TY - JOUR A1 - Steiger, Tamara A1 - Foltan, Maik A1 - Philipp, Alois A1 - Müller, Thomas A1 - Gruber, Michael A1 - Bredthauer, Andre A1 - Krenkel, Lars A1 - Birkenmaier, Clemens A1 - Lehle, Karla T1 - Accumulations of von Willebrand factor within ECMO oxygenators: Potential indicator of coagulation abnormalities in critically ill patients? JF - Artificial Organs N2 - Clot formation within membrane oxygenators (MOs) remains a critical problem during extracorporeal membrane oxygenation (ECMO). The composition of the clots-in particular, the presence of von Willebrand factor (vWF)-may be an indicator for prevalent nonphysiological flow conditions, foreign body reactions, or coagulation abnormalities in critically ill patients. Mats of interwoven gas exchange fibers from randomly collected MOs (PLS, Maquet, Rastatt, Germany) of 21 patients were stained with antibodies (anti-vWF and anti-P-selectin) and counterstained with 4 ',6-diamidino-2-phenylindole. The extent of vWF-loading was correlated with patient and technical data. While 12 MOs showed low vWF-loadings, 9 MOs showed high vWF-loading with highest accumulations close to crossing points of adjacent gas fibers. The presence and the extent of vWF-fibers/"cobwebs," leukocytes, platelet-leukocyte aggregates (PLAs), and P-selectin-positive platelet aggregates were independent of the extent of vWF-loading. However, the highly loaded MOs were obtained from patients with a significantly elevated SOFA score, severe thrombocytopenia, and persistent liver dysfunction. The coagulation abnormalities of these critically ill patients may cause an accumulation of the highly thrombogenic and elongated high-molecular-weight vWF multimers in the plasma which will be trapped in the MOs during the ECMO therapy. KW - ECMO KW - PLATELET ACTIVATION KW - THROMBOSIS KW - BLOOD FLOW KW - INFLAMMATION Y1 - 2019 U6 - https://doi.org/10.1111/aor.13513 SN - 1525-1594 VL - 43 IS - 11 SP - 1065 EP - 1076 PB - Wiley CY - Hoboken ER - TY - INPR A1 - Pangerl, Jonas A1 - Moser, Elisabeth A1 - Müller, Max A1 - Weigl, Stefan A1 - Jobst, Simon A1 - Rück, Thomas A1 - Bierl, Rudolf A1 - Matysik, Frank-Michael T1 - A Highly Sensitive Acetone and Ethanol Quantum Cascade Laser Based Photoacoustic Sensor: Characterization and Multi-Component Spectra Recording in Synthetic Breath T2 - SSRN Electronic Journal N2 - Trace gas analysis in breath is challenging due to the vast number of different components. We present a highly sensitive quantum cascade laser based photoacoustic setup for breath analysis. Scanning the range between 8260 and 8270 nm with a spectral resolution of 48 pm, we are able to quantify acetone and ethanol within a typical breath matrix containing water and CO2. We photoacoustically acquired spectra within this region of mid-infra-red light and prove that those spectra do not suffer from non-spectral interferences. The purely additive behavior of a breath sample spectrum was verified by comparing it with the independently acquired single component spectra using Pearson and Spearman correlation coefficients. A previously presented simulation approach is improved and an error attribution study is presented. With a 3σ detection limit of 6.5 ppbV in terms of ethanol and 250 pptV regarding acetone, our system is among the best performing presented so far. KW - Photoacoustic spectroscopy KW - quantum cascade laser KW - spectral simulation KW - breath analysis KW - acetone Y1 - 2022 U6 - https://doi.org/10.2139/ssrn.4305376 PB - Elsevier ER - TY - JOUR A1 - Haus, Moritz A1 - Foltan, Maik A1 - Philipp, Alois A1 - Müller, Thomas A1 - Lingel, Maximilian P. A1 - Krenkel, Lars A1 - Gruber, Michael A1 - Lehle, Karla T1 - Neutrophil extracellular traps -a potential trigger for the development of thrombocytopenia during extracorporeal membrane oxygenation N2 - Neutrophil extracellular traps (NETs) have recently emerged as a potential link between inflammation, immunity, and thrombosis, as well as other coagulation disorders