Publications by authors named "Paul Walter"

18 Publications

  • Page 1 of 1

Morphology and Progression in Primary Varicose Vein Disorder Due to 677C>T and 1298A>C Variants of MTHFR.

EBioMedicine 2015 Feb 15;2(2):158-64. Epub 2015 Jan 15.

Institute of Human Genetics, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany.

Background: Clinical assessment and prognostic stratification of primary varicose veins have remained controversial and the molecular pathogenesis is unknown. Previous data have suggested a contribution of the MTHFR (methylenetetrahydrofolate reductase) polymorphism c.677C>T.

Methods: We collected blood and vein specimens from 159 consecutive patients undergoing varicose vein surgery, or autologous vein reconstruction for arterial occlusive disease as controls. We compared the frequencies of c.677C>T and another polymorphism of MTHFR, c.1298A>C, with morphology and types of complicated disease. Morphology was recorded as a trunk or perforator type and peripheral congestive complication was defined as chronic venous insufficiency (CEAP C3-6) associated with edema and skin manifestations.

Findings: Multivariate analysis of genotypes for c.677C>T and c.1298A>C indicated that c.677C>T was associated significantly with the trunk phenotype (43/53 patients, 81%, p < 0.01), while c.1298A>C was associated significantly with the perforator phenotype (18/24 patients, 75%, p < 0.01) of primary varicose veins. Accordingly, when both c.677C>T and c.1298A>C displayed a heterozygous genotype, the patients were more likely to present with both phenotypes. Additionally, c.1298A>C was found to be strongly linked to the congestive complication (34/51 patients, 67%, p < 0.01).

Interpretation: Both polymorphisms of MTHFR may be involved in the morphological specification of primary varicose veins and contribute to the development of complicated disease.

Funding: None.
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http://dx.doi.org/10.1016/j.ebiom.2015.01.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4484817PMC
February 2015

Vitamin D effects on bone and muscle.

Int J Vitam Nutr Res 2011 Jul;81(4):264-72

Centre on Aging and Mobility, University of Zurich, Zurich, Switzerland.

Increasing data suggest that higher 25-hydroxyvitamin D [25(OH)D] serum concentrations are advantageous for health. At present, strong evidence for causality is available for fracture and fall prevention, while promising epidemiologic and mechanistic studies suggest a key role of vitamin D in the preservation of cardiovascular health, and the prevention of cancer and other common chronic disease. For lower extremity function, fall prevention, hip bone density, and for fracture prevention optimal benefits are observed with 25(OH)D levels of at least 75 nmol/L to 100 nmol/L [1]. This threshold may be reached in 50 % of adults with 800 to 1000 IU vitamin D per day. This manuscript will discuss the evidence of vitamin D in fall and fracture prevention and how these data transfer to the most recent recommendations by the IOF (International Osteoporosis Foundation) and the IOM (Institute of Medicine).
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http://dx.doi.org/10.1024/0300-9831/a000072DOI Listing
July 2011

Emerging nutrition gaps in a world of affluence - micronutrient intake and status globally.

Int J Vitam Nutr Res 2011 Jul;81(4):238-9

DSM Nutritional Products, Kaiseraugst, Switzerland.

Nutrition is important for human health in all stages of life - from conception to old age. Today we know much more about the molecular basis of nutrition. Most importantly, we have learnt that micronutrients, among other factors, interact with genes, and new science is increasingly providing more tools to clarify this interrelation between health and nutrition. Sufficient intake of vitamins is essential to achieve maximum health benefit. It is well established that in developing countries, millions of people still suffer from micronutrient deficiencies. However, it is far less recognized that we face micronutrient insufficiencies also in developed countries.
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http://dx.doi.org/10.1024/0300-9831/a000068DOI Listing
July 2011

Tilt table testing with video EEG monitoring in the evaluation of patients with unexplained loss of consciousness.

Clin EEG Neurosci 2011 Jul;42(3):202-5

Department of Neurology Emory University, Atlanta, Georgia, USA.

