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Biomedical subjects

C Bartels

Publications and source records attributed to C Bartels.

At least 37 records · Page 2Linked to original sources
PubMed1999

Integrality of nasalization and F1. II. Basic sensitivity and phonetic labeling measure distinct sensory and decision-rule interactions.

In vowel perception, nasalization and height (the inverse of the first formant, F1) interact. This paper asks whether the interaction results from a sensory process, decision mechanism, or both. Two experiments used vowels varying in height, degree of nasalization, and three other stimulus parameters: the frequency region of F1, the location of the nasal pole/zero complex relative to F1, and whether a consonant following the vowel was oral or nasal. A fixed-classification experiment, designed to estimate basic sensitivity between stimuli, measured accuracy for discriminating stimuli differing in F1, in nasalization, and on both dimensions. A configuration derived by a multidimensional scaling analysis revealed a perceptual interaction that was stronger for stimuli in which the nasal pole/zero complex was below rather than above the oral pole, and that was present before both nasal and oral consonants. Phonetic identification experiments, designed to measure trading relations between the two dimensions, required listeners to identify height and nasalization in vowels varying in both. Judgments of nasalization depended on F1 as well as on nasalization, whereas judgments of height depended primarily on F1, and on nasalization more when the nasal complex was below than above the oral pole. This pattern was interpreted as a decision-rule interaction that is distinct from the interaction in basic sensitivity. Final consonant nasality had little effect in the classification experiment; in the identification experiment, nasal judgments were more likely when the following consonant was nasal.

Humans↗
PubMed1999

Successful dilatation of the small aortic root for implantation of a larger valve prosthesis.

Optimal hemodynamic performance is of paramount importance when implanting a prosthesis in a patient with a small aortic annulus. In order to avoid prosthesis size/patient body surface area mismatch, current techniques advocate aortic annulus patch enlargement or the use of a supra-annular prosthesis to ensure the implantation of an appropriately sized aortic valve. We present the first description of mechanical dilatation of a small aortic annulus as a simple alternative method.

Aged↗
PubMed1999

[Our first experiences with intermittent assisted ventilation in patients with amyotrophic lateral sclerosis].

Amyotrophic lateral sclerosis is one of the most frequent neuromuscular diseases in adults. Chronic respiratory failures is an almost compulsory symptom in the progression of this disease, and in association with pulmonary infections, responsible for the majority of deaths. We report on a series of 43 patients. An advanced stage of clinical disease was seen in half of them. After detection of respiratory failure corresponding to the guidelines of muscle centres of the DGM (Deutsche Gesellschaft für Muskelerkrankungen), seven patients (16.3%) were willing to be provided with a system for intermittent non-invasive ventilation. All patients achieved stabilisation of respiratory function, both with respect to the normalisation of arterial gases and subjective improvement of well-being. During the course of treatment four patients deliberately underwent permanent invasive ventilation. In our opinion home ventilation is a valid additional tool in the palliative treatment of amyotrophic lateral sclerosis. The treatment, however, must be supported by an interdisciplinary team.

Adult↗
PubMed1998

Characterization of flexible molecules in solution: the RGDW peptide.

Molecular dynamics simulations with adaptive umbrella sampling of the potential energy are used to study conformations of the adhesion peptide RGDW. The peptide is simulated in a box of explicit water. It results in a combination of room temperature (300 K) simulations, in which conformations dominating the average properties of the system are sampled, with high temperature ( approximately 1000 K) simulations in which free energy barriers separating different local minima are crossed efficiently. The simulations with explicit water are compared to simulations of the isolated peptide using different treatments of the electrostatics, and to published experimental data. There is good agreement for data related to the backbone conformation of the peptide. Some discrepancies are evident for data related to side-chain conformations. Together the simulations and experiments provide a description of the RGDW system that is more detailed and reliable than what can be obtained by either simulations or experiments alone.