which present a major challenge in the context of extracorporeal membrane oxygenation (ECMO). By examining blood from ECMO patients for NETs and their precursors and correlating them with clinical and laboratory biomarkers of coagulation and inflammation, this study aims to evaluate the association between the presence of NETs in the bloodstream of ECMO patients and the development of potentially severe coagulation disorders during ECMO therapy. Therefore, blood samples were collected from healthy volunteers (n=13) and patients receiving veno-venous (VV) ECMO therapy (n=10). To identify NETs and their precursors, DNA and myeloperoxidase as well as granulocyte marker CD66b were visualized simultaneously by immunofluorescence staining in serial blood smears. Differentiation of DNA-containing objects and identification of NETs and their precursors was performed semiautomatically by a specific algorithm using the shape and size of DNA staining and the intensity of MPO and CD66b signal. Neutrophil extracellular traps and their precursors could be detected in blood smears from patients requiring VV ECMO. Compared to volunteers, ECMO patients presented significantly higher rates of NETs and NET precursors as well as an increased proportion of neutrophil granulocytes in all detected nucleated cells. A high NET rate prior to the initiation of ECMO therapy was associated with both increased iL-6 and TNF-α levels as an expression of a high cytokine burden. These patients with increased NET release also presented an earlier and significantly more pronounced decrease in platelet counts and ATIII activity following initiation of therapy compared with patients with less elevated NETs. These findings provide further indications for the development of immune-mediated acquired thrombocytopenia in ECMO patients. KW - Neutrophil extracellular traps (NET) KW - Immunoflorescence KW - Thrombocytopenia KW - Extracorporeal membrane oxygenation (ECMO) KW - Sepsis KW - immunothrombosis KW - Coagulation disorder Y1 - 2024 UR - https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2024.1339235/abstract U6 - https://doi.org/10.3389/fimmu.2024.1339235 VL - 15 PB - frontiers ER - TY - JOUR A1 - Klein, C. A1 - Nabbefeld, T. A1 - Hattab, H. A1 - Meyer, D. A1 - Jnawali, G. A1 - Kammler, Martin A1 - Meyer zu Heringdorf, Frank-Joachim A1 - Golla-Franz, A. A1 - Müller, B. H. A1 - Schmidt, Thomas A1 - Henzler, M. A1 - Horn-von Hoegen, Michael T1 - Lost in reciprocal space? Determination of the scattering condition in spot profile analysis low-energy electron diffraction JF - Review of scientific instruments N2 - The precise knowledge of the diffraction condition, i.e., the angle of incidence and electron energy, is crucial for the study of surface morphology through spot profile analysis low-energy electron diffraction (LEED). We demonstrate four different procedures to determine the diffraction condition: employing the distortion of the LEED pattern under large angles of incidence, the layer-by-layer growth oscillations during homoepitaxial growth, a G(S) analysis of a rough surface, and the intersection of facet rods with 3D Bragg conditions. Y1 - 2011 U6 - https://doi.org/10.1063/1.3554305 VL - 82 IS - 3 PB - American Institute of Physics ER - TY - GEN A1 - Weber, Karsten A1 - Sonar, Arne A1 - Gerhards, Helene A1 - Bittner, Uta A1 - Krug, Henriette A1 - Reuter-Oppermann, Melanie A1 - Pumplun, Luisa A1 - Müller, Helene A1 - Buxmann, Peter A1 - Schneider, Diana A1 - Zoglauer, Thomas ED - Sonar, Arne ED - Weber, Karsten T1 - Künstliche Intelligenz und Gesundheit BT - Ethische, philosophische und sozialwissenschaftliche Explorationen N2 - Der Einsatz von künstlicher Intelligenz im Gesundheitsbereich verspricht besonders großen Nutzen durch eine bessere Versorgung sowie effizientere Abläufe und bietet damit letztlich auch ökonomische Vorteile. Dem stehen unter anderem Befürchtungen entgegen, dass sich durch den Einsatz von künstlicher Intelligenz das