39 results on '"Warwas, S."'
Search Results
2. (503) Donor-Related Clinical Factors Influencing One-Year Outcomes in Adult Patients after Orthotopic Heart Transplantation - A Single-Center Polish Experience
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Kuczaj, A.A., primary, Warwas, S., additional, Król, B., additional, Hrapkowicz, T., additional, Śliwka, J., additional, Pawlak, S., additional, and Przybyłowski, P., additional
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- 2023
- Full Text
- View/download PDF
3. (1372) - Toxic Milk- Should We Still be Afraid of Breastfeeding While on Tacrolimus Therapy: A Case Study
- Author
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Danel, A., Warwas, S., Przybyłowski, P., Śliwka, J., Pawlak, S., Trzcińska, I., and Hrapkowicz, T.
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- 2024
- Full Text
- View/download PDF
4. Heart Retransplantation from an Anti-HBcore Positive Donor
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Kuczaj, A., primary, Warwas, S., additional, Przybyłowski, P., additional, and Zembala, M., additional
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- 2021
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5. Experimental and computational studies on the femoral fracture risk for advanced core decompression
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Tran, T. N., Warwas, S., Haversath, M., Classen, T., Hohn, H. P., Jäger, M., Kowalczyk, W., and Landgraeber, S.
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- 2014
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6. Ergebnisse der Advanced Core Decompression bei Osteonekrose des Femurkopfes in Abhängigkeit von Alter und Geschlecht
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Warwas, S, Jäger, M, and Landgraeber, S
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Core Decompression ,Hüfte ,ddc: 610 ,Osteonekrose ,610 Medical sciences ,Medicine - Abstract
Fragestellung: Zur Vermeidung einer frühzeitigen endoprothetischen Versorgung bei nachgewiesener Osteonekrose des Femurkopfes (ONF) hat sich, neben anderen Verfahren, die Advanced Core Decompression (ACD) etabliert. Bezüglich der Therapieergebnisse konnten die Faktoren „Stadium“[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018)
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- 2018
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7. Einfluss der Größe von Osteonekrosen des Femurkopfes auf den Knorpel
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Landgraeber, S, Kowalczyk, W, Warwas, S, Jäger, M, Haubold, J, Theysohn, J, and Tran, TN
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ddc: 610 ,Osteonekrose ,610 Medical sciences ,Medicine ,Hüftkopf ,Knorpelschäden - Abstract
Fragestellung: In klinischen Studien zu Osteonekrosen der Femurkopfes (ONFK) gibt es Hinweise darauf, dass die Defektausdehnung sowohl den Spontanverlauf als auch die Ergebnisse nach erfolgter Behandlung in Hinblick auf Hüftkopfeinbrüche beeinflussen. Zudem wird vermutet, dass auch die Traglast[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018)
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- 2018
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8. Deep Learning With Anatomical Priors: Imitating Enhanced Autoencoders In Latent Space For Improved Pelvic Bone Segmentation In MRI
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Pham, D. D., primary, Dovletov, G., additional, Warwas, S., additional, Landgraeber, S., additional, Jager, M., additional, and Pauli, J., additional
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- 2019
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9. Behandlung von Osteonekrosen des Hüftkopfes mit Einbruch der subchondralen Lamelle und darüberliegendem Knorpelschaden
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Landgraeber, S, Warwas, S, Lazik-Palm, A, Haubold, J, Theysohn, J, and Jäger, M
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Knorpelzelltransplantation ,ddc: 610 ,Hüftarthroskopie ,Osteonekrose ,610 Medical sciences ,Medicine ,Hüftkopfnekrose - Abstract
Fragestellung: Für die Behandlung von Osteonekrosen des Femurkopfes (ONF) gibt es verschiedene hüftkopferhaltende Operationsverfahren. Dabei ist zumindest die Anwendung der Core Decompression auf Fälle begrenzt bei denen es noch nicht zu einem röntgenologisch sichtbaren Einbruch [zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)
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- 2017
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10. Prävalenz und Outcome-Einfluss der CAM-Deformität bei Patienten mit Hüftkopfnekrose
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Warwas, S, Jäger, M, and Landgraeber, S
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CAM ,ddc: 610 ,ARCO ,Osteonekrose ,610 Medical sciences ,Medicine - Abstract
Fragestellung: Die Osteonekrose des Femurkopfes (ONF) stellt eine schwerwiegende Erkrankung des Hüftgelenkes dar, welche unbehandelt regelmäßig zum Einbruch der Gelenkfläche führt. Es gibt Beobachtungsstudien, die über ein gehäuftes Auftreten der CAM-Deformität[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)
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- 2017
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11. Behandlung von Osteonekrosen des Femurkopfes mittels modifizierter Advanced Core Decompression
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Landgraeber, S, Warwas, S, and Jäger, M
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Hüfte ,ddc: 610 ,Knochenersatzstoff ,Osteonekrose ,autologer Knochen ,610 Medical sciences ,Medicine - Abstract
Fragestellung: Bei der Behandlung von Osteonekrosen des Femurkopfes (ONF) wird der Erhalt des Hüftkopfes angestrebt um einen endoprothetischen Gelenkersatz zu vermeiden. Dazu werden zunehmend Verfahren verwendet, die eine Ausräumung der Nekrose anstreben. Bei der sogenannten Advanced Core [zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2016)
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- 2016
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12. Polar appearance models: A fully automatic approach for femoral model initialization in MRI
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Pham, D. D., primary, Morariu, C. A., additional, Terheiden, T., additional, Warwas, S., additional, Landgraeber, S., additional, Jager, M., additional, and Pauli, J., additional
- Published
- 2018
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13. Prävalenz des femoro-acetabulären Impingements bei Patienten mit Osteonekrose des Hüftkopfes
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Warwas, S, Jäger, M, and Landgraeber, S
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PINCER ,Hüfte ,CAM ,ddc: 610 ,Impingement ,610 Medical sciences ,Medicine ,Hüftkopfnekrose - Abstract
Fragestellung: Die Literatur unterscheidet zwischen zwei Typen des femoro-acetabulären Impingements (FAI): dem CAM-Typ mit femoral gelegener Pathologie und dem PINCER-Typ mit acetabulärer Ursache. Für beide Formen zeigt die aktuelle Studienlage eine Prävalenz von ~15% in[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2015)
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- 2015
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14. Proliferation und osteogene Differenzierung mesenchymaler Stromazellen auf Poly-DL-Lactid + BMP-2-beschichteten Titanoberflächen
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Haversath, M, Hülsen, T, Tassemeier, T, Landgraeber, S, Herten, M, Warwas, S, Krauspe, R, and Jäger, M
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ddc: 610 ,Titanoberflächen ,BMP-2 ,Proliferation ,Poly-DL-Lactid ,Differenzierung ,mesenchymale Stromazellen ,610 Medical sciences ,Medicine - Abstract
Fragestellung: Meist in Kombination mit einer Osteosynthese wird rhBMP-2 bei Knochendefekten kritischer Größe klinisch angewandt um Knochenregeneration und -heilung zu fördern. In dieser Studie soll die Proliferation und osteogene Differenzierung von humanen mesenchymalen Stromazellen[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2015)
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- 2015
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15. Donor-Related Clinical Factors Influencing One-Year Outcomes in Adult Patients after Orthotopic Heart Transplantation - A Single-Center Polish Experience.
