Publications by authors named "Ulrich Stefenelli"

13 Publications

  • Page 1 of 1

Dynamics of Left Ventricular Myocardial Work in Patients Hospitalized for Acute Heart Failure.

J Card Fail 2021 Jul 29. Epub 2021 Jul 29.

Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany; Department of Medicine I, University Hospital Würzburg, Würzburg, Germany. Electronic address:

Background: The left ventricular ejection fraction (LVEF) is the most commonly used measure describing pumping efficiency, but it is heavily dependent on loading conditions and therefore not well-suited to study pathophysiologic changes. The novel concept of echocardiography-derived myocardial work (MyW) overcomes this disadvantage as it is based on LV pressure-strain loops. We tracked the in-hospital changes of indices of MyW in patients admitted for acute heart failure (AHF) in relation to their recompensation status and explored the prognostic utility of MyW indices METHODS AND RESULTS: We studied 126 patients admitted for AHF (mean 73 ± 12 years, 37% female, 40% with a reduced LVEF [<40%]), providing pairs of echocardiograms obtained both on hospital admission and prior to discharge. The following MyW indices were derived: global constructive and wasted work (GCW, GWW), global work index (GWI), and global work efficiency. In patients with HF with reduced ejection fraction with decreasing N-terminal prohormone B-natriuretic peptide levels during hospitalization, the GCW and GWI improved significantly, whereas the GWW remained unchanged. In patients with HF with preserved ejection fraction, the GCW and GWI were unchanged; however, in patients with no decrease or eventual increase in N-terminal prohormone B-natriuretic peptide, we observed an increase in GWW. In all patients with AHF, higher values of GWW were associated with a higher risk of death or rehospitalization within 6 months after discharge (per 10-point increment hazard ratio 1.035, 95% confidence interval 1.005-1.065).

Conclusions: Our results suggest differential myocardial responses to decompensation and recompensation, depending on the HF phenotype in patients presenting with AHF. The GWW predicted the 6-month prognosis in these patients, regardless of LVEF. Future studies in larger cohorts need to confirm our results and identify determinants of short-term and longer term changes in MyW.
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http://dx.doi.org/10.1016/j.cardfail.2021.07.004DOI Listing
July 2021

Establishing a cardiac training group for patients with heart failure: the "HIP-in-Würzburg" study.

Clin Res Cardiol 2021 Jun 22. Epub 2021 Jun 22.

Department of Internal Medicine I, University Hospital Würzburg, CardiologyWürzburg, Germany.

Background: Exercise training in heart failure (HF) is recommended but not routinely offered, because of logistic and safety-related reasons. In 2020, the German Society for Prevention&Rehabilitation and the German Society for Cardiology requested establishing dedicated "HF training groups." Here, we aimed to implement and evaluate the feasibility and safety of one of the first HF training groups in Germany.

Methods: Twelve patients (three women) with symptomatic HF (NYHA class II/III) and an ejection fraction ≤ 45% participated and were offered weekly, physician-supervised exercise training for 1 year. Patients received a wrist-worn pedometer (M430 Polar) and underwent the following assessments at baseline and after 4, 8 and 12 months: cardiopulmonary exercise test, 6-min walk test, echocardiography (blinded reading), and quality of life assessment (Kansas City Cardiomyopathy Questionnaire, KCCQ).

Results: All patients (median age [quartiles] 64 [49; 64] years) completed the study and participated in 76% of the offered 36 training sessions. The pedometer was worn ≥ 1000 min per day over 86% of the time. No cardiovascular events occurred during training. Across 12 months, NT-proBNP dropped from 986 pg/ml [455; 1937] to 483 pg/ml [247; 2322], and LVEF increased from 36% [29;41] to 41% [32;46]%, (p for trend = 0.01). We observed no changes in exercise capacity except for a subtle increase in peak VO% predicted, from 66.5 [49; 77] to 67 [52; 78]; p for trend = 0.03. The physical function and social limitation domains of the KCCQ improved from 60 [54; 82] to 71 [58; 95, and from 63 [39; 83] to 78 [64; 92]; p for trend = 0.04 and = 0.01, respectively. Positive trends were further seen for the clinical and overall summary scores.

Conclusion: This pilot study showed that the implementation of a supervised HF-exercise program is feasible, safe, and has the potential to improve both quality of life and surrogate markers of HF severity. This first exercise experiment should facilitate the design of risk-adopted training programs for patients with HF.
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http://dx.doi.org/10.1007/s00392-021-01892-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218974PMC
June 2021

Long-term quality of life after intensified multi-modality treatment of oral cancer including intra-arterial induction chemotherapy and adjuvant chemoradiation.