Amides↗
PubMed1998

Solution conformations and thermodynamics of structured peptides: molecular dynamics simulation with an implicit solvation model.

Calculations of the ensemble of solution conformations and thermodynamics of an analogue of the C-terminal helix of ribonuclease A (RN24) and of a synthetic, beta-hairpin forming peptide (BH8) are presented. For efficient sampling of conformation space, molecular dynamics simulations with an implicit solvent potential and umbrella sampling of the potential energy are performed. Starting from the fully extended chains, the simulations yield several folding and unfolding transitions between disordered (coil) conformations of the peptides and the "native" state (RN24, helix; BH8, hairpin); the simulations also lead to the occurrence of "misfolded" conformations (RN24, hairpin; BH8, helix). In agreement with experiment, the calculations predict 58% helix for RN24 at 275 K and an antiparallel-beta content of 38% at 275 K for BH8; the calculated probabilities for the misfolded species are 2% or smaller at all temperatures considered (250-1100 K). Good agreement is also shown between the calculated 3JHNalpha spin-spin coupling constants of RN24 and BH8 at 275 K, and those obtained from NMR experiments at the same temperature. From the calculated probabilities of helix (h), beta-hairpin (b), and coil (c), the free energy differences between the structured substates are DeltaGch=Gc-Gh approximately 1 kcal/mol and DeltaGbh>/=1.8 kcal/mol for RN24, and DeltaGcb approximately 0.7 kcal/mol and DeltaGhb>/=2.7 kcal/mol for BH8. The free energy difference between "correctly" folded and misfolded secondary structures are of interest for understanding the alpha to beta transition that is thought to play a role in amyloid fibril formation.

Amino Acid Sequence↗
PubMed1998

Endovascular presence of viable Chlamydia pneumoniae is a common phenomenon in coronary artery disease.

OBJECTIVES: We sought to examine coronary arteries for the presence of viable bacteria of the fastidious species Chlamydia pneumoniae. BACKGROUND: The respiratory pathogen C. pneumoniae has been implicated in the pathogenesis of coronary artery disease (CAD). Previous studies have demonstrated an antichlamydial seroresponse to be a cardiovascular risk factor and coronary atheromata to contain chlamydial components in varying proportions. Endovascular demonstration of replicating bacteria is required to provide evidence for an infectious component in CAD and a rationale to discuss antimicrobial therapy. METHODS: Myocardial revascularization was performed in 70 patients. Atherosclerotic lesions from 53 coronary endarterectomy and 17 restenotic bypass samples were cultured and subjected to nested polymerase chain reaction (PCR) for C. pneumoniae. Antichlamydial immunoglobulin G (IgG), IgA and IgM was examined by microimmunofluorescence. RESULTS: Viable C. pneumoniae was recovered from 11 (16%) of 70 atheromata, and chlamydial deoxyribonucleic acid (DNA) was detected in 21 (30%) of 70 atheromata; 17 nonatherosclerotic control samples were PCR-negative (p < 0.01). Fifteen (28%) of 53 endarterectomy and 6 (35%) of 17 bypass samples were PCR-positive. DNA sequencing of six different PCR products did not reveal differences between coronary isolates and respiratory reference strains, suggesting that common respiratory strains gain access to the systemic circulation. Serologic results did not correlate with direct detection results and did not identify individual endovascular infection. CONCLUSIONS: A significant proportion of atherosclerotic coronary arteries harbor viable C. pneumoniae. This finding supports the hypothesis of a chlamydial contribution to atherogenesis. Whether chlamydiae initiate atherosclerotic injury, facilitate its progression or colonize atheromata is unknown. However, the endovascular presence of viable bacteria justifies a controlled clinical investigation of antimicrobial treatment benefit in the therapy and prevention of CAD.

Adult↗
PubMed1998

Poor correlation between microimmunofluorescence serology and polymerase chain reaction for detection of vascular Chlamydia pneumoniae infection in coronary artery disease patients.

