottal enlargement is an effective method for relieving symptoms of dyspnea due to BVFP. Postoperatively, voice quality objectively worsened; however, this was not perceived by the patients themselves. Laryngostroboscopic findings did not correlate strongly with voice and respiratory outcomes. Level of Evidence 2b. Laryngoscope, 125:2749-2755, 2015 © 2015 The American Laryngological, Rhinological and Otological Society, Inc.


PubMed | Katharinenhospital Stuttgart, University of Würzburg, University of Cologne, University of Marburg and 5 more.
Type: Journal Article | Journal: The Laryngoscope | Year: 2016

Bilateral vocal fold paralysis (BVFP) is a rare but life-threatening condition mostly caused by iatrogenic damage to the peripheral recurrent laryngeal nerve. Endoscopic enlargement techniques have been the standard treatment for decades. However, prospective studies using internationally accepted phoniatric and respiratory evaluation guidelines are rare.Prospective observational multicenter study.Twelve clinical centers screened 61 patients, of whom 36 were eligible according to the study protocol. Subjects were assessed with specific phoniatric and respiratory tests preoperatively and at 1 and 6 months postoperatively.Important respiratory parameters improved significantly 6 months postoperatively (peak expiratory and expiratory flow), confirming that a glottal enlargement effectively reduced the obstruction. Objective parameters dealing with voice quality worsened significantly (maximum phonation time, voice range profile, hoarseness), whereas subjective voice assessment (VHI-12) did not change significantly.Endoscopic glottal enlargement is an effective method for relieving symptoms of dyspnea due to BVFP. Postoperatively, voice quality objectively worsened; however, this was not perceived by the patients themselves. Laryngostroboscopic findings did not correlate strongly with voice and respiratory outcomes.2b.


Hamzei F.,University Clinic of Jena | Kruger H.,University of Hamburg | Peters M.,University of Hamburg | Ketels G.,University of Hamburg | And 4 more authors.
Neurologie und Rehabilitation | Year: 2012

Objective: Constraint-Induced Movement Therapy (CIMT) has been shown to be effective in improving use of the affected arm after stroke. Since paresis of the lower extremity after stroke also reduces the quality of life, a comparable rehabilitation therapy for that extremity is required to improve mobility and independence. The aim of this pilot study was to evaluate whether CIMT for the upper extremity might serve as a useful model for an efficacious motor therapy to improve lower extremity function. Design: The more affected extremity was treated six hours per day for ten consecutive weekdays in 16 chronic stroke patients with the concept of CIMT, termed "Shaping-Induced Movement Therapy for lower extremity" (SIMT). Motor function was tested by self-rating assessments and newly developed motor function tests, and via established tests. Results: Measurements of motor leg function improved in all patients and persisted for the next three months. Factors such as gender, loss of sensation, lesion side and others had no impact on functional improvement. Conclusions: CIMT for the upper extremity can be used as a model for treatment of the lower extremity to produce a functional improvement ("proof of principle") that persists for at least the three months tested. © Hippocampus Verlag 2012.


Fahling M.,Charité - Medical University of Berlin | Mathia S.,Charité - Medical University of Berlin | Paliege A.,Charité - Medical University of Berlin | Koesters R.,French Institute of Health and Medical Research | And 6 more authors.
Journal of the American Society of Nephrology | Year: 2013

Renal hypoxia occurs in AKI of various etiologies, but adaptation to hypoxia, mediated by hypoxia-inducible factor (HIF), is incomplete in these conditions. Preconditional HIF activation protects against renal ischemia-reperfusion injury, yet the mechanisms involved are largely unknown, and HIF-mediated renoprotection has not been examined in other causes of AKI. Here, we show that selective activation of HIF in renal tubules, through Pax8-rtTA - based inducible knockout of von Hippel-Lindau protein (VHL-KO), protects from rhabdomyolysis-induced AKI. In this model, HIF activation correlated inversely with tubular injury. Specifically, VHL deletion attenuated the increased levels of serum creatinine/urea, caspase-3 protein, and tubular necrosis induced by rhabdomyolysis in wild-type mice. Moreover, HIF activation in nephron segments at risk for injury occurred only in VHL-KO animals. At day 1 after rhabdomyolysis, when tubular injury may be reversible, the HIF-mediated renoprotection in VHL-KO mice was associated with activated glycolysis, cellular glucose uptake and utilization, autophagy, vasodilation, and proton removal, as demonstrated by quantitative PCR, pathway enrichment analysis, and immunohistochemistry. In conclusion, a HIF-mediated shift toward improved energy supply may protect against acute tubular injury in various forms of AKI. Copyright © 2013 by the American Society of Nephrology.


PubMed | University Clinic of Jena
Type: Journal Article | Journal: Neurorehabilitation and neural repair | Year: 2012

Mirror therapy (MT) is a promising therapeutic approach in stroke patients with severe hand paresis.The ipsilateral (contralesional) primary sensorimotor cortex (SMC) and the mirror neuron system have been suggested to play decisive roles in the MT network. The present study investigated its underlying neural plasticity.Two groups of healthy participants (n = 13 in each group) performed standardized fine motor tasks moving pegs and marbles (20 min/d for 4 days) with their right hand with either a mirror (mirror training group, MG) or a nonreflective board (control training group, CG) positioned orthogonally in front of them. The number of items moved by each hand was tested after each training session. Functional MRI (fMRI) was acquired before and after the training procedure to investigate the mirror training (MTr)-specific network by the analysis of the factors Time and Group.The hand performance test of the trained right hand did not differ between the 2 groups. The untrained left hand improved significantly more in the MG compared with the CG. fMRI analysis of action observation and imitation of grasping tasks demonstrated MTr-specific activation changes within the right dorsal and left ventral premotor cortex as well as in the left SMC (SMC(left)). Analysis of functional and effective connectivity showed a MTr-specific increase of functional coupling between each premotor region and the left supplementary motor area, which in turn showed an increased functional interaction with the ipsilateral SMC(left).MTr remodels the motor system by functionally connecting hand movement to the ipsilateral SMC. On a system level, it leads to interference of the neural circuit related to motor programming and observation of the trained hand with the illusionary movement of the untrained hand.

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