It is well established that convulsive movements often accompany syncopal events yet many patients with these clinical features are misdiagnosed with seizures and often referred to epilepsy centers because they are refractory to treatment with anticonvulsant medications. Tilt table testing is the gold standard for diagnosing vasodepressor syncope, but it can fail to provide clinical details that help distinguish convulsive syncope from epileptic seizures and psychogenic events. This study evaluates the diagnostic utility of the addition of video and EEG monitoring during tilt table testing for patients with refractory episodes of unexplained loss of consciousness. Retrospective analysis was performed of 40 consecutive patients who were referred to the Emory Epilepsy Center and underwent tilt table testing with concomitant video-EEG between March 1, 2007 and December 1, 2008. EEG was recorded throughout the study in addition to video recording and single channel EKG. Events were classified as vasodepressor syncope, presyncope, or psychogenic. Tilt combined with video EEG was diagnostic in 26/40 (65%) of patients. Vasodepressor syncope was seen in 17/40 (42.5%), 9 of which had associated involuntary movements. Three patients experienced psychogenic non-epileptic events. Antiepileptic drugs (AEDs) were being prescribed for 17 patients, 7 of which were discontinued as a result of the testing. The majority of patients (38/40) had undergone prior neurological and cardiac evaluation with routine EEG, neuroimaging and/or Holter monitoring. Patients with convulsive syncope are often misdiagnosed and treated with AEDs despite prior neurodiagnostic and cardiac evaluation. Tilt table testing with video-EEG is useful in patients with refractory episodes of unexplained loss of consciousness and can avoid expensive non-diagnostic evaluations as well as ongoing treatment with unnecessary AEDs.
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http://dx.doi.org/10.1177/155005941104200311DOI Listing
July 2011

Bioactive compounds: definition and assessment of activity.

Nutrition 2009 Nov-Dec;25(11-12):1202-5. Epub 2009 Aug 19.

Department of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany.

Biomarkers and their role in evaluating efficacy and safety were the topic of the 23rd Hohenheim Consensus Meeting at the University of Hohenheim in Stuttgart. Scientists who had published and reviewed scientific and regulatory papers on the topic were invited, among them basic researchers, toxicologists, clinicians, and nutritionists. The participants were presented with 11 questions (in bold font), which were discussed and answered (in italic font) at the workshop, with the aim of summarizing the current state of knowledge on the subject. The explicatory text accompanying the short answers was produced and agreed on after the conference and was backed up by corresponding references.
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http://dx.doi.org/10.1016/j.nut.2009.04.023DOI Listing
February 2010

10 years of Functional Foods in Europe.

Authors:
Paul Walter

Int J Vitam Nutr Res 2008 Dec;78(6):253-60

University of Basel, Nelkenrain 2, CH-4104 Oberwil, Switzerland.

In 1999, the Scientific Concepts of Functional Foods in Europe: Consensus Document was published. In the last ten years the main emphasis of progress has been in the following areas: Functions of Food: It has become very clear that a large part of the known functions of vegetables, fruits and grains are not only due to the well known vitamins and minerals, but that a large variety of other non-nutritive biologically active compounds in these foods have also specific actions on human health. An increasing number of these food ingredients are now known. Claims relevant to Functional Foods: In a European Commission Concerted Action lead by ILSI Europe, the Assessment of Scientific Support for Claims on Foods (PASSCLAIM) led to criteria to assess the scientific evidence to support claims on foods. The relative strengths and limitations of types of scientific approaches and data that are relevant to different health and disease states as well as providing guidance on the interpretation of the criteria are also described. Legislation: The new European Regulation on Nutrition and Health Claims made on Foods entered into force on January 19, 2007. The regulation sets out conditions for their use, establishes a system for their scientific evaluation, and will create European lists of authorised claims. This process will be the most important development for the acceptance of foods with special functions in Europe.
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http://dx.doi.org/10.1024/0300-9831.78.6.253DOI Listing
December 2008

Bioactive compounds: safety and efficacy.

Nutrition 2009 Nov-Dec;25(11-12):1206-11. Epub 2009 Aug 8.

Department of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany.

The efficacy and safety of bioactive compounds depend on a few known and unknown parameters. What is a physiologic dose and how can that dose be defined in cases of bioactive compounds with a poor knowledge of supply and distribution? What safety sets are needed? How can individual aspects such as polymorphisms or differences in absorption be considered? A group of experts tried to answer these and related questions during the 23rd Hohenheim Consensus Meeting at the University of Hohenheim in Stuttgart.
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http://dx.doi.org/10.1016/j.nut.2009.06.014DOI Listing
February 2010

Prolonged classical NF-kappaB activation prevents autophagy upon E. coli stimulation in vitro: a potential resolving mechanism of inflammation.

Mediators Inflamm 2008 ;2008:725854

Department of Anesthesiology and Intensive Care, University of Ulm, 89075 Ulm, Germany.