Chlamydia pneumoniae has been associated to coronary artery disease by various methods including recovery of viable bacteria from plaques. The pathogenetical relevance of this is unclear but investigation of antichlamydial therapy in coronary arteriosclerosis is already in progress. The microimmunofluorescence test (MIF), the only species-specific serological assay available, might be considered useful in identifying patients with vascular chlamydial infection. However, this has never been systematically examined. We compared levels of C. pneumoniae antibodies in sera using MIF with direct detection of C. pneumoniae in coronary artery segments from 158 patients undergoing myocardial revascularization. A polymerase chain reaction (PCR) protocol, recently evaluated for use with vascular materials, detected C. pneumoniae infection in 34 patients. Correlation of serology and PCR was poor: in relation to PCR. MIF-IgG analysis had 21% sensitivity, 90% specificity, 37% positive predictive value, and 81% negative predictive value for detection of chlamydial presence. Thus, the MIF test currently appears not suitable to predict individual vascular C. pneumoniae infection.

Aged↗
PubMed1998

Discrepancies between sizer and valve dimensions: implications for small aortic root.

BACKGROUND: Precise labeling of sizer and valve diameters is crucial for optimal valve selection especially in the small aortic root. This study examines the accuracy of manufacturers' markings on small aortic prostheses and sizers. METHODS: Sizer and valve dimensions of 22 different mechanical aortic prostheses (19 to 23 mm) were evaluated by caliper micrometer measurements. RESULTS: Nearly all sizers exceeded their marked dimensions by up to 1.0 mm. Measured tissue annulus diameters for 19-mm-labeled valves varied between 18.3 and 19.6 mm, for 21-mm valves from 20.5 to 21.6 mm, and for 23-mm valves from 22.4 to 23.5 mm, respectively. The orifice areas ranged from 1.5 to 2.06 cm2 for 19-mm valves, from 2.0 to 2.55 cm2 for 21-mm valves, and from 2.4 to 3.09 cm2 for 23-mm valves, respectively. CONCLUSIONS: Actual sizer dimensions and tissue annulus diameters of various small mechanical aortic prostheses varied considerably from their marked diameters. These differences should be considered to ensure the optimal prosthesis selection for each patient.

Aortic Valve↗
PubMed1998

Endovascular presence of Chlamydia pneumoniae DNA is a generalized phenomenon in atherosclerotic vascular disease.

The common respiratory pathogen Chlamydia pneumoniae has been implicated in the pathogenesis of coronary artery disease and acute myocardial infarction. In order to verify the endovascular presence of potentially viable chlamydia by detection of genomic DNA, we examined atherosclerotic arteries from various vascular regions using a C. pneumoniae specific nested polymerase chain reaction (PCR). The samples were obtained during surgical revascularization procedures or at autopsy. Chlamydial DNA was detected in 51/238 (21%) atherosclerotic samples. A total of 17 non-atherosclerotic control samples were PCR-negative. Chlamydial presence was detected in 36/140 (26%) vascular samples obtained at coronary revascularization procedures, in 9/61 (15%) samples from carotid artery stenosis, 3/17 (18%) samples from the aorta, and 3/20 (15%) iliac artery samples. Histomorphological discrimination of infected and non-infected arterial samples was not possible. Antichlamydial IgG and IgM response as examined by microimmunofluorescence assay did not aid identification of individual endovascular infection. C. pneumoniae is present in a significant proportion of atherosclerotic arteries. Its occurrence in atheromatous plaques is not limited to coronary arteries and may be considered indicative of an infectious component in atherosclerosis. However, it remains unclear whether chlamydia actually initiates atherosclerotic injury, facilitates its progression, or merely colonizes pre-existing atheromata.

Adult↗
PubMed1998

Impairment of mitochondrial function in skeletal muscle of patients with amyotrophic lateral sclerosis.

