RepoMed (Medizinische Hochschule Hannover)
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Impact of relationship status on psychological parameters in adults with congenital heart disease.
No full textObjective Adult congenital heart disease (ACHD) is a growing disease entity, posing questions concerning psychosocial outcomes across the lifespan. Spousal relationships were shown to benefit cardiovascular and mental health in the general population. We assessed the association of relationship status with anxiety and depression in ACHD patients and determined whether patients considered disease-related concerns potential mediators of relationship problems. Methods N = 390 ACHD patients were included. Self-report questionnaires were used to assess relationship status, ACHD-related relationship problems, socio-demographic variables, and depression and anxiety scores. Further, clinical parameters concerning the heart condition were determined. Results N = 278 (71%) patients were currently in a relationship, while N = 112 (29%) were not in a relationship. Groups did not significantly differ regarding age, sex, and cardiovascular parameters. Two-way MANCOVA with relationship status and sex as independent variables, controlling for age, NYHA class, and NT-proBNP, showed an association of relationship status with depression, while sex was associated with anxiety. N = 97 (25%) patients reported disease-related adverse effects on a current or prior relationship. In detail, worries about body image (N = 57, 61%), own fears (N = 51, 54%), problems arising from wish to have children (N = 33, 35%), fears regarding a joint future (N = 29, 31%), partner's fears or lack of understanding (N = 28, 30%), and sexual problems (N = 21, 22%) were cited. Conclusion Relationships status was associated with depression, while sex was associated with anxiety in ACHD patients. Relationship status as well as potential relationship problems, and the importance of social support for mental and physical well-being, should be considered when treating ACHD patients
Die FGF23-induzierte Aktivierung des intrakardialen Renin-Angiotensin-Aldosteron-Systems führt zu kardialer Fibrose
No full textLebensqualität und körperliche Aktivität sowie deren Einfluss auf den pulmonalen Verlauf von Kindern und Jugendlichen mit Cystischer Fibrose
Get PDFThe effect of Toll-like receptor agonists on the immunogenicity of MVA-SARS-2-S vaccine after intranasal administration in mice
Get PDFBackground and aims Modified Vaccinia virus Ankara (MVA) represents a promising vaccine vector for respiratory administration to induce protective lung immunity including tertiary lymphoid structure, the bronchus-associated lymphoid tissue (BALT). However, MVA expressing the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Spike protein (MVA-SARS-2-S) required prime-boost administration to induce high titers of anti-Spike antibodies in serum and bronchoalveolar lavage (BAL). As the addition of adjuvants enables efficient tailoring of the immune responses even to live vaccines, we tested whether Toll-like receptor (TLR)-agonists affect immune responses induced by a single dose of intranasally applied MVA-SARS-2-S. Methods We intranasally immunized C57BL/6 mice with MVA-SARS-2-S vaccine in the presence of either TLR3 agonist polyinosinic polycytidylic acid [poly(I:C)], TLR4 agonist bacterial lipopolysaccharide (LPS) from Escherichia coli, or TLR9 agonist CpG oligodeoxynucleotide (CpG ODN) 1826. At different time-points after immunization, we analyzed induced immune responses using flow cytometry, immunofluorescent microscopy, and ELISA. Results TLR agonists had profound effects on MVA-SARS-2-S-induced immune responses. At day 1 post intranasal application, the TLR4 agonist significantly affected MVA-induced activation of dendritic cells (DCs) within the draining bronchial lymph nodes, increasing the ratio of CD11b+CD86+ to CD103+CD86+ DCs. Nevertheless, the number of Spike-specific CD8+ T cells within the lungs at day 12 after vaccination was increased in mice that received MVA-SARS-2-S co-administered with TLR3 but not TLR4 agonists. TLR9 agonist did neither significantly affect MVA-induced DC activation nor the induction of Spike-specific CD8+ T cells but reduced both number and size of bronchus-associated lymphoid tissue. Surprisingly, the addition of all TLR agonists failed to boost the levels of Spike-specific antibodies in serum and bronchoalveolar lavage. Conclusions Our study indicates a potential role of TLR-agonists as a tool to modulate immune responses to live vector vaccines. Particularly TLR3 agonists hold a promise to potentiate MVA-induced cellular immune responses. On the other hand, additional research is necessary to identify optimal combinations of agonists that could enhance MVA-induced humoral responses
Telemedicine-supported Rehabilitation after COVID-19 infection (long-covid)