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Kuczaj, A.A., Warwas, S., Król, B., Hrapkowicz, T., Śliwka, J., Pawlak, S., and Przybyłowski, P.
- Subjects
- *
HEART transplantation , *ARTIFICIAL blood circulation , *GRAFT rejection , *HEART transplant recipients , *CARDIAC arrest - Abstract
The study aimed to determine the influence of ischemia time, sudden cardiac arrest, and troponin levels in the donor on annual survival, cellular rejection, and functional parameters in adult heart transplant recipients The study population consisted of 258 (199 (77%) men) consecutive adult patients (pts) treated with orthotopic heart transplantation (OHT) between 2015 and 2020 in a single heart transplant center : The baseline characteristics of the recipient population were as follows: mean age at the time of OHT was 55 years (±12), ischemic etiology was present in 83 (32%), diabetes mellitus in 62 (24%), severe renal insufficiency in 13 (5%), obesity in 26 (10%), mechanical circulatory support (MCS) before OHT in 61 (23.64%) pts. A basic immunotherapy scheme consisted of tacrolimus used in 255 (99%) pts, cyclosporine in 3 (1%), everolimus in 42 (16%), and mycophenolate in 256 (99%) pts. The mean donor age equaled 38 (± 10) years. 57 (23%) donors had a sudden cardiac arrest (SCA). The mean donor troponin level was 53 (±142.26) ng/l, mean graft ischemic time was 165 (± 51) min. There were 39 (15.12%) cases of sex mismatch and 23 (8.91%) female-to-male transplantations. One-year acute cellular rejection index (ACRI) was: median = 0.077; Q1 = 0; Q3 = 0.154. LVEF in the first year: median = 56%; Q1 = 55%; Q3 = 60%. TAPSE in the first year: median = 13mm; Q1 = 12mm; Q3 = 15mm. Mortality in the first year equaled 25.58%. The troponin donor levels were significantly higher in donors who underwent SCA (20.0 ng/l vs 4.12 ng/l, p=0.006). However, median LVEF and median TAPSE in pts who received a heart from donors after SCA did not significantly differ from pts who received it from non-SCA donors (58% vs 55%, p= 0.095, 13mm vs 13mm, p= 0.83). There was no correlation between the ACRI and the graft ischemia time (R=-0.04, p=0.61), troponin level in donors, and ACRI (R=-0.02, p=0.80). In the population of the deceased in the first year after OHT, median donor troponin levels were 0.41 ng/l vs 5.28 ng/l in survivors; p=0.56, median ischemia time 168 min vs 160 min; p=0.24 Ischemia time, SCA, and troponin levels in accepted heart donors do not seem to influence the donor's annual survival, cellular rejection, and functional parameters in adult heart transplant recipients [ABSTRACT FROM AUTHOR]
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- 2023
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16. Arthroscopic synovectomy and radiosynoviorthesis: a treatment option for recurrent arthritis symptoms in patients with pachydermoperiostosis
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Warwas, S., primary, Specker, C., additional, Jäger, M., additional, and Landgraeber, S., additional
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- 2013
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17. Making Multiagent System Designs Reusable: A Model-Driven Approach.
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Warwas, S. and Klusch, M.
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- 2011
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18. Semantics and Agents for Intelligent Simulation and Collaboration in the 3D Internet.
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Klusch, M., Xiaoqi Cao, Kapahnke, P., and Warwas, S.
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- 2011
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19. Model-driven Approach to the Integration of Multiagent Systems and Semantic Web Services.
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Hahn, C., Nesbigall, S., Warwas, S., Zinnikus, I., Klusch, M., and Fischer, K.
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- 2008
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20. Integration of Multiagent Systems and Semantic Web Services on a Platform Independent Level.
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Hahn, C., Nesbigall, S., Warwas, S., Zinnikus, I., Fischer, K., and Klusch, M.
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- 2008
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21. (1372) - Toxic Milk- Should We Still be Afraid of Breastfeeding While on Tacrolimus Therapy: A Case Study.
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Kuczaj, A., Danel, A., Warwas, S., Przybyłowski, P., Śliwka, J., Pawlak, S., Trzcińska, I., and Hrapkowicz, T.
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- *
TACROLIMUS , *BREASTFEEDING , *GOAT milk - Published
- 2024
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22. Thyroid Dysfunction in Advanced Heart Failure Patients and Its Correlation with Amiodarone Therapy: A Two-Year Study.