Ann Maxillofac Surg 2015 Jan-Jun;5(1):26-31

Private Practice Ziegelhüttenweg 1-3, Frankfurt am Main, Germany.

Background: Quality of life (QoL) studies are well established when accompanying trials in head and neck cancer, but studies on long-term survivors are rare.

Aims: The aim was to evaluate long-term follow-up patients treated with an intensified multi-modality therapy.

Setting And Design: Cross-sectional study, tertiary care center.

Patients And Methods: A total of 135 oral/oropharyngeal cancer survivors having been treated with an effective four modality treatment (intra-arterial induction chemotherapy, radical surgery, adjuvant radiation, concurrent systemic chemotherapy) filled European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and HN35 questionnaires. Mean distance to treatment was 6.1 (1.3-16.6) years. Results were compared with a reference patient population (EORTC reference manual). In-study group comparison was also carried out.

Statistical Analysis: One-sample t-test, Mann-Whitney-test, Kruskal-Wallis analysis.

Results: QoL scores of both populations were well comparable. Global health status, cognitive and social functioning, fatigue, social eating, status of teeth, mouth opening and dryness, and sticky saliva were significantly worse in the study population; pain and need for pain killers, cough, need for nutritional support, problems with weight loss and gain were judged to be significantly less. Patients 1-year posttreatment had generally worse scores as compared to patients with two or more years distance to treatment. Complex reconstructive measures and adjuvant (chemo) radiation were main reasons for significant impairment of QoL.

Conclusion: Subjective disease status of patients following a maximized multi-modality treatment showed an expectable high degree of limitations, but was generally comparable to a reference group treated less intensively, suggesting that the administration of an intensified multi-modality treatment is feasible in terms of QoL/effectivity ratio.
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http://dx.doi.org/10.4103/2231-0746.161055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555943PMC
September 2015

Periimplant changes in different transplanted soft tissues around loaded endosseous implants in patients after oral tumor surgery.

Implant Dent 2013 Dec;22(6):650-5

*Associate Professor, Goethe-University Frankfurt, Frankfurt am Main, Germany; Private Practice, Nauheim, Germany. †Private Practice, Backnang, Germany. ‡Services-in-Statistics, Würzburg, Germany. §Private Practice, Griesheim, Germany.

Purpose: To examine periimplant reaction of transplanted soft tissues foreign to oral cavity when compared with local gingiva.

Methods: In 58 oral cancer patients, 210 dental implants were inserted mainly in the mandible after radical surgery and reconstruction. Ninety-six implants penetrated transplants (split skin, mucosal, platysma, pectoralis major, and intestinal) and were compared with 114 implants penetrating local gingiva. Prosthetic treatment consisted of telescopic or bar-retained overdentures or (in case of intestinal grafts) implant-supported fixed prostheses. Follow-up lasted between 30 and 60 months. Plaque index, sulcus bleeding index, pocket probing depth, and width of vestibular-/oral attached mucosa were measured.

Results: Plaque index (before second year; P < 0.01) and pocket probing depth (after first year; P < 0.02-0.04) displayed significant differences with disadvantage for split skin grafts. Sulcus bleeding did not exceed index 1. Attached mucosa had no significant effect on periimplant health.

Conclusion: Transplanted extraoral tissues behaved similarly when compared with local gingiva, showing no detrimental effect on periimplant health in oral cancer patients. Split skin and mucosal grafts had worst performance.
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http://dx.doi.org/10.1097/01.id.0000433935.76603.0aDOI Listing
December 2013

Life stage differences in mammary gland gene expression profile in non-human primates.

Breast Cancer Res Treat 2012 Jun 25;133(2):617-34. Epub 2011 Oct 25.

Department of Gynecologic Endocrinology and Reproductive Medicine, University Women's Hospital, Berne, Switzerland.

