TY - JOUR A1 - Albanna, W. A1 - Conzen, C. A1 - Weiss, M. A1 - Clusmann, H. A1 - Fuest, M. A1 - Mueller, M. A1 - Brockmann, M.A. A1 - Vilser, W. A1 - Schmidt-Trucksäss, A. A1 - Hoellig, A. A1 - Seiz, M. A1 - Thomé, C. A1 - Kotliar, Konstantin A1 - Schubert, G.A. T1 - Retinal Vessel Analysis (RVA) in the context of subarachnoid hemorrhage: A proof of concept study JF - PLoS ONE N2 - Background Timely detection of impending delayed cerebral ischemia after subarachnoid hemorrhage (SAH) is essential to improve outcome, but poses a diagnostic challenge. Retinal vessels as an embryological part of the intracranial vasculature are easily accessible for analysis and may hold the key to a new and non-invasive monitoring technique. This investigation aims to determine the feasibility of standardized retinal vessel analysis (RVA) in the context of SAH. Methods In a prospective pilot study, we performed RVA in six patients awake and cooperative with SAH in the acute phase (day 2–14) and eight patients at the time of follow-up (mean 4.6±1.7months after SAH), and included 33 age-matched healthy controls. Data was acquired using a manoeuvrable Dynamic Vessel Analyzer (Imedos Systems UG, Jena) for examination of retinal vessel dimension and neurovascular coupling. Results Image quality was satisfactory in the majority of cases (93.3%). In the acute phase after SAH, retinal arteries were significantly dilated when compared to the control group (124.2±4.3MU vs 110.9±11.4MU, p<0.01), a difference that persisted to a lesser extent in the later stage of the disease (122.7±17.2MU, p<0.05). Testing for neurovascular coupling showed a trend towards impaired primary vasodilation and secondary vasoconstriction (p = 0.08, p = 0.09 resp.) initially and partial recovery at the time of follow-up, indicating a relative improvement in a time-dependent fashion. Conclusion RVA is technically feasible in patients with SAH and can detect fluctuations in vessel diameter and autoregulation even in less severely affected patients. Preliminary data suggests potential for RVA as a new and non-invasive tool for advanced SAH monitoring, but clinical relevance and prognostic value will have to be determined in a larger cohort. Y1 - 2016 U6 - http://dx.doi.org/10.1371/journal.pone.0158781 SN - 1932-6203 VL - 11 IS - 7 PB - PLOS CY - San Francisco ER - TY - JOUR A1 - Albanna, Walid A1 - Conzen, Catharina A1 - Weiss, Miriam A1 - Seyfried, Katharina A1 - Kotliar, Konstantin A1 - Schmidt, Tobias Philip A1 - Kuerten, David A1 - Hescheler, Jürgen A1 - Bruecken, Anne A1 - Schmidt-Trucksäss, Arno A1 - Neumaier, Felix A1 - Wiesmann, Martin A1 - Clusmann, Hans A1 - Schubert, Gerrit Alexander T1 - Non-invasive assessment of neurovascular coupling after aneurysmal subarachnoid hemorrhage: a prospective observational trial using retinal vessel analysis JF - Frontiers in Neurology N2 - Delayed cerebral ischemia (DCI) is a common complication after aneurysmal subarachnoid hemorrhage (aSAH) and can lead to infarction and poor clinical outcome. The underlying mechanisms are still incompletely understood, but animal models indicate that vasoactive metabolites and inflammatory cytokines produced within the subarachnoid space may progressively impair and partially invert neurovascular coupling (NVC) in the brain. Because cerebral and retinal microvasculature are governed by comparable regulatory mechanisms and may be connected by perivascular pathways, retinal vascular changes are increasingly recognized as a potential surrogate for altered NVC in the brain. Here, we used non-invasive retinal vessel analysis (RVA) to assess microvascular function in aSAH patients at different times after the ictus. Y1 - 2021 U6 - http://dx.doi.org/10.3389/fneur.2021.690183 SN - 1664-2295 VL - 12 IS - 12 SP - 1 EP - 15 ER - TY - JOUR A1 - Albanna, Walid A1 - Kotliar, Konstantin A1 - Lüke, Jan Niklas A1 - Alpdogan, Serdar A1 - Conzen, Catharina A1 - Lindauer, Ute A1 - Clusmann, Hans A1 - Hescheler, Jürgen A1 - Vilser, Walthard A1 - Schneider, Toni A1 - Schubert, Gerrit Alexander T1 - Non-invasive evaluation of neurovascular coupling in the murine retina by dynamic retinal vessel analysis JF - Plos one N2 - Background Impairment of neurovascular coupling (NVC) was recently reported in the context of subarachnoid hemorrhage and may correlate with disease severity and outcome. However, previous techniques to