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"text": "\n60164\nPosterior continuous curvilinear capsulorhexis with hydrogel and silicone intraocular lens implantation: development of capsulorhexis size and capsule opacification.\n\nGeorgopoulos, M\n\nMenapace, R\n\nFindl, O\n\nRainer, G\n\nPetternel, V\n\nKiss, B\n\nBeiträge in Fachzeitschriften\nISI:000169396500012\n11408126.0\n10.1016/S0886-3350(00)00793-8\nNone\nPURPOSE: To evaluate the influence of primary posterior continuous curvilinear capsulorhexis (PCCC) on capsule opacification development and capsular bag changes within the first year after cataract surgery with 2 intraocular lenses (IOLs) of comparable design but different material. SETTING: Department of Ophthalmology, University of Vienna, Medical School, Vienna, Austria. METHODS: Thirty-seven patients with age-related cataract had bilateral small incision cataract surgery with a PCCC performed after capsular tension ring insertion. One eye was randomly assigned to receive a hydrogel IOL and the other eye, a silicone IOL. Standardized digital retroillumination photographs were taken 1 day, 1 week, and 1, 3, 6, and 12 months after surgery to evaluate changes in the dimensions of the anterior and posterior capsulorhexis opening area and the presence of anterior and posterior capsule opacification. RESULTS: The area of the anterior continuous curvilinear capsulorhexis (ACCC) opening was significantly reduced during the first 6 postoperative months. The shrinkage was more pronounced (-25%) in the silicone IOL group than in the hydrogel IOL group. Ten percent of eyes with a silicone IOL had marked shrinkage of the ACCC. The area of the PCCC did not change in eyes with a hydrogel IOL but was larger (+20%) in eyes with a silicone IOL. