RepoMed (Medizinische Hochschule Hannover)
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Pharmacological and psychological approaches to insomnia treatment in cardiac patients: a narrative literature review
Get PDFSleep disorders are highly prevalent in the general population and are considered a major public health issue. Insomnia constitutes the most frequent sleep disorder in healthy individuals and has been shown to be even more frequent in patients with physical illnesses including cardiovascular diseases. Inadequate sleep quality and short sleep duration, independent of underlying causes, have been linked to the development and progression of cardiometabolic disorders. Additionally, insomnia has been found to be associated with adverse outcome measures, including daytime sleepiness, fatigue, decreased self-reported physical functioning, lower exercise capacity, poor health related quality of life, depressive symptoms, higher rates of hospitalization and increased mortality in patients with cardiovascular diseases. Against this background, comparatively little information is available in the literature regarding the treatment of chronic insomnia in cardiac patient populations. While guidelines for the general population suggest cognitive behavioral therapy for insomnia as a first-line treatment option and preliminary evidence suggests this treatment to be beneficial in cardiac patients with insomnia symptoms, it is often limited by availability and possibly the clinician's poor understanding of sleep issues in cardiac patients. Therefore, pharmacologic treatment remains an important option indicated by the high number of hypnotic drug prescriptions in the general population and in patients with cardiovascular disorders. In this narrative review of the literature, we summarize treatment options for chronic insomnia based on clinical guidelines for the general population and highlight necessary considerations for the treatment of patients with cardiovascular diseases
Identification of novel autoantibodies in Sjögren's disease
Get PDFIntroduction The diagnosis of Sjögren's disease (SjD) in patients without autoantibodies against Ro/SSA is a major challenge. We aimed to identify novel autoantibodies in SjD that may facilitate the diagnostic procedure for Ro/SSA negative SjD. Methods IgG and IgA autoantibody reactivity of 94 potential candidate autoantigens for SjD, selected from a discovery screen of 1,629 human antigens coupled to Luminex beads and prior knowledge about potential biological relevance, were examined in serum of SjD patients (n=347) using Luminex and ELISA technology. Healthy (HC, n=118) and non-Sjögren's sicca syndrome (NSS, n=44) individuals served as controls. To assess disease specificity, the novel autoantibodies were also measured in serum of patients with Rheumatoid Arthritis (RA, n=50), Systemic Lupus Erythematosus (SLE, n=49), and Systemic Sclerosis (SSc, n=37). Results 45 novel autoantibodies were significantly (p ≤ 0.05) more prevalent in SjD than in HC and were detected in up to 19% of the SjD cohort. The most common autoantibodies were against CCL4, M5, TMPO and OAS3. Some of the novel autoantibodies were associated with extraglandular disease manifestations, such as anti-TONSL or anti-IL6 with pulmonary involvement. We have developed a three and five marker panel for the detection of Ro/SSA negative patients, consisting of anti-FNBP4, anti-SNRPC, anti-CCL4, anti-M3 and anti-KDM6B, which had a sensitivity of up to 46% with a specificity of 95% (SjD vs. HC). Both panels discriminate these patients from HC, whereas the three-marker more effectively differentiates between Ro/SSA negative patients and NSS. Discussion Novel autoantibodies will facilitate the diagnosis of Ro/SSA negative patients with SjD, in particular our predictive panel will be useful in the diagnosis and differentiation of these patients from healthy and NSS individuals in a clinical context. In addition, the autoantibodies may also be useful for risk stratification of extraglandular manifestations
Feasibility study of an experimental social space-oriented rehabilitation concept for people with intellectual and/or multiple disabilities: a study protocol
Get PDFIntroduction The United Nations underlines the participation in all domains of daily living for people with intellectual and/or multiple disabilities in the Disability Rights Convention, which also includes medical services. In line with this, the German Federal Participation Act has further developed the relevant disability policy at the national level. This also implies access to comprehensive medical care. In 2015, Germany created a legal basis for the establishment of medical centres for adults with intellectual and/or multiple disabilities in order to ensure basic medical care for these patients. However, the medical centres cannot provide complex rehabilitation. Mobile rehabilitation can be another tool to address the underuse of medical rehabilitation for people with intellectual and/or multiple disabilities. Mobile rehabilitation refers to rehabilitation services provided in a patient's home or local community, rather than in a traditional inpatient or outpatient rehabilitation facility. The advantages of mobile rehabilitation are its accessibility for patients with mobility problems, the comfort of a familiar environment, which can reduce stress, and the fact that rehabilitation can be tailored to the patient's living conditions and daily routine. In Germany, mobile rehabilitation is currently only available in the field of geriatrics.Within the framework of the feasibility study 'Social space-oriented individualised medical rehabilitation for people with intellectual and/or multiple disabilities (SIMRE),' a social space-oriented rehabilitation concept was developed to close the rehabilitation gap for people with intellectual