Activation of NF-kappaB is known to prevent apoptosis but may also act as proapoptotic factor in order to eliminate inflammatory cells. Here, we show that classical NF-kappaB activation in RAW 264.7 and bone marrow-derived macrophages upon short E. coli coculture is necessary to promote cell death at late time points. At 48 hours subsequent to short-term, E. coli challenge increased survival of NF-kappaB-suppressed macrophages was associated with pattern of autophagy whereas macrophages with normal NF-kappaB signalling die. Cell death of normal macrophages was indicated by preceding downregulation of autophagy associated genes atg5 and beclin1. Restimulation of macrophages with LPS at 48 hours after E. coli treatment results in augmented proinflammatory cytokine production in NF-kappaB-suppressed macrophages compared to control cells. We thus demonstrate that classical NF-kappaB activation inhibits autophagy and promotes delayed programmed cell death. This mechanism is likely to prevent the recovery of inflammatory cells and thus contributes to the resolution of inflammation.
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http://dx.doi.org/10.1155/2008/725854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430012PMC
August 2008

[Internal quality control of histological diagnosis in pathology. A nine-year experience].

Ann Pathol 2008 Feb 20;28(1):9-16. Epub 2008 May 20.

Département de pathologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.

Internal quality control (IQC) is a necessary component of total quality management. We report our experience with an internal audit scheme focusing on the histological diagnosis. We outline other strategies of IQC and analyze the causes of errors and ways to prevent them. Some practical guidelines to initiate this type of procedure are presented. Our audit was designed to check the accuracy of diagnosis, the clarity and completeness of the report, the quality of the documents leading to the diagnosis, and the turn-around time. It consisted of a retrospective analysis of 4185 randomly selected cases (representing 2% of all cases), over nine years. The control took place once a week and was done by two pathologists working as a team. The mean time spent by each pathologist was 45 minutes per week. Errors were scored using a 3-level grading scheme depending on their potential harm or impact on patient care. The overall rate of errors was 1.1%, and 0.1% of errors were potentially harmful to the patients. A single case (0.02%), in which a cancer was missed, had a real impact on patient care. Retrospective analysis of randomly selected cases mirrors the overall activity of a surgical pathology department. Nevertheless, each lab has to develop its own strategy of IQC, based on its size, its functioning, and its objectives. Although it may be difficult to initiate quality assurance when medical time is already limited, it is a helpful procedure in a more and more demanding medical and societal context and a pragmatic step towards "culture of quality".
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http://dx.doi.org/10.1016/j.annpat.2008.01.003DOI Listing
February 2008

Hands-on defibrillation: an analysis of electrical current flow through rescuers in direct contact with patients during biphasic external defibrillation.

Circulation 2008 May 5;117(19):2510-4. Epub 2008 May 5.

Emory University Hospital, Cardiac Electrophysiology Department, 1364 Clifton Rd NE, Suite F424, Atlanta, GA 30322, USA.

Background: Brief interruptions in chest compressions reduce the efficacy of resuscitation from cardiac arrest. Interruptions of this type are inevitable during hands-off periods for shock delivery to treat ventricular tachyarrhythmias. The safety of a rescuer remaining in contact with a patient being shocked with modern defibrillation equipment has not been investigated.

Methods And Results: This study measured the leakage voltage and current through mock rescuers while they were compressing the chests of 43 patients receiving external biphasic shocks. During the shock, the rescuer's gloved hand was pressed onto the skin of the patient's anterior chest. To simulate the worst case of an inadvertent return current pathway, a skin electrode on the rescuers thigh was connected to an electrode on the patient's shoulder. In no cases were shocks perceptible to the rescuer. Peak potential differences between the rescuer's wrist and thigh ranged from 0.28 to 14 V (mean 5.8+/-5.8 V). The average leakage current flowing through the rescuer's body for each phase of the shock waveform was 283+/-140 microA (range 18.9 to 907 microA). This was below several recommended safety standards for leakage current.

Conclusions: Rescuers performing chest compressions during biphasic external defibrillation are exposed to low levels of leakage current. The present findings support the feasibility of uninterrupted chest compressions during shock delivery, which may enhance the efficacy of defibrillation and cardiocerebral resuscitation.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.107.763011DOI Listing
May 2008

Usefulness of detectable levels of troponin, below the 99th percentile of the normal range, as a clue to the presence of underlying coronary artery disease.

Am J Cardiol 2007 Sep 14;100(5):764-9. Epub 2007 Jun 14.

Interventionelle Kardiologie Spandau, Berlin, Germany.

The aim of the study was to evaluate whether markers of myocardial injury and ischemia are helpful in detecting coronary artery disease (CAD) in patients with stable angina. Venous blood was obtained before and after a bicycle exercise test in 47 outpatients with suspected CAD for measurement of cardiac troponin I (cTnI), heart-type fatty acid binding protein, and glycogen phosphorylase BB. Patients with a coronary artery stenosis >/=70% in diameter (n = 33) were compared with patients with coronary narrowing <50% (controls, n = 14). None of the markers increased after bicycle exercise testing. cTnI measured before and after exercise was higher in the CAD group than in controls (p <0.001). The area under the curve for diagnosis was greater when the cTnI value was detectable than with stress testing alone. In conclusion, baseline cTnI was of value in detecting CAD and also during follow-up in predicting the need for further revascularization.
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http://dx.doi.org/10.1016/j.amjcard.2007.03.096DOI Listing
September 2007

Endometrial brush cytology in the surveillance of post-menopausal patients under tamoxifen: a prospective longitudinal study.