evaluate NVC required invasive procedures. Retinal vessels may represent an alternative option for non-invasive assessment of NVC. Methods A prototype of an adapted retinal vessel analyzer was used to assess retinal vessel diameter in mice. Dynamic vessel analysis (DVA) included an application of monochromatic flicker light impulses in predefined frequencies for evaluating NVC. All retinae were harvested after DVA and electroretinograms were performed. Results A total of 104 retinal scans were conducted in 21 male mice (90 scans). Quantitative arterial recordings were feasible only in a minority of animals, showing an emphasized reaction to flicker light impulses (8 mice; 14 scans). A characteristic venous response to flicker light, however, could observed in the majority of animals. Repeated measurements resulted in a significant decrease of baseline venous diameter (7 mice; 7 scans, p < 0.05). Ex-vivo electroretinograms, performed after in-vivo DVA, demonstrated a significant reduction of transretinal signaling in animals with repeated DVA (n = 6, p < 0.001). Conclusions To the best of our knowledge, this is the first non-invasive study assessing murine retinal vessel response to flicker light with characteristic changes in NVC. The imaging system can be used for basic research and enables the investigation of retinal vessel dimension and function in control mice and genetically modified animals. Y1 - 2018 U6 - http://dx.doi.org/10.1371/journal.pone.0204689 VL - 13 IS - 10 PB - PLOS CY - San Francisco ER - TY - JOUR A1 - Albanna, Walid A1 - Lueke, Jan Niklas A1 - Sjapic, Volha A1 - Kotliar, Konstantin A1 - Hescheler, Jürgen A1 - Clusmann, Hans A1 - Sjapic, Sergej A1 - Alpdogan, Serdan A1 - Schneider, Toni A1 - Schubert, Gerrit Alexander A1 - Neumaier, Felix T1 - Electroretinographic Assessment of Inner Retinal Signaling in the Isolated and Superfused Murine Retina JF - Current Eye Research Y1 - 2017 U6 - http://dx.doi.org/10.1080/02713683.2017.1339807 SN - 1460-2202 IS - Article in press SP - 1 EP - 9 PB - Taylor & Francis CY - London ER - TY - JOUR A1 - Albanna, Walid A1 - Lüke, Jan Niklas A1 - Schubert, Gerrit Alexander A1 - Dibué-Adjei, Maxine A1 - Kotliar, Konstantin A1 - Hescheler, Jürgen A1 - Clusmann, Hans A1 - Steiger, Hans-Jakob A1 - Hänggi, Daniel A1 - Kamp, Marcel A. A1 - Schneider, Toni A1 - Neumaier, Felix T1 - Modulation of Ca v 2.3 channels by unconjugated bilirubin (UCB) – Candidate mechanism for UCB-induced neuromodulation and neurotoxicity JF - Molecular and Cellular Neuroscience Y1 - 2019 U6 - http://dx.doi.org/10.1016/j.mcn.2019.03.003 SN - 1044-7431 VL - 96 IS - 4 SP - 35 EP - 46 PB - Elsevier CY - Amsterdam ER - TY - JOUR A1 - Alnemer, Momin Sami Mohammad A1 - Kotliar, Konstantin A1 - Neuhaus, Valentin A1 - Pape, Hans-Christoph A1 - Ciritsis, Bernhard D. T1 - Cost-effectiveness analysis of surgical proximal femur fracture prevention in elderly: a Markov cohort simulation model JF - Cost Effectiveness and Resource Allocation N2 - Background Hip fractures are a common and costly health problem, resulting in significant morbidity and mortality, as well as high costs for healthcare systems, especially for the elderly. Implementing surgical preventive strategies has the potential to improve the quality of life and reduce the burden on healthcare resources, particularly in the long term. However, there are currently limited guidelines for standardizing hip fracture prophylaxis practices. Methods This study used a cost-effectiveness analysis with a finite-state Markov model and cohort simulation to evaluate the primary and secondary surgical prevention of hip fractures in the elderly. Patients aged 60 to 90 years were simulated in two different models (A and B) to assess prevention at different levels. Model A assumed prophylaxis was performed during the fracture operation on the contralateral side, while Model B included individuals with high fracture risk factors. Costs were obtained from the Centers for Medicare & Medicaid Services, and transition probabilities and health state utilities were derived from available literature. The baseline assumption was a 10% reduction in fracture risk after prophylaxis. A sensitivity analysis was also conducted to assess the reliability and variability of the results. Results With a 10% fracture risk reduction, model A costs between $8,850 and $46,940 per quality-adjusted