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Clinical outcome and predictors of survival after TIPS insertion in patients with liver cirrhosis

World Journal of Gastroenterology 2012年第37期18卷 5211-5218页

作者： Hauke S Heinzow philipp lenz Michael Khler Frank Reinecke Hansjrg Ullerich Wolfram Domschke Dirk Domagk Tobias Meister Department of Medicine B University of Muenster Institute of Radiology University of Muenster Department of Medicine Ⅱ Helios Albert-Schweitzer-Hospital

AIM:To determine the clinical outcome and predictors of survival after transjugular intrahepatic portosystemic stent shunt (TIPS) implantation in cirrhotic patients. METHODS:Eighty-one patients with liver cirrhosis and consequential portal hypertension had TIPS implantation (bare metal) for either refractory ascites (RA) (n= 27) or variceal bleeding (VB) (n = 54). Endpoints for the study were:technical success, stent occlusion and stent stenosis, rebleeding, RA and mortality. Clinical records of patients were collected and analysed. Baseline characteristics [e.g., age, sex, CHILD score and the model for end-stage liver disease score (MELD score), underlying disease] were retrieved. The Kaplan-Meier method was employed to calculate survival from the time of TIPS implantation and comparisons were made by log rank test. A multivariate analysis of factors influencing survival was carried out using the Cox proportional hazards regression model. Results were expressed as medians and ranges. Comparisons between groups were performed by using the Mann-Whitney Utest and the χ 2 test as appropriate. RESULTS:No difference could be seen in terms of age, sex, underlying disease or degree of portal pressure gradient (PPG) reduction between the ascites and the bleeding group. The PPG significantly decreased from 23.4 ± 5.3 mmHg (VB) vs 22.1 ± 5.5 mmHg (RA) before TIPS to 11.8 ± 4.0 vs 11.7 ± 4.2 after TIPS implantation (P = 0.001 within each group). There was a tendency towards more patients with stage CHILD A in the bleeding group compared to the ascites group (24 vs 6, P = 0.052). The median survival for the ascites group was 29 mo compared to > 60 mo for the bleeding group (P = 0.009). The number of radiological controls for stent patency was 6.3 for bleeders and 3.8 for ascites patients (P = 0.029). Kaplan-Meier calculation indicated that stent occlusion at first control (P = 0.027), ascites prior to TIPS implantation (P = 0.009), CHILD stage (P = 0.013), MELD score (P = 0.001

关键词： TIPS 预测因子临床疗效肝硬化患者 Cox回归模型压力梯度毫米汞柱

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Diagnostic imaging advances in murine models of colitis

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World Journal of Gastroenterology 2016年第3期22卷 996-1007页

作者： Markus Brückner philipp lenz Marcus M Mücke Faekah Gohar Peter Willeke Dirk Domagk Dominik Bettenworth Department of Medicine B University Hospital of MünsterAlbert-Schweitzer-Campus 1D-48149 MünsterGermany Department of Paediatric Rheumatology and Immunology University Hospital of MünsterAlbert-Schweitzer-Campus 1D-48149 MünsterGermany Department of Medicine D University Hospital of MünsterAlbert-Schweitzer-Campus 1D-48149 MünsterGermany Department of Medicine I Josephs-Hospital WarendorfAcademic Teaching HospitalUniversity of MünsterAm Krankenhaus 2D-48231 WarendorfGermany

Inflammatory bowel diseases(IBD) such as Crohn's disease and ulcerative colitis are chronic-remittent inflammatory disorders of the gastrointestinal tract still evoking challenging clinical diagnostic and therapeutic situations. Murine models of experimental colitis are a vital component of research into human IBD concerning questions of its complex pathogenesis or the evaluation of potential new drugs. To monitor the course of colitis, to the present day, classical parameters like histological tissue alterations or analysis of mucosal cytokine/chemokine expression often require euthanasia of animals. Recent advances mean revolutionary noninvasive imaging techniques for in vivo murine colitis diagnostics are increasingly available. These novel and emerging imaging techniques not only allow direct visualization of intestinal inflammation, but also enable molecular imaging and targeting of specific alterations of the inflamed murine mucosa. For the first time, in vivo imaging techniques allow for longitudinal examinations and evaluation of intra-individual therapeutic response. This review discusses the latest developments in the different fields of ultrasound, molecularly targeted contrast agent ultrasound, fluorescence endoscopy, confocal laser endomicroscopy as well as tomographic imaging with magnetic resonance imaging, computed tomography and fluorescence-mediated tomography,discussing their individual limitations and potential future diagnostic applications in the management of human patients with IBD.