Eur J Obstet Gynecol Reprod Biol 2007 May 22;132(1):126-8. Epub 2006 Jun 22.

Service de Gynécologie-obstétrique, Centre Hospitalier Universitaire, 1 place de l'Hôpital, 67091 Strasbourg Cedex, France.

Objective: To evaluate cytological sampling of endometrium using Endobrush (Lab CCD, Paris, France) in the surveillance of tamoxifen-treated patients.

Study Design: Between February 1995 and October 1997, 687 tamoxifen-treated patients had serial ultrasound screening for endometrial pathology. In case of endometrial double layer thickness of more than 8mm, a cytological examination of endometrium was attempted followed by hysteroscopy and curettage.

Results: One hundred and eighty-nine patients had abnormal endometrial ultrasound findings. Cytological smear was not obtained in 39 patients because of cervical stenosis or pain in 33 and 6 cases, respectively. One hundred and fifty patients had cytological endometrial sampling followed by hysteroscopy and curettage. Cytological and histological findings correlated well in 145 cases (141 benign lesions and 4 endometrial cancers). There were five false positive (four atypia and one cancer). All patients remained free of endometrial cancer at 5 years follow-up.

Conclusion: In tamoxifen-treated patients, endometrial cytology was reliable for detection of endometrial pathology, and was well accepted by the patients.
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http://dx.doi.org/10.1016/j.ejogrb.2006.04.023DOI Listing
May 2007

Prolonged cholestasis associated with short-term use of celecoxib.

Gastroenterol Clin Biol 2005 Dec;29(12):1286-8

Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Hôpital de Hautepierre.

Drug-induced liver injury due to celecoxib, a first generation Cox-2 inhibitor, has been rarely reported. We describe one case of severe and prolonged cholestasis after treatment with celecoxib for 12 days in a young woman with no evidence of other causes of liver disease or allergy. Jaundice lasted for 3 months, pruritus and abnormal liver biochemistry persisted for 18 months after stopping the drug. Liver biopsy specimens showed a cholestatic pattern of liver injury with only minimal mononuclear infiltrate in the portal tracts. This case report supports the notion that celecoxib may cause bland, long term cholestasis.
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http://dx.doi.org/10.1016/s0399-8320(05)82223-7DOI Listing
December 2005

Beyond deficiency: potential benefits of increased intakes of vitamin K for bone and vascular health.

Eur J Nutr 2004 Dec 5;43(6):325-35. Epub 2004 Feb 5.

Dept. of Biochemistry, University of Maastricht, P. O. Box 616, 6200 MD Maastricht, The Netherlands.

Vitamin K is well known for its role in the synthesis of a number of blood coagulation factors. During recent years vitamin K-dependent proteins were discovered to be of vital importance for bone and vascular health. Recommendations for dietary vitamin K intake have been made on the basis of the hepatic requirements for the synthesis of blood coagulation factors. Accumulating evidence suggests that the requirements for other functions than blood coagulation may be higher. This paper is the result of a closed workshop (Paris, November 2002) in which a number of European vitamin K experts reviewed the available data and formulated their standpoint with respect to recommended dietary vitamin K intake and the use of vitamin K-containing supplements.
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http://dx.doi.org/10.1007/s00394-004-0480-4DOI Listing
December 2004

Risk assessment and risk management of vitamins and minerals.

Int J Vitam Nutr Res 2004 May;74(3):223-33

OBJECTIVE OF WORKSHOP: The EANS workshop held in 1998 examined the various approaches to determine requirements and safety of vitamins and minerals. The methodology used and approaches taken on both sides of the Atlantic provided the focus of the event. Over three years later, and with risk assessment much advanced, the progress made was reviewed and inadequacies as well as limitations were defined. In addition, this workshop looked beyond assessment to the broader context in which nutrition science operates. What are the particular problems facing risk managers in the light of risk assessment conclusions? To what extent can nutrition research provide the answers that risk managers require and should the nutrition research agenda be shaped by the needs of the policymaker?
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http://dx.doi.org/10.1024/0300-9831.74.3.223DOI Listing
May 2004

Why are fruits and vegetables so healthy?

Authors:
Paul Walter

Int J Vitam Nutr Res 2003 Mar;73(2):53

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http://dx.doi.org/10.1024/0300-9831.73.2.53DOI Listing
March 2003