Breast cancer (BC) is the most common malignancy of women in the developed world. To better understand its pathogenesis, knowledge of normal breast development is crucial, as BC is the result of disregulation of physiologic processes. The aim of this study was to investigate the impact of reproductive life stages on the transcriptional profile of the mammary gland in a primate model. Comparative transcriptomic analyses were carried out using breast tissues from 28 female cynomolgus macaques (Macaca fascicularis) at the following life stages: prepubertal (n = 5), adolescent (n = 4), adult luteal (n = 5), pregnant (n = 6), lactating (n = 3), and postmenopausal (n = 5). Mammary gland RNA was hybridized to Affymetrix GeneChip(®) Rhesus Macaque Genome Arrays. Differential gene expression was analyzed using ANOVA and cluster analysis. Hierarchical cluster analysis revealed distinct separation of life stage groups. More than 2,225 differentially expressed mRNAs were identified. Gene families or pathways that changed across life stages included those related to estrogen and androgen (ESR1, PGR, TFF1, GREB1, AR, 17HSDB2, 17HSDB7, STS, HSD11B1, AKR1C4), prolactin (PRLR, ELF5, STAT5, CSN1S1), insulin-like growth factor signaling (IGF1, IGFBP1, IGFBP5), extracellular matrix (POSTN, TGFB1, COL5A2, COL12A1, FOXC1, LAMC1, PDGFRA, TGFB2), and differentiation (CD24, CD29, CD44, CD61, ALDH1, BRCA1, FOXA1, POSTN, DICER1, LIG4, KLF4, NOTCH2, RIF1, BMPR1A, TGFB2). Pregnancy and lactation displayed distinct patterns of gene expression. ESR1 and IGF1 were significantly higher in the adolescent compared to the adult animals, whereas differentiation pathways were overrepresented in adult animals and pregnancy-associated life stages. Few individual genes were distinctly different in postmenopausal animals. Our data demonstrate characteristic patterns of gene expression during breast development. Several of the pathways activated during pubertal development have been implicated in cancer development and metastasis, supporting the idea that other developmental markers may have application as biomarkers for BC.
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http://dx.doi.org/10.1007/s10549-011-1811-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822905PMC
June 2012

Interactive coordination of currently depressed inpatient mothers and their infants during the postpartum period.

Infant Ment Health J 2011 Sep 26;32(5):542-562. Epub 2011 Jul 26.

Children's Hospital Harvard Medical School, Boston.

In healthy mother-infant dyads, interactions are characterized by a pattern of matching and mismatching interactive states with quick reparation of mismatches into matches. In contrast, dyads in which mothers have postpartum depression show impaired mother-infant interaction patterns over the first few months of the infant's life. The majority of studies that have examined such interaction patterns have drawn on community samples rather than on depressed inpatient samples of mothers who were in a state of current depression at the time of assessment. To date, no study has investigated specific microanalytic patterns of interactive coordination between depressed German mothers and their infants using the Face-to-Face Still-Face paradigm (FFSF). The primary goal of this study was to evaluate specific patterns of dyadic coordination and the capacity for repairing states of miscoordination in an inpatient sample of postpartum currently depressed mothers and their infants as compared with a healthy control group. A sample of 28 depressed inpatient German mothers and their infants (age range = 1-8 months, M age = 4.06 months) and 34 healthy dyads (range = 1-8 months, M age = 3.89 months) were videotaped while engaging in the FFSF. A focus was placed on the play and reunion episodes. Compared with healthy dyads, dyads with depressed mothers showed less coordination of positive matched states and longer latencies when repairing interactive mismatching states into positive matched states. Clinical implications are discussed.
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http://dx.doi.org/10.1002/imhj.20312DOI Listing
September 2011

Female surgeons' mentoring experiences and success in an academic career in Switzerland.

Swiss Med Wkly 2011 18;141:w13233. Epub 2011 Jul 18.

Department of Surgery, Spitalzentrum Biel, Switzerland.

Principles: An increasing proportion of women are working in medicine, although only very few choose surgical specialties and the interest in an academic pursuit is generally smaller among women compared to their male colleagues. The aim of the present study was to analyse factors critical for a successful academic career for female surgeons in Switzerland and to assess the value of mentor-mentee relationships in this context.

Methods: An anonymous national survey among board-certified female surgeons and female residents was conducted in Switzerland during spring 2008. The support in career advancement was investigated with five scales: networking, career planning, coaching, role model and emotional support scale. Career development was assessed based on the following criteria: number of talks at scientific conferences, number of peer-reviewed publications, participation in research projects, months of research as a fulltime activity, amount of awarded scholarships, amount of obtained third-party funds and number of research awards obtained.

Results: In total, 189/318 (59.4%) questionnaires were returned. Mentor-mentee relationships were reported by 109/189 (58%) respondents. The bivariate analysis showed a positive influence on the sum score regarding the respondents who were in a mentor-mentee relationship or who had support in doing household work (p = 0.09).