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Kuczaj A, Warwas S, Danel A, Przybyłowski P, and Hrapkowicz T
- Abstract
(1) Background: Advanced heart failure often accompanies ventricular arrhythmias, necessitating antiarrhythmic therapies. Amiodarone, commonly used for this purpose, may induce thyroid dysfunction due to its high iodine content. However, the prevalence and correlation of thyroid dysfunction with amiodarone in end-stage heart failure patients remain unclear. Aim: This study aimed to evaluate the prevalence and types of thyroid dysfunction and their association with amiodarone among 200 patients diagnosed with advanced heart failure eligible for transplantation. (2) Methods: Consecutively enrolled patients received treatment following the European Society of Cardiology guidelines and were followed-up for two years. Ventricular arrhythmias affected 58.5% of the cohort, with 24.5% receiving amiodarone therapy. (3) Results: Thyroid metabolism dysfunction was evident in 61 patients, notably overrepresented in women ( p = 0.0028). Hyperthyroidism (34 patients) and hypothyroidism (27 patients) were observed, with a significant amiodarone-related correlation. Despite this, thyroid dysfunction was not associated with increased mortality among the studied group. (4) Conclusions: Thyroid dysfunction is prevalent in advanced heart failure patients, with a notable proportion linked to amiodarone. However, its presence does not correspond to higher mortality rates. Understanding these associations is crucial for effective management in this patient population. Further exploration is warranted to refine approaches to thyroid dysfunction in refractory heart failure.
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- 2024
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23. Does the induction immunotherapy (basiliximab) influence the early acute cellular rejection index after orthotopic heart transplantation?- Preliminary assessment report.
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Kuczaj A, Warwas S, Zakliczyński M, Pawlak S, Przybyłowski P, Śliwka J, and Hrapkowicz T
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- Male, Adult, Humans, Middle Aged, Female, Basiliximab therapeutic use, Tacrolimus, Everolimus, Graft Rejection, Immunosuppressive Agents therapeutic use, Immunotherapy, Recombinant Fusion Proteins therapeutic use, Heart Transplantation, Renal Insufficiency
- Abstract
The study aimed to determine the influence of induction therapy on the acute cellular rejection (ACR) index in adult heart transplant recipients during the one-year observation. The study population consisted of 256 consecutive adult patients (pts), aged 51.5 (±11.9) years, 199 (77%) men treated with orthotopic heart transplantation (OHT) in the period between 2015 and 2020 in a single high-volume heart transplant center. The endomyocardial biopsies (EMBs) were performed according to the protocol consisting of 7 protocolary EMBs for up to 3 months and 10 EMBs for up to one year after OHT. The rejection index (ACRI) was calculated as the number of scheduled EMBs with the ACR ≥ 2 divided by the total number of protocolary EMBs. The study population was divided into two groups according to the application of basiliximab. The total number of pts. who received basiliximab was 10 (3.9%). The main indications for the usage of the induction therapy were heart retransplantation, mechanical circulatory support (MCS), severe renal insufficiency (eGFR <30 mL/min/1.73 m2), and a panel of reactive antibody (PRA) > 10%. In the group with induction, the mean age was 49 (±14) years; 3 (30%) patients had the MCS prior to OHT, and 3 (30%) patients had heart retransplantation. Four (40%) patients had diabetes mellitus, and 4 (40%) patients had severe renal insufficiency. As maintenance therapy during the observation period, tacrolimus was given to 10 (100%) patients, everolimus to 2 (20%) patients, and MPA to 9 (90%) patients. In the group with no induction, the mean age was 51.8 (±12) years, MCS was used in 56 (23%) patients, 2 (0.8%) patients were retransplanted; 10 (4%) patients had eGFR <30 mL/min/1.73 m2 and 58 (24%) patients had diabetes. Tacrolimus was administered to 243 (99%) patients, cyclosporine to 3 (1%), everolimus to 40 (16%), and mycophenolate to 245 (99.6%) heart recipients. The median one-year ACRI was 0.0, IQR:0.0-0.08 in the group with induction vs. 0.077, IQR: 0.0-0.154 with no induction; p = 0.11. ACRI up to three months was significantly higher in the entire cohort in comparison to up to one year (P < 0.01). The multivariate analysis showed that only everolimus implementation and younger age at the time of transplant influenced patients' mortality rate (P < 0.01). Significant graft rejections (≥ 2R ISHLT) are most common in the first three months after OHT. Patients who are initially at high risk of significant cellular rejection may benefit from induction therapy., (Copyright © 2023 Elsevier B.V. All rights reserved.)
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- 2023
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24. Gut Microbiome in Patients after Heart Transplantation-Current State of Knowledge.
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Olek K, Kuczaj AA, Warwas S, Hrapkowicz T, Przybyłowski P, and Tanasiewicz M
- Abstract
The human gut microbiota include over 10 trillion microorganisms, such as bacteria, fungi, viruses, archaea, and protozoa. Many reports indicate the strong correlation between dysbiosis and the severity of cardiovascular diseases. Microbiota seem to interact with the host's alloimmunity and may have an immunomodulatory role in graft rejection processes. In our study, we present the current state of the knowledge of microbiota in heart transplant recipients. We present up-to-date microbiota diagnostic methods, interactions between microbiota and immunosuppressive drugs, the immunomodulatory effects of dysbiosis, and the available strategies (experimental and clinical strategies) to modulate host microbiota.
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- 2023
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25. Predictors of post-stroke delirium incidence and duration: Results of a prospective observational study using high-frequency delirium screening.