In skeletal muscle homogenates of 14 patients with sporadic amyotrophic lateral sclerosis, an approximately twofold lower specific activity of NADH:CoQ oxidoreductase in comparison to an age matched control group (n=28) was detected. This finding was confirmed by a detailed analysis of mitochondrial oxidative phosphorylation in skeletal muscle using saponin-permeabilized muscle fibers. (i) A significantly lowered maximal glutamate+malate and pyruvate+malate supported respiration of saponin-permeabilized fibers was detected in the patients group. (ii) Titrations with the specific inhibitor of NADH:CoQ oxidoreductase amytal revealed a higher sensitivity of respiration to this inhibitor indicating an elevated flux control coefficient of this enzyme. (iii) Applying functional imaging of mitochondria using ratios of NAD(P)H and flavoprotein autofluorescence images of saponin-permeabilized fibers we detected the presence of partially respiratory chain inhibited mitochondria on the single fiber level. A secondary defect of mitochondrial function due to the neurogenic changes in muscle seems to be unlikely since no mitochondrial abnormalities were detectable in biopsies of patients with spinal muscular atrophy. These results support the viewpoint that an impairment of mitochondria may be of pathophysiological significance in the etiology of amyotrophic lateral sclerosis.

Adult↗
PubMed1998

The significance of oncometry for infusion therapy during pediatric heart surgery.

BACKGROUND: The colloid osmotic pressure (COP) is not routinely assessed during pediatric heart surgery. Two cases of unrecognized hyperoncotic states associated with renal failure have been observed after pediatric heart surgery. We studied the hypothesis that the COP cannot be estimated from the total plasma protein (TPP) or albumin level. METHODS: The course of COP and its correlation to the TPP and albumin level were investigated in 25 children undergoing elective heart surgery. Infusion therapy was performed solely on the basis of clinical parameters and TPP/albumin levels. COP values were determined in a blinded fashion at the end of the study. RESULTS: No correlation between TPP/albumin and the COP could be determined preoperatively. On arrival at the ICU correlation was strong. A weak correlation was observed at 24 hours and 48 hours after surgery. However, the observed wide range of the confidential bands indicates that the COP cannot be estimated correctly, neither from the TPP, nor from the albumin level. Due to colloidal oversubstitution COP was significantly increased compared to preoperative level at 48 hrs following surgery. CONCLUSIONS: As estimation of COP from TPP or albumin level is inaccurate, oncometry should be performed during pediatric heart surgery.

Blood Proteins↗
PubMed1997

Cardiac risk stratification for high-risk vascular surgery.

BACKGROUND: The best strategy for cardiac risk assessment before high-risk vascular surgery remains controversial. A cardiac risk stratification protocol was evaluated in patients undergoing high-risk vascular surgery. Our investigation paralleled the elaboration of the American College of Cardiology/ American Heart Association (ACC/AHA) Guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery and is highly comparable to the proposed guidelines. METHODS AND RESULTS: A cardiac risk stratification protocol was evaluated prospectively in 203 patients scheduled for aortic surgery. Key points of the study were cardiac mortality/morbidity and cost-effectiveness. Patients were stratified into low (n = 101), intermediate (n = 79), and high (n = 23) cardiac risk after clinical predictors. After stratification, the degree of estimated functional capacity assessed by treadmill exercise and daily living activities and expressed by metabolic equivalents (METs) was critical for further cardiac evaluation. In intermediate-risk patients with an estimated functional capacity < 5 METs and in all high-risk patients, noninvasive cardiac testing and/or subsequent medical care were performed. Noninvasive testing was considered necessary in 41 patients, coronary angiography in 7, and myocardial revascularization in 1. Overall hospital mortality was 3.5%. Cardiac mortality and morbidity were 1% and 12.4%, respectively. CONCLUSIONS: Cardiac risk stratification for high-risk vascular surgery patients, according to a protocol similar to the ACC/AHA Guidelines for Cardiovascular Evaluation for Noncardiac Surgery, demonstrated excellent clinical outcome. This approach appears to be a safe and economical strategy for preoperative cardiac evaluation.