Conclusions: A supporting network, especially in terms of a mentor, is crucial so that female physicians interested in an academic career get the opportunity to accomplish their purpose. There is considerable potential for improvement as almost half of the respondents did not have a mentor in this survey.
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http://dx.doi.org/10.4414/smw.2011.13233DOI Listing
December 2011

Women in surgery: a survey in Switzerland.

Arch Surg 2010 Nov;145(11):1119-21

Department of Surgery, University Hospital Bern, Switzerland.

An increasing proportion of women work in medicine; however, only few choose surgical specialties. The objective of this study was to analyze the current situation of female surgeons and surgical residents in Switzerland concerning their personal and professional fulfillment. Of 318 female surgeons and surgical residents included in our study, 189 (59.4%) returned the anonymous questionnaire. Mentor-mentee relationships were mentioned by 110 (58.2%) of the 189 respondents. On the basis of a 7-point Likert scale, these women responded that they were moderately satisfied with their professional (mean score [SD], 2.7 [1.3]) and personal (mean score [SD], 3.0 [1.7]) lives. Of the 189 respondents, 113 (59.8%) mentioned that they felt underappreciated. The most important ways suggested for increasing the attractiveness of a surgical career for women were a reduction in workload (49 respondents [25.9%]), more flexible working hours (38 respondents [20.1%]), and better structured residency programs (23 respondents [12.2%]).
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http://dx.doi.org/10.1001/archsurg.2010.245DOI Listing
November 2010

Prevalence of burnout among surgical residents and surgeons in Switzerland.

Arch Surg 2010 Oct;145(10):1013-6

Department of Surgery, University Hospital Bern, Switzerland.

Burnout is a pathologic reaction in response to long-term work-related stress. The aim of this study was 2-fold: first, to assess the prevalence and degree of burnout among surgical residents and surgeons in Switzerland and, second, to identify predictors of burnout in the surgical community. Four hundred five of 618 anonymous questionnaires (65.5%) were returned. Among respondents, 3.7% and 35.1% showed high and moderate degrees of burnout, respectively. Respondents with high and moderate degrees of burnout had higher summary scores of perceived stress (P < .001). In multiple logistic regression analysis, the strongest predictors of burnout were poor interaction with nurses, disturbances due to telephone consultations, and high overall workload. To reduce burnout, new work models should be sought, in addition to decreasing work intensity and workload rather than restricting work hours alone.
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http://dx.doi.org/10.1001/archsurg.2010.188DOI Listing
October 2010

Botulinum toxin as preventive treatment for migraine: a randomized double-blind study.

Eur Neurol 2009 20;62(4):204-11. Epub 2009 Jul 20.

Department of Neurology, Medizinische Hochschule, Hannover, Germany.

Aim: To determine if botulinum toxin type A (BoNT-A) injections can reduce the frequency and severity of migraines.

Methods: Patients (n = 127) were randomized to receive placebo or two doses of BoNT-A (Dysport). The primary endpoint was reduction in number of migraine attacks up to week 8 and between weeks 8 and 12 after injection. Patient diaries were used to record secondary endpoints, including frequency, severity and duration of migraine attacks.

Results: There was a mean reduction of 0.54 and 0.94 attacks/month with placebo and BoNT-A, respectively, and absolute attack count was less in the verum group (3.6 vs. 4.2 attacks/month), but this was not statistically significant. The patients' global assessment of efficacy was significantly better than placebo in the high-dose group (p = 0.02) but no effects were seen for the other secondary efficacy parameters.

Conclusion: Our study showed a trend towards a reduced attack rate with verum but did not show any statistically significant efficacy of BoNT-A in the prophylactic treatment of migraine.
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http://dx.doi.org/10.1159/000228987DOI Listing
November 2009

Growth of the orbit after frontoorbital advancement using nonrigid suture vs rigid plate fixation technique.

J Pediatr Surg 2008 Nov;43(11):2075-81

Department of Cranio-Maxillofacial Plastic Surgery, Johann Wolfgang Goethe-University Medical School, Surgical Center, Frankfurt am Main, Germany.

Purpose: To demonstrate whether a measurable difference occurs on the growth of the orbit when using 2 forms of stabilization of the supra-orbital rim after upper orbital osteotomy in children with craniosynostosis. The 2 methods of fixation include sutures providing nonrigid fixation and titanium or resorbable osteosynthesis plates.