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Fleischmann R, Andrasch T, Warwas S, Kunz R, Gross S, Witt C, Ruhnau J, Vogelgesang A, Ulm L, Mengel A, and von Sarnowski B
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- Humans, Male, Female, Middle Aged, Aged, Aged, 80 and over, Incidence, Risk Factors, Pain, Depression diagnosis, Stroke complications, Stroke epidemiology, Stroke diagnosis, Delirium diagnosis, Delirium epidemiology, Delirium etiology
- Abstract
Background: Post-stroke delirium (PSD) is a modifiable predictor for worse outcome in stroke. Knowledge of its risk factors would facilitate clinical management of affected patients, but recently updated national guidelines consider available evidence insufficient., Aims: The study aimed to establish risk factors for PSD incidence and duration using high-frequency screening., Methods: We prospectively investigated patients with ischemic stroke admitted within 24 h. Patients were screened twice daily for the presence of PSD throughout the treatment period. Sociodemographic, treatment-related, and neuroimaging characteristics were evaluated as predictors of either PSD incidence (odds ratios (OR)) or duration (PSD days/unit of the predictor, b ), using logistic and linear regression models, respectively., Results: PSD occurred in 55/141 patients (age = 73.8 ± 10.4 years, 61 female, National Institutes of Health Stroke Scale (NIHSS) = 6.4 ± 6.5). Age (odds ratio (OR) = 1.06 (95% confidence interval (CI): 1.02-1.10), b = 0.08 (95% CI = 0.04-0.13)), and male gender ( b = 0.99 (95% CI = 0.05-1.93)) were significant non-modifiable risk factors. In a multivariable model adjusted for age and gender, presence of pain (OR < sub > mvar = 1.75 (95% CI = 1.12-2.74)), urinary catheter (OR < sub > mvar = 3.16 (95% CI = 1.10-9.14)) and post-stroke infection (PSI; OR < sub > mvar = 4.43 (95% CI = 1.09-18.01)) were predictors of PSD incidence. PSD duration was impacted by presence of pain ( b < sub > mvar = 0.49 (95% CI = 0.19-0.81)), urinary catheter ( b < sub > mvar = 1.03 (95% CI = 0.01-2.07)), intravenous line ( b < sub > mvar = 0.36 (95% CI = 0.16-0.57)), and PSI ( b < sub > mvar = 1.60 (95% CI = 0.42-2.78)). PSD (OR = 3.53 (95% CI = 1.48-5.57)) and PSI (OR = 5.29 (95% CI = 2.92-7.66)) independently predicted inferior NIHSS at discharge. Insular and basal ganglia lesions increased the PSD risk about four- to eight-fold., Discussion/conclusion: This study identified modifiable risk factors, the management of which might reduce the negative impact PSD has on outcome.
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- 2023
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26. The implantation of AV leadless pacemaker - a case report.
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Warwas S, Jędrzejczyk-Patej E, Jagosz M, Mazurek M, Kowalski O, Średniawa B, and Kalarus Z
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- Female, Humans, Adult, Heart Ventricles, Anti-Bacterial Agents, Atrioventricular Block therapy, Atrioventricular Block etiology, Pacemaker, Artificial adverse effects, Endocarditis complications
- Abstract
In early 2020 Food and Drug Administration (FDA) approved Micra AV - a new type of leadless pacemaker with atrioventricular synchrony, to treat patients with atrio-ventricular (AV) blocks. We describe one of the first in Poland case of a patient who was implanted with Micra AV pacemaker., Case Report: A 38-year-old female patient was admitted to the clinic due to the 29-seconds event of a complete AV block without an escape rhythm and was implanted with a dual chamber pacemaker without any complications. After several months she was admitted again with suspicion of ventricular perforation by the pacemaker electrode and underwent a replacement procedure of both pacemaker's leads. Nevertheless, one week later the patient developed a fever with significantly elevated inflammatory markers. The blood cultures were negative but in the transesophageal echocardiography features of cardiac device-related infective endocarditis were observed. Empirical antibiotic therapy was administered, and the device was removed. The Heart Team qualified the patient for the implantation of a MicraTM AV leadless pacemaker. The procedure was performed without any complications and the device was implanted to the right ventricle. All parameters were correct, and the patient was discharged., Conclusions: Micra AV may be a feasible and safe option for young patients with paroxysmal AV block after device-related complications., (© 2022 MEDPRESS.)
- Published
- 2022
27. Patient-Related Preoperative Clinical Factors Influencing 1-Year Survival After Orthotopic Heart Transplantation - A Single Center Polish Experience.
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Kuczaj A, Pawlak S, Przybyłowski P, Warwas S, Śliwka JE, Zakliczyński M, and Hrapkowicz T
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- Female, Humans, Poland, Retrospective Studies, Risk Factors, Treatment Outcome, Heart Failure etiology, Heart Failure surgery, Heart Transplantation adverse effects, Heart-Assist Devices
- Abstract
BACKGROUND End-stage heart failure is a growing problem in Poland. Orthotopic heart transplantation remains the best treatment option. Although increasing, the number of heart transplants is disproportionately low compared with patient need. Therefore, it is crucial to identify factors contributing to improvement of heart transplantation outcomes. To find factors providing best survival and optimal recipient selection, we analyzed pretransplant patient-related clinical factors. MATERIAL AND METHODS Between May 2015 and May 2020, we performed 258 cardiac transplants at our institution. We reviewed possible patient-related clinical factors affecting the 1-year survival of our patients and analyzed factors related to survival. Mean age at transplant was 53.5 (±11.8) years; 22.9% of patients were women. Preoperative factors were analyzed using univariable and multivariable analyses. RESULTS In this cohort, 31.8% were diabetic, 43% had ischemic etiology of heart failure, and 15.3% had reversible pulmonary hypertension. Mechanical circulatory support was used in 22%. During 1-year observation, 64 (24.8%) patients died. Univariable analysis showed ischemic etiology (hazard ratio [HR]=2.05, CI=1.227-3.429; P=0.01) and left ventricular assist device were associated with 1-year risk of death (HR=1.953, CI=1.090-3.499; P=0.02). Urgent listing trended toward worsened prognosis (HR=1.509, CI=0.95-2.397; P=0.08). Multivariable analysis showed ischemic etiology (HR=1.81, CI=1.075-3.059; P=0.03), total mechanical circulatory support (HR=1.93, CI=1.080-3.437; P=0.03), decreased eGFR (HR=0.987, CI=0.975-0.998; P=0.03), and protein level (HR=0.97, CI=0.951-0.998; P=0.04) were independently associated with worse 1-year survival after transplantation. CONCLUSIONS Ischemic etiology and mechanical circulatory support were the most important preoperative factors. Malnutrition and renal failure were additional risk factors. Age alone did not influence 1-year survival.