关键词： confocal laser endomicroscopy contrastenhanced ultrasound Dextran Sodium Sulphate colitis experimental colitis fluorescence imaging endoscopy Imaging Inflammatory bowel disease Tomography

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Detection and characterization of murine colitis and carcinogenesis by molecularly targeted contrast-enhanced ultrasound

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World Journal of Gastroenterology 2017年第16期23卷 2899-2911页

作者： Markus Brückner Jan Heidemann Tobias M Nowacki Friederike Cordes Jorg Stypmann philipp lenz Faekah Gohar Andreas Lügering Dominik Bettenworth Department of Medicine B University Hospital of MünsterD-48149 MünsterGermany Department of Gastroenterology Klinikum Bielefeld MitteAcademic Teaching HospitalUniversity of MünsterD-33604 BielefeldGermany Department of Cardiology and Angiology University Hospital of MünsterD-48149 MünsterGermany Department of Palliative Care University Hospital of MünsterD-48149 MünsterGermany Department of Paediatric Rheumatology and Immunology University Hospital of MünsterD-48149 MünsterGermany Medical Care Center Portal 10 D-48155 MünsterGermany

AIM To study mucosal addressin cellular adhesion molecule-1(MAd CAM-1) and vascular endothelial growth factor(VEGF)-targeted contrast enhanced ultrasound(CEUS) for the assessment of murine colitis and carcinogenesis. METHODS C57BL/6 mice were challenged with 3% dextran sodium-sulfate(DSS) for three, six or nine days to study the development of acute colitis. Ultrasound was performed with and without the addition of unspecific contrast agents. MAd CAM-1-targeted contrast agent was used to detect and quantify MAd CAM-1 expression. Inflammatory driven colorectal azoxymethane(AOM)/DSS-induced carcinogenesis was examined on day 42 and 84 using VEGF-targeted contrast agent. Highly specific tissue echogenicity was quantified using specialized software. Sonographic findings were correlated to tissue staining, western blot analysis and immunohistochemistry to quantify the degree of inflammation and stage of carcinogenesis. RESULTS Native ultrasound detected increased general bowel wall thickening that correlated with more progressed and more severe DSS-colitis(healthy mice: 0.3 mm ± 0.03 vs six days DSS: 0.5 mm ± 0.2 vs nine days DSS: 0.6 mm ± 0.2, P < 0.05). Moreover, these sonographic findings correlated well with clinical parameters such as weight loss(r2 = 0.74) and histological damage(r2 = 0.86)(P < 0.01). In acute DSS-induced murine colitis, CEUS targeted against MAd CAM-1 detected and differentiated stages of mild, moderate and severe colitis via calculation of mean pixel contrast intensity in decibel(9.6 d B ± 1.6 vs 12.9 d B ± 1.4 vs 18 d B ± 3.33, P < 0.05). Employing the AOM/DSSinduced carcinogenesis model, tumor development was monitored by CEUS targeted against VEGF and detected a significantly increased echogenicity in tumors as compared to adjacent healthy mucosa(healthy mucosa, 1.6 d B ± 1.4 vs 42 d, 18.2 d B ± 3.3 vs 84 d, 18.6 d B ± 4.9, P < 0.01). Tissue echogenicity strongly correlated with histological analysis and immunohistochemistry findings(VEGF-posi

关键词： Colitis Dextran sodium-sulfate AOMDSS Carcinogenesis Ultrasound Contrast-enhanced ultrasound Vascular endothelial growth factor Mucosal addressin cellular adhesion molecule-1

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Intraductal ultrasound substantiates diagnostics of bile duct strictures of uncertain etiology

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World Journal of Gastroenterology 2013年第6期19卷 874-881页

作者： Tobias Meister Hauke S Heinzow Carina Woestmeyer philipp lenz Josef Menzel Torsten Kucharzik Wolfram Domschke Dirk Domagk Department of Medicine B University of Münster Department of Medicine Ⅱ HELIOS AlbertSchweitzer University Teaching Hospital Department of MedicineⅡ Klinikum IngolstadtD-85049 IngolstadtGermany Department of Medicine University Teaching Hospital Lüneburg