life-year ($/QALY). Additionally, it proved most cost-effective in the age range between 61 and 81 years. The sensitivity analysis established that a reduction of ≥ 2.8% is needed for prophylaxis to be definitely cost-effective. The cost-effectiveness at the secondary prevention level was most sensitive to the cost of the contralateral side’s prophylaxis, the patient’s age, and fracture treatment cost. For high-risk patients with no fracture history, the cost-effectiveness of a preventive strategy depends on their risk profile. In the baseline analysis, the incremental cost-effectiveness ratio at the primary prevention level varied between $11,000/QALY and $74,000/QALY, which is below the defined willingness to pay threshold. Conclusion Due to the high cost of hip fracture treatment and its increased morbidity, surgical prophylaxis strategies have demonstrated that they can significantly relieve the healthcare system. Various key assumptions facilitated the modeling, allowing for adequate room for uncertainty. Further research is needed to evaluate health-state-associated risks. KW - Hip fractures KW - Prevention KW - Geriatric KW - Cost-effectiveness KW - Prophylaxis Y1 - 2023 U6 - http://dx.doi.org/10.1186/s12962-023-00482-4 SN - 1478-7547 N1 - Corresponding author: Momin S. Alnemer IS - 21, Article number: 77 PB - Springer Nature ER - TY - JOUR A1 - Angermann, Susanne A1 - Günthner, Roman A1 - Hanssen, Henner A1 - Lorenz, Georg A1 - Braunisch, Matthias C. A1 - Steubl, Dominik A1 - Matschkal, Julia A1 - Kemmner, Stephan A1 - Hausinger, Renate A1 - Block, Zenonas A1 - Haller, Bernhard A1 - Heemann, Uwe A1 - Kotliar, Konstantin A1 - Grimmer, Timo A1 - Schmaderer, Christoph T1 - Cognitive impairment and microvascular function in end-stage renal disease JF - International Journal of Methods in Psychiatric Research (MPR) N2 - Objective Hemodialysis patients show an approximately threefold higher prevalence of cognitive impairment compared to the age-matched general population. Impaired microcirculatory function is one of the assumed causes. Dynamic retinal vessel analysis is a quantitative method for measuring neurovascular coupling and microvascular endothelial function. We hypothesize that cognitive impairment is associated with altered microcirculation of retinal vessels. Methods 152 chronic hemodialysis patients underwent cognitive testing using the Montreal Cognitive Assessment. Retinal microcirculation was assessed by Dynamic Retinal Vessel Analysis, which carries out an examination recording retinal vessels' reaction to a flicker light stimulus under standardized conditions. Results In unadjusted as well as in adjusted linear regression analyses a significant association between the visuospatial executive function domain score of the Montreal Cognitive Assessment and the maximum arteriolar dilation as response of retinal arterioles to the flicker light stimulation was obtained. Conclusion This is the first study determining retinal microvascular function as surrogate for cerebral microvascular function and cognition in hemodialysis patients. The relationship between impairment in executive function and reduced arteriolar reaction to flicker light stimulation supports the involvement of cerebral small vessel disease as contributing factor for the development of cognitive impairment in this patient population and might be a target for noninvasive disease monitoring and therapeutic intervention. KW - cerebral small vessel disease KW - cognitive impairment KW - dialysis KW - retinal vessels Y1 - 2022 U6 - http://dx.doi.org/10.1002/mpr.1909 SN - 1049-8931 (Print) SN - 1557-0657 (Online) VL - 31 IS - 2 SP - 1 EP - 10 PB - Wiley ER - TY - JOUR A1 - Attar, Mandana Hossein Zadeh A1 - Merk, Hans F. A1 - Kotliar, Konstantin A1 - Wurpts, Gerda A1 - Röseler, Stefani A1 - Moll-Slodowy, Silke A1 - Plange, Johann A1 - Baron, Jens Malte A1 - Balakirski, Galina T1 - The CD63 basophil activation test as a diagnostic tool for assessing autoimmunity in patients with chronic spontaneous urticaria JF - European Journal of Dermatology Y1 - 2019 U6 - http://dx.doi.org/10.1684/ejd.2019.3680 VL - 29 IS - 6 SP - 614 EP - 618 ER - TY - JOUR A1 - Balakirski, Galina A1 - Kotliar, Konstantin A1 - Pauly, Karolin J. A1 - Krings, Laura K. A1 - Rübben, Albert A1 - Baron, Jens M. A1 - Schmitt, Laurenz T1 - Surgical Site Infections After Dermatologic Surgery