- Published
- 2022
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28. Quality of life in patients with a subcutaneous vs. transvenous implantable cardioverter-defibrillator.
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Jagosz M, Jędrzejczyk-Patej E, Kowalska W, Mazurek M, Warwas S, Wiktor D, Sokal A, Kowalski O, Lenarczyk R, Średniawa B, and Kalarus Z
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- Arrhythmias, Cardiac therapy, Electric Countershock, Humans, Quality of Life, Surveys and Questionnaires, Treatment Outcome, Defibrillators, Implantable
- Abstract
Background: The implantable cardioverter-defibrillator (ICD) and subcutaneous ICD (S-ICD) are well-accepted life-saving devices for treating potentially lethal ventricular arrhythmia, but little is known about quality of life (QoL) in patients with S-ICD and ICD., Aims: Our study aimed to compare QoL in patients with S-ICD and ICD., Methods: All consecutive patients who had S-ICD implanted between October 2015 and September 2021 were included in the study. A cohort of transvenous ICD (TV-ICD) patients was matched to S-ICD subjects by sex, age, indications for the device, and type of prevention. All patients were requested to fulfill two standardized questionnaires to assess QoL: 36-Item Short Form Health Survey (SF-36) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) 6 months after device implantation., Results: Patients with S-ICD (n = 49) and TV-ICD (n = 49) did not differ regarding baseline characteristics. There were no statistically significant differences between S-ICD and TV-ICD subgroup, both for mental and physical QoL assessed in SF-36 and MLHFQ (all P = NS). The median MLHFQ total score was 24 (9-41) for S-ICD and 28 (14-43) for TV-ICD (P = 0.83). The median total score for the SF-36 questionnaire was 62.5 (29-86) vs. 59 (38-77) for S-ICD and TV-ICD, respectively (P = 0.78)., Conclusions: Quality of life after device implantation does not differ significantly between the groups of patients with subcutaneous and conventional implantable cardioverter-defibrillator.
- Published
- 2022
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29. Heart Retransplantation From an Hepatitis B Core Antibody (Anti-HBcore)-Positive Donor: A Case Report.
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Kuczaj A, Warwas S, Przybyłowski P, and Zembala M
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- Antiviral Agents therapeutic use, Graft Rejection etiology, Graft Rejection prevention & control, Heart Failure surgery, Hepatitis B prevention & control, Humans, Immunosuppressive Agents therapeutic use, Lamivudine therapeutic use, Male, Middle Aged, Reoperation, Risk Factors, Tissue Donors, Graft Rejection diagnosis, Heart Transplantation adverse effects, Hepatitis B Antibodies blood, Hepatitis B Core Antigens immunology
- Abstract
Heart transplantation is performed in patients with end-stage heart failure. The number of suitable donors for patients on the urgent heart transplantation waiting list is still low, and effort has been made to increase the number of suitable donors, including extended-criteria donors. We present a case report of heart retransplantation because of graft failure from an hepatitis B core antibody (anti-HBcore-positive, HBcAb [+]) and HBs antigen-negative (HBsAg [-]) donor to a seronegative recipient. We show that the procedure, with the use of antiviral prophylaxis, is a safe option for the recipient. Based on anatomopathologic and histopathologic examination of the explanted graft, we also suggest that acute cellular rejection in the transplanted heart may exist despite negative findings in right-sided endomyocardial biopsy., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
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30. Course and Recognition of Poststroke Delirium: A Prospective Noninferiority Trial of Delirium Screening Tools.
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Fleischmann R, Warwas S, Andrasch T, Kunz R, Witt C, Mengel A, and von Sarnowski B
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- Aged, Aged, 80 and over, Delirium epidemiology, Female, Humans, Incidence, Male, Mass Screening methods, Middle Aged, Prospective Studies, Delirium diagnosis, Delirium etiology, Neuropsychological Tests, Stroke complications
- Abstract
Background and Purpose: Poststroke delirium (PSD) is an independent predictor of unfavorable outcome. Despite its individual and socioeconomic burden, its frequency, clinical course, and routine detection remain unresolved. This study aimed to assess psychometric properties of established delirium screening tools and investigate the natural course of PSD., Methods: This study investigated patients presenting with high-risk transient ischemic attacks or ischemic stroke within 24 hours during a 3-month period. Twice-daily screenings for PSD were done using the confusion assessment method, nursing delirium scale, and rapid delirium assessment, and evaluated for noninferiority against Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. We investigated demographic and stroke characteristics as predictors of PSD, neurological deficits as predictors of false screening results, and conducted a simulation study to estimate the best timing to identify PSD., Results: We enrolled 141 patients (73.8±10.4 years of age, 61 female) with a mean National Institutes of Health Stroke Scale score of 6.4±6.5. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition based PSD incidence was 39%, which manifested within 24 hours in 25% and 72 hours in almost all cases. The confusion assessment method was the only screening tool noninferior to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ratings providing a sensitivity of 82% and specificity of 80%. Age (odds ratio, 1.07 [1.02-1.13] per year, P =0.004) and National Institutes of Health Stroke Scale (odds ratio, 1.24 [1.15-1.34] per point, P <0.001) were predictors of PSD. False-positive screening results were associated with stroke-induced disorientation (odds ratio, 6.1 [3.2-11.61], P <0.001) and neglect (odds ratio, 2.17 [1.22-3.87], P =0.008). Simulations revealed that one in 4 cases is missed with less than daily screenings., Conclusions: PSD is a common complication of stroke and transient ischemic attack. Detection is challenged by confounding effects such as focal neurological deficits and the necessity for at least daily screenings. Future studies are required to investigate implementation of these findings in clinical routine. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03930719.