Arzt-Patienten-Verhältnis verändern könnte, Arbeitsplätze gefährdet seien oder die Ökonomisierung des Gesundheitswesens einen weiteren Schub erfahren könnte. Zuweilen wird die Debatte um diese Technologie, zumal in der Öffentlichkeit, emotional und fern sachlicher Argumente geführt. Die Autorinnen und Autoren untersuchen die Geschichte des KI-Einsatzes in der Medizin, deren öffentliche Wahrnehmung, Governance der KI, die Möglichkeiten und Grenzen der Technik sowie Einsatzgebiete, die bisher noch nicht oder nur wenig im Fokus der Aufmerksamkeit waren. Dabei erweist sich die KI als leistungsfähiges Werkzeug, das zahlreiche ethische und soziale Fragen aufwirft, die bei der Einführung anderer Technologien bereits gestellt wurden; allerdings gibt es auch neue Herausforderungen, denen sich Professionen, Politik und Gesellschaft stellen müssen. KW - Ethik KW - Künstliche Intelligenz KW - Gesundheit KW - Technikfolgenabschätzung Y1 - 2022 SN - 978-3-515-12977-0 U6 - https://doi.org/10.25162/9783515129770 PB - Franz Steiner CY - Stuttgart ER - TY - JOUR A1 - Beyer, Thomas A1 - Weigert, Markus A1 - Quick, Harald H. A1 - Pietrzyk, Uwe A1 - Vogt, Florian A1 - Palm, Christoph A1 - Antoch, Gerald A1 - Müller, Stefan P. A1 - Bockisch, Andreas T1 - MR-based attenuation correction for torso-PET/MR imaging BT - pitfalls in mapping MR to CT data JF - European Journal of Nuclear Medicine and Molecular Imaging N2 - Purpose MR-based attenuation correction (AC) will become an integral part of combined PET/MR systems. Here, we propose a toolbox to validate MR-AC of clinical PET/MRI data sets. Methods Torso scans of ten patients were acquired on a combined PET/CT and on a 1.5-T MRI system. MR-based attenuation data were derived from the CT following MR–CT image co-registration and subsequent histogram matching. PET images were reconstructed after CT- (PET/CT) and MR-based AC (PET/MRI). Lesion-to-background (L/B) ratios were estimated on PET/CT and PET/MRI. Results MR–CT histogram matching leads to a mean voxel intensity difference in the CT- and MR-based attenuation images of 12% (max). Mean differences between PET/MRI and PET/CT were 19% (max). L/B ratios were similar except for the lung where local misregistration and intensity transformation leads to a biased PET/MRI. Conclusion Our toolbox can be used to study pitfalls in MR-AC. We found that co-registration accuracy and pixel value transformation determine the accuracy of PET/MRI. KW - PET/MRI KW - PET/CT KW - Attenuation correction KW - Kernspintomografie KW - Positronen-Emissions-Tomografie KW - Schwächung Y1 - 2008 U6 - https://doi.org/10.1007/s00259-008-0734-0 VL - 35 IS - 6 SP - 1142 EP - 1146 ER - TY - JOUR A1 - Weigert, Markus A1 - Pietrzyk, Uwe A1 - Müller, Stefan P. A1 - Palm, Christoph A1 - Beyer, Thomas T1 - Whole-body PET/CT imaging BT - Combining software- and hardware-based co-registration JF - Zeitschrift für Medizinische Physik N2 - Aim Combined whole-body (WB) PET/CT imaging provides better overall co-registration compared to separate CT and PET. However, in clinical routine local PET-CT mis-registration cannot be avoided. Thus, the reconstructed PET tracer distribution may be biased when using the misaligned CT transmission data for CT-based attenuation correction (CT-AC). We investigate the feasibility of retrospective co-registration techniques to align CT and PET images prior to CT-AC, thus improving potentially the quality of combined PET/CT imaging in clinical routine. Methods First, using a commercial software registration package CT images were aligned to the uncorrected PET data by rigid and non-rigid registration methods. Co-registration accuracy of both alignment approaches was assessed by reviewing the PET tracer uptake patterns (visual, linked cursor display) following attenuation correction based on the original and co-registered CT. Second, we investigated non-rigid registration based on a prototype ITK implementation of the B-spline algorithm on a similar targeted MR-CT registration