No full textThe data are a cross-sectional analysis, of a study (DRKS00026245) collected between September 2021 and June 2022. The study was conducted at Hannover Medical School (Lower Saxony, Germany) by the Department of Rehabilitation and Sports Medicine, the Department of Respiratory Medicine, the Department of Neurology, and the Department of Rheumatology and Immunology. Patients with post-COVID-19 syndrome were studied. We included patients from October 2021 to May 2022. The Clinic for Rehabilitation and Sports Medicine at Hannover Medical School in cooperation with the Department of Respiratory Medicine was responsible for the study design, statistical planning, inclusion of study participants, data collection and analysis. Medical evaluation and Exercise testing: After study inclusion, all subjects completed a comprehensive medical evaluation including pulmonary function testing measured by body plethysmography standardized to European Respiratory Society (ERS). We assessed height and weight in a standardized fashion and estimated fat and fat-free mass with a bioimpedance analysis (InBody 720, Biospace, Seoul, Korea). To determine steps per day, patients received a wearable (Forerunner 45, Garmin, Olathe, United States). For testing parameters of exercise capacity and maximum power output patients performed an incremental exercise test using a spirometric system (Oxycon CPX, CareFusion, Würzburg, Germany) on a speed independent bicycle ergometer (Ergoline P150, Bitz, Germany) with 60 to 70 revolutions per minute. The exercise test were carried out in the presence of a physician (specialist for cardiology or internal medicine) together with a sports scientist or a medical technical assistant, all experienced and trained in conducting, evaluating and interpreting exercise performance diagnostics. Except six examinations the incremental test started with a load of 20 Watt (W) increasing in 10 W steps every minute and was stopped with the onset of subjective overexertion because of peripheral muscle fatigue and/or pulmonary limitations. The subjective perceived exertion was assessed by the Borg-scale (Borg G. Borg's perceived exertion and pain scales. Champaign, IL, US: Human Kinetics; 1998.). Heart rate and oxygen uptake were continuously measured breath by breath. Body weight normalized values for maximum power output and VO2max were also expressed as percentage to age- and gender-adjusted reference values (Löllgen H, Leyk D. Exercise Testing in Sports Medicine. Dtsch Arztebl Int 2018 Jun 15;115(24):409-416.; Rapp D, Scharhag J, Wagenpfeil S, Scholl J. Reference values for peak oxygen uptake: cross-sectional analysis of cycle ergometry-based cardiopulmonary exercise tests of 10 090 adult German volunteers from the Prevention First Registry. BMJ Open 2018 Mar 5;8(3):e018697-018697.). The 6MWT is a test to assess submaximal exercise capacity by walking distance. Participants walked a slope-free corridor for a total of six minutes at their own speed and the reached distance was recorded in meters (ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002 Jul 1;166(1):111-117.). The tests were supervised by a trained sports scientists or medical technical assistants. Questionnaires: We distributed a questionnaire for the estimation of HrQoL (short form 36 [SF-36]). We assessed the severity of depression and anxiety with the Hospital Anxiety and Depression Scale (HADS) (Snaith RP. The Hospital Anxiety And Depression Scale. Health Qual Life Outcomes 2003 Aug 1;1:29-29.) and the Fatigue was measured with the FAS (© FAS Fatigue Assessment Scale: ild care foundation [http://www.ildcare.nl]). Data format: The data is stored in an Excel spreadsheet with the .xlsx data format. Units: Questionnaires - points oxygen uptake - ml/min/kg ; % power output - W ; W/kg pulmonary capacity - ml 6MWT -
The molecular basis of differential immunological HLA-B*57:01-associated adverse drug reactions
Get PDFLMS-based pediatric reference values for parameters of phosphate homeostasis in the HARP cohort
Get PDFSupplemental Material zu folgender Publikation (Abstract) Context: The assessment of phosphate homeostasis in children is challenging due the marked changes in laboratory parameters during growth and development, and the lack of adequate reference values. Objective: To develop Lambda-Mu-Sigma (LMS)-based continuous pediatric reference percentiles for 7 key laboratory parameters of phosphate homeostasis. Design: Cross-sectional single center study: HAnnover Reference values for Pediatrics (HARP) study. Setting: Hospital clinics and secondary school. Patients: Four hundred and fifty-five children aged 0.1-18 years (254 boys). Main outcome measures: LMS-based continuous reference percentiles for serum phosphate, plasma intact fibroblast growth factor 23 (iFGF23), and its cofactor soluble Klotho (sKlotho), tubular maximum phosphate reabsorption per glomerular filtration rate (TmP/GFR), fractional tubular reabsorption of phosphate (TRP), and urinary calcium/creatinine (Ca/Crea) and phosphate/creatinine (Pi/Crea) ratios. Results: LMS-based percentiles and z-scores were established for 7 key laboratory parameters of phosphate homeostasis which were all found to be age-dependent. Serum phosphate, TmP/GFR and sKlotho associated with sex. Serum phosphate, TmP/GFR, and urine Ca/Crea and Pi/Crea levels are highest in infancy and decline until age 18 years, while phosphate and TmP/GFR values reached adult levels earlier in girls compared to boys. iFGF23 concentrations are highest in infancy and fall to a stable plateau by 4 years of age, while sKlotho peaks during adolescence. Conclusion: This is the first report of LMS-based continuous pediatric reference percentiles for key laboratory parameters of phosphate homeostasis that allow calculation of standardized patient z-scores to facilitate test result interpretation in children and adolescents