- Published
- 2021
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31. Correction: Partial Hemiresurfacing of Osteochondral Defects of the Talus? Surgical Technique and Preliminary Report from Four Patients.
- Author
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Beck S, Busch A, Zilkens C, Warwas S, and Jäger M
- Abstract
Competing Interests: Disclosure The authors report no conflicts of interest in this work.
- Published
- 2018
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32. Partial Hemiresurfacing of Osteochondral Defects of the Talus? Surgical Technique and Preliminary Report from Four Patients.
- Author
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Beck S, Busch A, Zilkens C, Warwas S, and Jäger M
- Subjects
- Adolescent, Arthroscopy, Athletic Injuries diagnostic imaging, Athletic Injuries surgery, Bone Plates, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Osteoarthritis diagnostic imaging, Osteochondrosis diagnostic imaging, Postoperative Complications diagnostic imaging, Postoperative Complications surgery, Reoperation, Retrospective Studies, Talus diagnostic imaging, Talus injuries, Visual Analog Scale, Volleyball injuries, Young Adult, Arthroplasty, Replacement methods, Debridement methods, Osteoarthritis surgery, Osteochondrosis surgery, Talus surgery
- Abstract
Background: Osteochondral lesions of the medial talus (OLT) frequently lead to chronic ankle pain and osteoarthritis. Arthroscopic debridement, subchondral bone stimulation by drilling, and microfracturing are options for primary therapy in small lesions. In larger lesions, restoration of the talar dome contour seems to be a mandatory course of action., Methods: In a case series, we followed up four patients being treated with a focal resurfacing prosthetic due to large osteochondral talar lesions. In contrast to other studies, we can report on an off-label application to restore defects of the lateral talar dome with two patients for the first time. At follow-up, three patients reported a remarkable reduction in pain and were able to return to sports activities. One patient developed pseudarthrosis of the medial malleolar osteosynthesis., Conclusions: With selected patients, focal resurfacing appears to be an option for large osteochondral defects of the talus., Competing Interests: None, (Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2018
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33. Modifications to advanced Core decompression for treatment of Avascular necrosis of the femoral head.
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Landgraeber S, Warwas S, Claßen T, and Jäger M
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- Adult, Arthroplasty, Replacement, Hip adverse effects, Bone Wires, Calcium Phosphates adverse effects, Calcium Sulfate adverse effects, Decompression, Surgical instrumentation, Female, Femur Head Necrosis pathology, Fluoroscopy instrumentation, Fluoroscopy methods, Follow-Up Studies, Humans, Male, Middle Aged, Organ Sparing Treatments methods, Prospective Studies, Prosthesis Failure, Transplantation, Autologous methods, Treatment Outcome, Young Adult, Bone Substitutes adverse effects, Bone Transplantation methods, Decompression, Surgical methods, Femur Head Necrosis surgery, Femur Neck transplantation
- Abstract
Background: "Advanced Core Decompression" (ACD) is a new technique for treatment of osteonecrosis of the femoral head (ONFH) that includes removal of the necrotic tissue using a percutaneous expandable reamer followed by refilling of the drill hole and the defect with an injectable, hard-setting, composite calcium sulphate (CaSO
4 )-calcium phosphate (CaPO4 ) bone graft substitute. As autologous bone has been shown to be superior to all other types of bone grafts, the aim of the study is to present and evaluate a modified technique of ACD with impaction of autologous bone derived from the femoral neck into the necrotic defect., Methods: A cohort of patients with an average follow-up of 30.06 months (minimum 12 months) was evaluated for potential collapse of the femoral head and any reasons that led to replacement of the operated hip. Only patients in stages 2a to 2c according to the Steinberg classification were included in the study., Results: In 75.9% the treatment was successful with no collapse of the femoral head or conversion to a total hip replacement. Analysis of the results of the different subgroups showed that the success rate was 100% for stage 2a lesions and 84.6% respectively 61.5% for stages 2b and 2c lesions., Conclusions: Previous studies with a comparable follow-up reported less favourable results for ACD without autologous bone. Especially in stages 2b and 2c the additional use of autologous bone has a positive effect. In comparison to other hip-preserving techniques, the modified ACD technique is a very promising and minimally invasive method for treatment of ONFH., Trial Registration: German clinical trials register ( DRKS00011269 , retrospectively registered).- Published
- 2017
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34. Two-year follow-up after advanced core decompression.
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Classen T, Warwas S, Jäger M, and Landgraeber S
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- Adult, Aged, Female, Follow-Up Studies, Hip Prosthesis, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Odds Ratio, Visual Analog Scale, Young Adult, Decompression, Surgical methods
- Abstract
The so-called "Advanced Core Decompression" (ACD) is a new option that tries to remove the necrotic tissue in patients with osteonecrosis of the femoral head (AVN) in a minimally invasive way by the use of a percutaneous expandable reamer and refilling with a resorbable and osteoinductive bone-graft substitute. Seventy-two hips of sixty patients with a mean follow-up of 29.14 months after ACD have been included in this study. Patients underwent physical examination preoperatively and six weeks after surgery as well as at two further follow-ups. Certain phases in disease progression and size of the necrotic lesion were differentiated on the basis of the classification of osteonecrosis of the femoral head by Steinberg.The femoral heads had collapsed in 24 cases (33%). Analysis of the survival rates with regard to defect size revealed that the largest defects had a significantly higher rate of femoral head collapse than the smaller defects. Clinical scores were also depending on defect size but also on disease stage. The current ACD technique has not yet achieved any significant improvement in the success rate of core decompression procedures. It can be concluded that the success of ACD depends especially on the defect size. Copyright © 2015 John Wiley & Sons, Ltd., (Copyright © 2015 John Wiley & Sons, Ltd.)