Aorta↗
PubMed1997

Inherited cerebellar diseases.

This chapter analyzes the neuropsychological deficits in inherited cerebellar diseases and compares their symptomatology with animal models in which the exact anatomical localization of degeneration is known and limited to the cerebellum. Both animal and human data suggest that cerebellar cortical atrophy affects functions of the frontal lobe system. Olivopontocerebellar atrophy is genetically and clinically in homogeneous. The dementia syndrome that occurs in a proportion of patients does not seem to be linked with cerebellar dysfunction. Patients suffering from Friedreich's disease have been described as exhibiting cognitive slowing and deficits in spatial tasks. Because other structures are more prominently involved than the cerebellum in this disease, other pathoanatomical correlates may explain the symptomatology.

Animals↗
PubMed1997

Integrality in the perception of tongue root position and voice quality in vowels.

In English and a large number of African and Southeast Asian languages, voice quality along a tense-lax dimension covaries with advancement of the tongue root in vowels: a laxer voice quality co-occurs with a more advanced tongue root. As laxing the voice increases energy in the first harmonic relative to higher ones and advancing the tongue root lowers F1, the acoustic consequences of these two articulations may integrate perceptually into a higher-level perceptual property, here called spectral "flatness." Two Garner-paradigm experiments evaluated this interaction across nearly the entire range of tense-lax voice qualities and a narrow range of F1 values. The acoustic consequences of laxness and advanced tongue root integrated into spectral flatness for tenser and laxer but not for intermediate voice qualities. Detection-theoretic models developed in earlier work proved highly successful in representing the perceptual interaction between these dimensions.

Humans↗
PubMed1997

The significance of oncometry for infusion therapy during pediatric heart surgery.

The colloid osmotic pressure (COP) is not routinely assessed during pediatric heart surgery. Two cases of unrecognized hyperoncotic states associated with renal failure have been observed after pediatric heart surgery. We studied the hypothesis that the COP cannot be estimated from the total plasma protein (TPP) or albumin level. The course of COP and its correlation to the TPP and albumin level were investigated in 25 children undergoing elective heart surgery. Infusion therapy was performed solely on the basis of clinical parameters and TPP/albumin levels. COP values were determined in a blinded fashion at the end of the study. No correlation between TPP/albumin and the COP could be determined preoperatively. On arrival at the ICU correlation was strong. A weak correlation was observed at 24 hours and 48 hours after surgery. However, the observed wide range of the confidential bands indicates that the COP cannot be estimated correctly, neither from the TPP, nor from the albumin level. Due to colloidal oversubstitution COP was significantly increased compared to preoperative level at 48 hrs following surgery. As estimation of COP from TPP or albumin level is inaccurate, oncometry should be performed during pediatric heart surgery.

Age Factors↗
PubMed1997

[Unusual computerized tomography and magnetic resonance imaging of cerebellar metastasis].

In a 68-year old patient with brainstem/cerebellum abnormalities, a left cerebellar mass was demonstrated. It was characterized by hyperdensities in computed tomography; MRI revealed conspicuously low signal intensities on T2 weighting and isointense signal values with a peripheral gadolinium enhancement on T1 weighting. The histological finding was a metastasis of a mucus-forming adenocarcinoma which had originated in a tumor of the ascending colon.

Adenocarcinoma, Mucinous↗
PubMed1996

Renal failure associated with unrecognized hyperoncotic states after pediatric heart surgery.

Despite severe alteration of transcapillary fluid exchange during cardiopulmonary bypass, colloid osmotic pressure is not routinely assessed. Infusion therapy during pediatric heart surgery is determined by clinical parameters and on the basis of total plasma protein level alone. Following this concept, postoperative renal dysfunction associated with unrecognized hyperoncotic disturbances has been observed in two children. Hyperoncotic states may not be identified by routine laboratory parameters.

Acute Kidney Injury↗