task, there showing promising results. Results Manual rigid, landmark-based co-registration introduced unacceptable misalignment, in particular in peripheral areas of the whole-body images. Manual, non-rigid landmark-based co-registration prior to CT-AC was successful with minor loco-regional distortions. Nevertheless, neither rigid nor non-rigid automatic co-registration based on the Mutual Information image to image metric succeeded in co-registering the CT and noAC-PET images. In contrast to widely available commercial software registration our implementation of an alternative automated, non-rigid B-spline co-registration technique yielded promising results in this setting with MR-CT data. Conclusion In clinical PET/CT imaging, retrospective registration of CT and uncorrected PET images may improve the quality of the AC-PET images. As of today no validated and clinically viable commercial registration software is in routine use. This has triggered our efforts in pursuing new approaches to a validated, non-rigid co-registration algorithm applicable to whole-body PET/CT imaging of which first results are presented here. This approach appears suitable for applications in retrospective WB-PET/CT alignment. Ziel Kombinierte PET/CT-Bildgebung ermöglicht verbesserte Koregistrierung von PET- und CT-Daten gegenüber separat akquirierten Bildern. Trotzdem entstehen in der klinischen Anwendung lokale Fehlregistrierungen, die zu Fehlern in der rekonstruierten PET- Tracerverteilung führen können, falls die unregistrierten CT-Daten zur Schwächungskorrektur (AC) der Emissionsdaten verwendet werden. Wir untersuchen daher die Anwendung von Bildregistrierungsalgorithmen vor der CT-basierten AC zur Verbesserung der PET-Aufnahmen. Methoden Mittels einer kommerziellen Registrierungssoftware wurden die CT-Daten eines PET/CT- Tomographen durch landmarken- und intensitätsbasierte rigide (starre) und nicht-rigide Registrierungsverfahren räumlich an die unkorrigierten PET-Emissionsdaten angepasst und zur AC verwendet. Zur Bewertung wurden die Tracerverteilungen in den PET-Bildern (vor AC, CT-AC, CT-AC nach Koregistrierung) visuell und mit Hilfe korrelierter Fadenkreuze verglichen. Zusätzlich untersuchten wir die ITK-Implementierung der bekannten B-spline basierten, nicht-rigiden Registrierungsansätze im Hinblick auf ihre Verwendbarkeit für die multimodale PET/CT-Ganzkörperregistrierung. Ergebnisse Mittels landmarkenbasierter, nicht-rigider Registrierung konnte die Tracerverteilung in den PET-Daten lokal verbessert werden. Landmarkenbasierte rigide Registrierung führte zu starker Fehlregistrierung in entfernten Körperregionen. Automatische rigide und nicht-rigide Registrierung unter Verwendung der Mutual-Information-Ähnlichkeitsmetrik versagte auf allen verwendeten Datensätzen. Die automatische Registrierung mit B-spline-Funktionen zeigte vielversprechende Resultate in der Anwendung auf einem ähnlich gelagerten CT–MR-Registrierungsproblem. Fazit Retrospektive, nicht-rigide Registrierung unkorrigierter PET- und CT-Aufnahmen aus kombinierten Aufnahmensystemen vor der AC kann die Qualität von PET-Aufnahmen im klinischen Einsatz verbessern. Trotzdem steht bis heute im klinischen Alltag keine validierte, automatische Registrierungssoftware zur Verfügung. Wir verfolgen dazu Ansätze für validierte, nicht-rigide Bildregistrierung für den klinischen Einsatz und präsentieren erste Ergebnisse. KW - PET/CT KW - combined imaging KW - image co-registration KW - attenuation KW - correction KW - Positronen-Emissions-Tomografie KW - Computertomografie KW - Bildgebendes Verfahren KW - Registrierung KW - Schwächung Y1 - 2008 U6 - https://doi.org/10.1016/j.zemedi.2007.07.004 VL - 18 IS - 1 SP - 59 EP - 66 ER - TY - GEN A1 - Beyer, Thomas A1 - Weigert, Markus A1 - Palm, Christoph A1 - Quick, Harald H. A1 - Müller, Stefan P. A1 - Pietrzyk, Uwe A1 - Vogt, Florian A1 - Martinez, M.J. A1 - Bockisch, Andreas T1 - Towards MR-based attenuation correction for whole-body PET/MR imaging T2 - The Journal of Nuclear Medicine KW - Kernspintomografie KW - Positronen-Emissions-Tomografie KW - Bildgebendes Verfahren KW - Schwächung Y1 - 2006 UR - http://jnm.snmjournals.org/content/47/suppl_1/384P.1.abstract VL - 47 IS - Suppl. 