Patients And Methods: In this prospective randomized study, the influence of the mentioned fixation materials was analyzed in a tertiary care center (university hospital). Sixteen consecutive children with craniosynostoses (trigonocephaly, brachycephaly, plagiocephaly) were included. All patients underwent bilateral frontoorbital advancement surgery. In 8 patients each, the fixation of the mobilized and reshaped supraorbital rim was carried out using either miniplates or sutures, resulting in a rigid or nonrigid fixation. By means of computed tomography scans taken preoperatively (mean age, 8months) and postoperatively (mean age, 6.5years), the development of the orbit was measured using the anterior interorbital distance, lateral orbital distance, medial orbital-wall length, lateral orbital-wall length, and medial orbital-wall protrusion. The results were compared to norm values and statistically evaluated.

Result: In all patients, a long-term improvement of the orbit was achieved with absolute distances staying below norm values. The choice of the fixation material was of minor importance.

Conclusion: Sutures providing nonrigid fixation of bone flaps seem to be feasible in reaching the aims of surgery in craniosynostotic children.
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http://dx.doi.org/10.1016/j.jpedsurg.2008.03.057DOI Listing
November 2008

Positive sentinel lymph nodes are a negative prognostic factor for survival in T1-2 oral/oropharyngeal cancer-a long-term study on 103 patients.

Ann Surg Oncol 2009 Feb 30;16(2):233-9. Epub 2008 Sep 30.

Department of Oral and Cranio-Maxillofacial Plastic Surgery, Johann Wolfgang Goethe University Medical School, Frankfurt am Main, Germany.

Background: To evaluate prognostic value of sentinel node biopsy (SNB) in oral/oropharyngeal squamous cell cancer (OOSCC) concerning overall/disease-free survival.

Methods: One hundred three consecutive patients with T1-2N0 OOSCC were consecutively recruited for SNB as single invasive staging method for the neck. Two hundred seventy-three sentinel nodes (SNs) were removed (mean, 2.65 per patient). Nine patients had 10 positive SNs (upstaging rate, 8.7%) found in levels I to III, leading to a therapeutic neck dissection.

Results: Mean observation time of all patients was 6.7 years; mean survival time of patients with negative or positive SNs was 6.9 and 3.7 years, respectively. There has been no false-negative result of SNB to date becoming manifest in ipsilateral node metastasis during follow-up. Five-year overall/disease-free survival of all patients was 82%/72%, respectively. The same parameters for the patients with negative SNs were 85%/74%, for those with positive SNs 38%/47%, respectively (statistically significant). There has been a higher statistical risk for locoregional recurrence for patients with positive SNs. Rates of metachronous second primary tumors developing during follow-up were 10.6% (negative SNs) and 44.4% (positive SNs).

Conclusion: SNB was a valuable diagnostic method in patients with T1-2N0 OOSCC avoiding elective neck dissections. Patients with positive SNs had statistically significantly higher rates of locoregional recurrences, second primary tumors, tumor-related deaths, and a worse overall/disease-free survival. To date, no therapeutic consequences in case of a positive SN beyond execution of modified radical neck dissection (to remove other positive nodes) and closer attention during follow-up can be concluded from this study.
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http://dx.doi.org/10.1245/s10434-008-0150-5DOI Listing
February 2009

[X-ray contrast media Melitrast-300 and Melitrast-270 in cardiological diagnosis].

Rontgenpraxis 2004 ;55(4):155-9

Medizinische Klinik, Klinikum Schwalmstadt, Krankenhausstr. 27, 34613 Schwalmstadt.

The aim of this study was the evaluation of safety and cardiologic efficacy of the non-ionic contrast agent Iosarcol (Melitrast), a contrast agent with low protein affinity in two different iodine concentrations. One hundred patients were prospectively randomized to receive either Melitrast-270 or Melitrast-300 for left heart ventriculography and coronary angiography. Clinical evaluation, blood pressure and pulse measurement were performed and an electrocardiogram was recorded before and after contrast application and the diagnostic efficacy using a score was evaluated. In three patients side effects could be observed 2 hours after the application (vertigo, sickness, sweating). Melitrast in both concentrations led to a good contrast during ventriculography and coronary angiography which could not be differentiated by two experienced observers. Thus a lower iodine concentration and by this a lower viscosity seems to favour Melitrast-270 for invasive cardiologic diagnosis.
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January 2005
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