AIM:To report the largest patient cohort study investigating the diagnostic yield of intraductal ultrasound (IDUS) in indeterminate strictures of the common bile ***:A patient cohort with bile duct strictures of unknown etiology was examined by ***,specificity and accuracy rates of IDUS were calculated relating to the definite diagnoses proved by histopathology or long-term follow-up in those patients who did not undergo *** of the endosonographic report allowed drawing conclusions with respect to the T and N staging in 147 *** staging was compared to the postoperative histopathological staging data allowing calculation of sensitivity,specificity and accuracy rates for T and N *** endoscopic retrograde cholangio-pancreatography and IDUS procedures were performed under fluoroscopic guidance using a side-viewing duodenoscope (Olympus TJF 160,Olympus,Ltd.,Tokyo,Japan).All procedures were performed under conscious sedation (propofol combined with pethidine) according to the German *** IDUS,a 6 F or 8 F ultrasound miniprobe was employed with a radial scanner of 15-20 MHz at the tip of the probe (Aloka Co.,Tokyo,Japan).RESULTS:A total of 397 patients (210 males,187 females,mean age 61.43 ± 13 years) with indeterminate bile duct strictures were *** hundred and sixty-four patients were referred to the department of surgery for operative exploration,thus surgical histopathological correlation was available for those *** of 264 patients,174 had malignant disease proven by surgery,in 90 patients benign disease was *** these patients decision for surgical exploration was made due to suspicion for malignant disease in multimodal diagnostics (computed tomography scan,endoscopic ultrasound or magnetic resonance imaging).Twenty benign bile duct strictures were misclassified by IDUS as malignant while 14 patients with malignant strictures were initially misdiagnosed by IDUS as benign resulting in s

关键词： Intraductal ultrasound Bile duct strictures Accuracy

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Prospective observational multicenter study to define a diagnostic algorithm for biliary candidiasis

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World Journal of Gastroenterology 2014年第34期20卷 12260-12268页

作者： philipp lenz Franziska Eckelskemper Thomas Erichsen Tim Lankisch Alexander Dechêne Gabriele Lubritz Frank lenze Torsten Beyna Hansjorg Ullerich Andre Schmedt Dirk Domagk Department of Medicine B University of MuensterD-48149 MuensterGermany Department of Gastroenterology Hepatology and EndocrinologyHannover Medical School30625 HannoverGermany Department of Gastroenterology and Hepatology University Hospital Essen45147 EssenGermany Institute of Medical Microbiology University Hospital MuensterD-48149 MuensterGermany

AIM:To develop an algorithm to improve the diagnosis and treatment of patients with biliary ***:We performed a prospective study of 127patients who underwent endoscopic retrograde cholangiopancreatography,for various biliary disorders,at 3 tertiary referral centers in Germany from July 2011through July 2012(***:NCT01109550).Bile,buccal,and stool samples were *** indicated,endoscopic transpapillary bile duct biopsies were performed to clarify the etiology of bile duct strictures and to prove invasive fungal ***:Candida species were detected in 38 of the 127 bile samples(29.9%).By multivariate analysis patients’age and previous endoscopic sphincterotomy were independent risk factors for biliary candidiasis(P7 d)(P=0.089)tend to be at risk for biliary *** patient was negative in mycological culture of bile fluid but invasive biliary candidiasis was diagnosed *** Candida subspecies detected,36.7%were azole-resistant,such as C *** patients received anti-mycotic therapy,based on our *** these,3 had cancer with biliary tract involvement,2had secondary sclerosing cholangitis,1 had retroperitoneal fibrosis,and 5 had *** all patients contamination was ruled out by smears of the endoscope ***:Gastroenterologists should be aware of frequent candida colonization in patients with cholangitis and biliary *** suggested algorithm facilitates the further clinical management.

关键词： Cholangitis Biliary candidiasis Invasive fungal infection Biliary obstruction

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Textile-Based Sensors for Inspection of Composite Materials

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材料科学与工程（中英文B版） 2020年第2期10卷 74-83页

作者： Reinhold Schneider Sabine Frick Angelika lenz Yavuz Caydamli philipp Arnold German Institutes of Textile and Fibre Research(DITF) Körschtalstr.26Denkendorf D-73770Germany University of Stuttgart Institute of Polymer Chemistry(IPOC)Pfaffenwaldring 55Stuttgart D-70569Germany University of Stuttgart Institute for System Dynamics(ISYS)Waldburgstr.19Stuttgart D-70563Germany

The monitoring of mechanical deformation and damage of composite materials is normally performed by established analytical methods,such as strain gauges and optical and piezoelectric ***,large areas outside of the measuring cell remain unconsidered.A large-area sensitive sensor for composites is presented,which is simply generated by printing a carbon layer on the reinforcing glass fiber fabrics or on any composite *** printed sensors enable to determine mechanical deformations and damages of the entire component and it responds with a measurable electrical resistance to external tension or pressure without any *** strongest influence on sensor signal was identified with low carbon concentration and thin *** sensors signal linearly correlates with the degree of deformation and bending velocity whereas bending direction can be identified through signal change under residual tensile stress or compressive stress.

关键词： Textile sensor carbon black printing coating composites bending ohmic resistance

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