and/or multiple disabilities. It is funded by the German Federal Ministry of Health. This study protocol describes the procedure of this feasibility study. Methods This study is a prospective mixed methods feasibility study. The rehabilitation concept combines outpatient and home-based rehabilitation, medical, and therapeutic care for people with intellectual and/or multiple disabilities. Analysis The primary target criteria are the feasibility and acceptance of the concept by participants, relatives, carers and the rehabilitation staff. Guided interviews with participants and their relatives and/or carers will be analysed using the content-structuring analysis according to Kuckartz. Quantitative analysis will include a cost-benefit analysis to provide information on the economic feasibility of the rehabilitation concept. Changes in individual participation, quality of life and rehabilitation goals will be assessed using a before-and-after comparison with questionnaires. The frequency and type of rehabilitation procedures used will be evaluated quantitatively.The trial was prospectively registered in the German Clinical Trials Register on 17 August 2023. (https://www.drks.de/DRKS00032493). Ethics and dissemination Ethical approval was granted by the Ethics Committee of Hannover Medical School (reference number: 10985_BO_S_2023).1. Publication: The results of the project will be made available to the public through open access publications. We plan to develop a treatment guideline for the treatment concept based on clinical experience.2. Widespread implementation: If the project is continued and adequately staffed, the rehabilitative care concept could be implemented nationwide, and the University Hospital could be available as a reference clinic. Trial registration number German Clinical Trials Register (reference number: DRKS00032493)
Nicotinamide Nucleotide Transhydrogenase deficiency and genetic susceptibility to high glucose-mediated peritoneal injury
No full textThe genetic predisposition to high glucose-induced injury to the peritoneal membrane (PM) during peritoneal dialysis (PD) and its mechanistic implications are of substantial clinical interest. We compared PD-induced peritoneal injury and fibrosis between two closely related mouse substrains. Compared to C57BL/6J mice, C57BL/6N mice exhibited significantly greater susceptibility to PD fluid-induced peritoneal damage, as indicated by the loss of the mesothelial cell monolayer, peritoneal membrane fibrosis, neoangiogenesis, inflammatory response, infiltration of pro-inflammatory M1 macrophages, and reduced ultrafiltration capacity. Given that C57BL/6J mice display a spontaneous loss-of-function mutation in the mitochondrial enzyme nicotinamide nucleotide transhydrogenase (NNT), which plays a critical role in maintaining mitochondrial redox balance and energy metabolism- both of which are severely challenged during PD- we conducted further NNT silencing experiments. Knockdown of NNT prevented the mitochondrial accumulation of reactive oxygen species (ROS), reduced pro-inflammatory mediator release in mouse peritoneal mesothelial cells, prevented M1 macrophage polarization in peritoneal macrophages, and strongly decreased proliferation under high glucose conditions in NIH-3T3 fibroblasts. We observed a reverse NNT reaction in fibroblasts, contributing to high glucose (HG)-induced mitochondrial reactive oxygen species (ROS) accumulation. Our results indicate decreased genetic susceptibility of C57BL/6J mice to PD-induced PM damage compared to C57BL/6N mice. Additionally, our in vitro experiments identify NNT, which is deficient in C57BL/6J mice, as a potential therapeutic target for PD-associated peritoneal injury
Validierung von Gewebs- und Plasma miRNA Biomarkern der Primary Non-Function nach Lebertransplantation
Get PDFDyadic Coping of NMOSD and MOGAD patients and their partners: a sociological and psychological examination of strategies (CoMMOnsense-Study)
Get PDFZufriedenheit von Ärzt*innen in stationären Mutter-/Vater-Kind Vorsorge- und Rehabilitationseinrichtungen
Get PDFEinschätzung der Infektionsaktivität von SARS-CoV-2 in Deutschland auf Basis von Seroprävalenzstudien und mathematischer Modellierung
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No difference in endothelial microvasculation measured by peripheral arterial tonometry in patients with Sjögren's disease and matched controls
Get PDFSjögren's disease (SjD) is a connective tissue autoimmune disorder characterized by inflammatory infiltration of the exocrine glands, leading to symptoms such as dryness, pain, and fatigue. Additionally, up to 50% of patients may experience extraglandular manifestations. SjD patients face a higher cardiovascular risk, including severe events like myocardial infarction and strokes, partly due to an increased likelihood of subclinical atherosclerosis. Therefore, identifying SjD patients at an early stage is essential to reduce morbidity and mortality. In this study, SjD patients who met the current ACR/EULAR 2016 classification criteria were consecutively enrolled in our outpatient clinic. A control cohort was recruited through a multimedia call for participation. To assess changes in endothelial functions, a reactive hyperemia index (RHI) was calculated using peripheral arterial tonometry with the EndoPAT® measurement device. RHI values below 1.67 were considered pathological. The dataset consists of 49 SjD patients and 27 healthy controls. Both groups had similar ages and comparable cardiovascular risk factors. No differences in RHI were observed between the two cohorts. The only significant factor that was predictive for a low RHI was an increased body mass index (p = 0.036). These findings suggest that EndoPAT measurements may not be a suitable method for detecting changes in endothelial function specific to patients with SjD