in Immunocompromised Patients: A Single-Center Experience JF - Dermatologic Surgery N2 - BACKGROUND Immunosuppression is often considered as an indication for antibiotic prophylaxis to prevent surgical site infections (SSI) while performing skin surgery. However, the data on the risk of developing SSI after dermatologic surgery in immunosuppressed patients are limited. PATIENTS AND METHODS All patients of the Department of Dermatology and Allergology at the University Hospital of RWTH Aachen in Aachen, Germany, who underwent hospitalization for a dermatologic surgery between June 2016 and January 2017 (6 months), were followed up after surgery until completion of the wound healing process. The follow-up addressed the occurrence of SSI and the need for systemic antibiotics after the operative procedure. Immunocompromised patients were compared with immunocompetent patients. The investigation was conducted as a retrospective analysis of patient records. RESULTS The authors performed 284 dermatologic surgeries in 177 patients. Nineteen percent (54/284) of the skin surgery was performed on immunocompromised patients. The most common indications for surgical treatment were nonmelanoma skin cancer and malignant melanomas. Surgical site infections occurred in 6.7% (19/284) of the cases. In 95% (18/19), systemic antibiotic treatment was needed. Twenty-one percent of all SSI (4/19) were seen in immunosuppressed patients. CONCLUSION According to the authors' data, immunosuppression does not represent a significant risk factor for SSI after dermatologic surgery. However, larger prospective studies are needed to make specific recommendations on the use of antibiotic prophylaxis while performing skin surgery in these patients. The available data on complications after dermatologic surgery have improved over the past years. Particularly, additional risk factors have been identified for surgical site infections (SSI). Purulent surgical sites, older age, involvement of head, neck, and acral regions, and also the involvement of less experienced surgeons have been reported to increase the risk of the SSI after dermatologic surgeries.1 In general, the incidence of SSI after skin surgery is considered to be low.1,2 However, antibiotics in dermatologic surgeries, especially in the perioperative setting, seem to be overused,3,4 particularly regarding developing antibiotic resistances and side effects. Immunosuppression has been recommended to be taken into consideration as an additional indication for antibiotic prophylaxis to prevent SSI after skin surgery in special cases.5,6 However, these recommendations do not specify the exact dermatologic surgeries, and were not specifically developed for dermatologic surgery patients and treatments, but adopted from other surgical fields.6 According to the survey conducted on American College of Mohs Surgery members in 2012, 13% to 29% of the surgeons administered antibiotic prophylaxis to immunocompromised patients to prevent SSI while performing dermatologic surgery on noninfected skin,3 although this was not recommended by Journal of the American Academy of Dermatology Advisory Statement. Indeed, the data on the risk of developing SSI after dermatologic surgery in immunosuppressed patients are limited. However, it is possible that due to the insufficient evidence on the risk of SSI occurrence in this patient group, dermatologic surgeons tend to overuse perioperative antibiotic prophylaxis. To make specific recommendations on the use of antibiotic prophylaxis in immunosuppressed patients in the field of skin surgery, more information about the incidence of SSI after dermatologic surgery in these patients is needed. The aim of this study was to fill this data gap by investigating whether there is an increased risk of SSI after skin surgery in immunocompromised patients compared with immunocompetent patients. Y1 - 2018 U6 - http://dx.doi.org/10.1097/DSS.0000000000001615 IS - 44 (12) SP - 1525 EP - 1536 PB - Wolters Kluwer ER - TY - JOUR A1 - Baumann, Marcus A1 - Schwarz, Sonja A1 - Kotliar, Konstantin A1 - Eynatten, Maximilian von A1 - Trucksaess, Arno A1 - Burckhardt, Klaus A1 - Lutz, Jens A1 - Heemann, Uwe A1 - Lanzl, Ines T1 - Non-diabetic chronic kidney disease influences retinal microvasculature JF - Kidney and Blood Pressure Research Y1 - 2009 SN - 1423-0143 VL - 32 IS - 6 SP - 428 EP - 433 PB - - ER -