- Published
- 2017
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35. Osteogenic differentiation and proliferation of bone marrow-derived mesenchymal stromal cells on PDLLA + BMP-2-coated titanium alloy surfaces.
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Haversath M, Hülsen T, Böge C, Tassemeier T, Landgraeber S, Herten M, Warwas S, Krauspe R, and Jäger M
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- Adolescent, Adult, Alkaline Phosphatase metabolism, Animals, Cell Adhesion drug effects, Cell Count, Cell Line, Cell Proliferation drug effects, Humans, Male, Mesenchymal Stem Cells drug effects, Mesenchymal Stem Cells enzymology, Mesenchymal Stem Cells ultrastructure, Mice, Middle Aged, Recombinant Proteins pharmacology, Surface Properties, Alloys pharmacology, Bone Morphogenetic Protein 2 pharmacology, Cell Differentiation drug effects, Coated Materials, Biocompatible pharmacology, Mesenchymal Stem Cells cytology, Osteogenesis drug effects, Polyesters pharmacology, Titanium pharmacology, Transforming Growth Factor beta pharmacology
- Abstract
RhBMP-2 is clinically applied to enhance bone healing and used in combination with titanium fixation implants. The purpose of this in vitro study was to compare the osteogenic differentiation and proliferation of hMSC on native polished versus sandblasted titanium surfaces (TS) and to test their behavior on pure poly-D,L-lactide (PDLLA) coated as well as PDLLA + rhBMP-2 coated TS. Furthermore, the release kinetics of PDLLA + rhBMP-2-coated TS was investigated. Human bone marrow cells were obtained from three different donors (A: male, 16 yrs; B: male, 27 yrs, C: male, 49 yrs) followed by density gradient centrifugation and flow cytometry with defined antigens. The cells were seeded on native polished and sandblasted TS, PDLLA-coated TS and PDLLA + rhBMP-2-coated TS. Osteogenic differentiation (ALP specific activity via ALP and BCA assay) and proliferation (LDH cytotoxicity assay) was examined on day 7 and 14 and release kinetics of rhBMP-2 was investigated on day 3, 7, 10, and 14. We found significant higher ALP specific activity and LDH activity on native polished compared to native sandblasted surfaces. PDLLA led to decreased ALP specific and LDH activity on both surface finishes. Additional rhBMP-2 slightly diminished this effect. RhBMP-2-release from coated TS decreased nearly exponentially with highest concentrations at the beginning of the cultivation period. The results of this in vitro study suggest that native TS stimulate hMSC significantly stronger toward osteogenic differentiation and proliferation than rhBMP-2 + PDLLA-layered TS in the first 14 days of cultivation. The PDLLA-layer seems to inhibit local hMSC differentiation and proliferation., (© 2015 Wiley Periodicals, Inc.)
- Published
- 2016
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36. Geometric analysis of an expandable reamer for treatment of avascular necrosis of the femoral head.
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Landgraeber S, Tran TN, Claßen T, Warwas S, Theysohn J, Lazik A, Jäger M, and Kowalczyk W
- Subjects
- Equipment Design, Female, Femur Head Necrosis diagnosis, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Prognosis, Decompression, Surgical instrumentation, Femur Head surgery, Femur Head Necrosis surgery, Surgical Instruments
- Abstract
"Advanced core decompression" (ACD) is a treatment option for osteonecrosis of the femoral head (ONFH) that aims at complete removal of the necrotic tissue using a percutaneous expandable reamer and refilling of the head with an osteoconductive bone-graft substitute. The objective of this study was to evaluate if the success of ACD depends on the amount of necrotic tissue remaining after the procedure and how efficiently the necrotic tissue can be removed with the current reamer. Three-dimensional models of proximal femora including ONFH were generated from the preoperative MRIs of 50 patients who underwent ACD. Best-case removal was calculated by geometrical analysis. In 28 of 50 cases, postoperative MRI was used to determine how much necrotic tissue had been removed. Prognostic values and correlations were evaluated in order to assess success or failure of the treatment. The amount of preoperative and remaining necrosis correlates significantly with treatment failure. The larger both volumes are, the more likely it is that treatment will fail. In patients with remaining necrosis of less than 1000 mm(3), no treatment failure was observed. The amount of necrosis actually removed differed significantly from the amount calculated as the best possible result. Simulation of the removal procedure showed that complete removal is not possible. These results led to the conclusion that the success of ACD depends on the amount of necrotic tissue remaining in the femoral head after the procedure. Modifications to the instrument are necessary to increase the amount of necrotic tissue that can be removed.
- Published
- 2015
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37. Prostacyclin suppresses twist expression in the presence of indomethacin in bone marrow-derived mesenchymal stromal cells.