1 SP - 384P ER - TY - GEN A1 - Weigert, Markus A1 - Beyer, Thomas A1 - Quick, Harald H. A1 - Pietrzyk, Uwe A1 - Palm, Christoph A1 - Müller, Stefan P. T1 - Generation of a MRI reference data set for the validation of automatic, non-rigid image co-registration algorithms T2 - Nuklearmedizin KW - Kernspintomografie KW - Referenzdaten KW - Registrierung KW - Algorithmus Y1 - 2007 VL - 46 IS - 2 SP - A116 ER - TY - GEN A1 - Weigert, Markus A1 - Palm, Christoph A1 - Quick, Harald H. A1 - Müller, Stefan P. A1 - Pietrzyk, Uwe A1 - Beyer, Thomas T1 - Template for MR-based attenuation correction for whole-body PET/MR imaging T2 - Nuklearmedizin KW - Kernspintomografie KW - Positronen-Emissions-Tomografie KW - Bildgebendes Verfahren KW - Schwächung Y1 - 2007 VL - 46 IS - 2 SP - A115 ER - TY - JOUR A1 - Lehle, Karla A1 - Philipp, Alois A1 - Krenkel, Lars A1 - Gruber, Michael A1 - Hiller, Karl-Anton A1 - Müller, Thomas A1 - Lubnow, Matthias T1 - Thrombocytopenia During Venovenous Extracorporeal Membrane Oxygenation in Adult Patients With Bacterial, Viral, and COVID-19 Pneumonia JF - ASAIO Journal N2 - Contact of blood with artificial surfaces triggers platelet activation. The aim was to compare platelet kinetics after venovenous extracorporeal membrane oxygenation (V-V ECMO) start and after system exchange in different etiologies of acute lung failure. Platelet counts and coagulation parameters were analyzed from adult patients with long and exchange-free (≥8 days) ECMO runs (n = 330) caused by bacterial (n = 142), viral (n = 76), or coronavirus disease 2019 (COVID-19) (n = 112) pneumonia. A subpopulation requiring a system exchange and with long, exchange-free runs of the second oxygenator (≥7 days) (n = 110) was analyzed analogously. Patients with COVID-19 showed the highest platelet levels before ECMO implantation. Independent of the underlying disease and ECMO type, platelet counts decreased significantly within 24 hours and reached a steady state after 5 days. In the subpopulation, at the day of a system exchange, platelet counts were lower compared with ECMO start, but without differences between underlying diseases. Subsequently, platelets remained unchanged in the bacterial pneumonia group, but increased in the COVID-19 and viral pneumonia groups within 2–4 days, whereas D-dimers decreased and fibrinogen levels increased. Thus, overall platelet counts on V-V ECMO show disease-specific initial dynamics followed by an ongoing consumption by the ECMO device, which is not boosted by new artificial surfaces after a system exchange. Y1 - 2025 U6 - https://doi.org/10.1097/MAT.0000000000002383 SN - 1058-2916 SN - 1538-943X PB - Wolters Kluwer ER - TY - GEN A1 - Kranz, Michael A1 - Wagner, Maria Stella A1 - Pointner, Daniel A1 - Waldbauer, Selina A1 - Müller, Thomas A1 - Lubnow, Matthias A1 - Foltan, Maik A1 - Krenkel, Lars A1 - Lehle, Karla T1 - Polymeric Embedding of Membrane Lungs: A Novel Method for Histological Investigations of Intra-Device Clot Formation T2 - 12th EuroELSO Congress, 24-27. April 2024, Krakow Y1 - 2024 ER - TY - GEN A1 - Kranz, Michael A1 - Wagner, Maria Stella A1 - Krenkel, Lars A1 - Müller, Thomas A1 - Lubnow, Matthias A1 - Philipp, Alois A1 - Lehle, Karla T1 - Clot Localization within Membrane Lungs using different Imaging Methods and Histological Clot Characterization as a way to prevent Thrombosis in Extracorporeal Membrane Oxygenation Y1 - 2023 VL - 2023 ER - TY - GEN A1 - Köster, Leonie A1 - Kranz, Michael A1 - Wagner, Maria Stella A1 - Foltan, Maik A1 - Müller, Thomas A1 - Lubnow, Matthias A1 - Krenkel, Lars A1 - Lehle, Karla T1 - Histological Investigations of Intra-Device Clot Formation in ECMO Pumps T2 - 12th EuroELSO Congress, 24-27. April 2024, Krakow Y1 - 2024 ER -