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Kemper O, Herten M, Fischer J, Haversath M, Beck S, Classen T, Warwas S, Tassemeier T, Landgraeber S, Lensing-Höhn S, Krauspe R, and Jäger M
- Subjects
- Adult, Alkaline Phosphatase metabolism, Antigens, CD metabolism, Cell Count, Cell Differentiation drug effects, Cell Proliferation drug effects, Collagen Type I metabolism, Core Binding Factor Alpha 1 Subunit metabolism, Epoprostenol administration & dosage, Female, Humans, Iloprost pharmacology, Immunohistochemistry, Indomethacin administration & dosage, L-Lactate Dehydrogenase metabolism, Male, Mesenchymal Stem Cells cytology, Mesenchymal Stem Cells drug effects, Osteocalcin metabolism, Bone Marrow Cells cytology, Epoprostenol pharmacology, Indomethacin pharmacology, Mesenchymal Stem Cells metabolism, Nuclear Proteins metabolism, Twist-Related Protein 1 metabolism
- Abstract
Background: Iloprost, a stable prostacyclin I2 analogue, seems to have an osteoblast-protective potential, whereas indomethacin suppresses new bone formation. The aim of this study was to investigate human bone marrow stromal cell (BMSC) proliferation and differentiation towards the osteoblastic lineage by administration of indomethacin and/or iloprost., Material/methods: Human bone marrow cells were obtained from 3 different donors (A=26 yrs/m; B=25 yrs/f, C=35 yrs/m) via vacuum aspiration of the iliac crest followed by density gradient centrifugation and flow cytometry with defined antigens (CD105+/73+/45-/14-). The cells were seeded and incubated as follows: without additives (Group 0; donor A/B/C), with 10(-7) M iloprost only (Group 0+ilo; A/B), with indomethacin only in concentrations of 10(-6) M (Group 1, A), 10(-5) M (Group 2, B), 10(-4) M (Group 3, A/B), and together with 10(-7) M iloprost (Groups 4-6, A/B/C). On Day 10 and 28, UV/Vis spectrometric and immunocytochemical assays (4 samples per group and donor) were performed to investigate cell proliferation (cell count measurement) and differentiation towards the osteoblastic lineage (CD34-, CD45-, CD105+, type 1 collagen (Col1), osteocalcin (OC), alkaline phosphatase (ALP), Runx2, Twist, specific ALP-activity)., Results: Indomethacin alone suppressed BMSC differentiation towards the osteoblastic lineage by downregulation of Runx2, Col1, and ALP. In combination with indomethacin, iloprost increased cell proliferation and differentiation and it completely suppressed Twist expression at Day 10 and 28. Iloprost alone did not promote cell proliferation, but moderately enhanced Runx2 and Twist expression. However, the proliferative effects and the specific ALP-activity varied donor-dependently., Conclusions: Iloprost partially antagonized the suppressing effects of indomethacin on BMSC differentiation towards the osteoblast lineage. It enhanced the expression of Runx2 and, only in the presence of indomethacin, it completely suppressed Twist. Thus, in the treatment of avascular osteonecrosis or painful bone marrow edema, the undesirable effects of indomethacin might be counterbalanced by iloprost.
- Published
- 2014
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38. A multicenter approach evaluating the impact of vitamin e-blended polyethylene in cementless total hip replacement.
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Jäger M, van Wasen A, Warwas S, Landgraeber S, Haversath M, and Group V
- Abstract
Since polyethylene is one of the most frequently used biomaterials as a liner in total hip arthroplasty, strong efforts have been made to improve design and material properties over the last 50 years. Antioxidants seems to be a promising alternative to further increase durability and reduce polyethylene wear in long term. As of yet, only in vitro results are available. While they are promising, there is yet no clinical evidence that the new material shows these advantages in vivo. To answer the question if vitamin-E enhanced ultra-high molecular weight polyethylene (UHMWPE) is able to improve long-term survivorship of cementless total hip arthroplasty we initiated a randomized long-term multicenter trial. Designed as a superiority study, the oxidation index assessed in retrieval analyses of explanted liners was chosen as primary parameter. Radiographic results (wear rate, osteolysis, radiolucency) and functional outcome (Harris Hip Scores, University of California-Los Angeles, Hip Disability and Osteoarthritis Outcome Score, Visual Analogue Scale) will serve as secondary parameters. Patients with the indication for a cementless total hip arthroplasty will be asked to participate in the study and will be randomized to either receive a standard hip replacement with a highly cross-linked UHMWPE-X liner or a highly cross-linked vitamin-E supplemented UHMWPE-XE liner. The follow-up will be 15 years, with evaluation after 5, 10 and 15 years. The controlled randomized study has been designed to determine if Vitamin-E supplemented highly cross-linked polyethylene liners are superior to standard XLPE liners in cementless total hip arthroplasty. While several studies have been started to evaluate the influence of vitamin-E, most of them evaluate wear rates and functional results. The approach used for this multicenter study, to analyze the oxidation status of retrieved implants, should make it possible to directly evaluate the ageing process and development of the implant material itself over a time period of 15 years.
- Published
- 2014
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39. Advanced core decompression, a new treatment option of avascular necrosis of the femoral head--a first follow-up.
- Author
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Landgraeber S, Theysohn JM, Classen T, Jäger M, Warwas S, Hohn HP, and Kowalczyk W
- Subjects
- Adult, Aged, Biomechanical Phenomena, Female, Femur Head Necrosis diagnostic imaging, Femur Head Necrosis pathology, Femur Head Necrosis physiopathology, Fluoroscopy, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Magnetic Resonance Imaging, Male, Middle Aged, Postoperative Care, Preoperative Care, Treatment Outcome, Decompression, Surgical methods, Femur Head Necrosis surgery
- Abstract
Aseptic necrosis of the femoral head (AVN) leads to destruction of the affected hip joint, predominantly in younger patients. Advanced core decompression (ACD) is a new technique that may allow better removal of the necrotic tissue by using a new percutaneous expandable reamer. A further modification is the refilling of the drill hole and the defect with an injectable, hard-setting, composite calcium sulphate (CaSO₄)-calcium phosphate (CaPO₄) bone graft substitute. Compression tests were performed on seven pairs of femoral cadaver bones. One femur of each pair was treated with ACD, while the opposite side remained untreated. Clinically, the postoperative outcome of 27 hips in 23 patients was performed by physical examination 6 weeks after ACD and at average follow-up of 9.69 months, and compared with the preoperative results. MRI was used to assess the removal of the necrotic tissue, any possible progression of AVN and evaluation of collapse. In the biomechanical analysis, the applied maximum compression force that caused the fracture did not significantly differ from the untreated opposite side. The overall results of postoperative physical examinations were significantly better than preoperatively. Five hips (18.5%) were converted to a total hip replacement. The follow-up MRIs of the other patients showed no progression of the necrotic area. The first follow-up results of ACD have been encouraging for the early stages of aseptic necrosis of the femoral head. In our opinion, an assured advantage is the high stability of the femoral neck after ACD, which allows quick rehabilitation., (Copyright © 2012 John Wiley & Sons, Ltd.)
- Published
- 2013
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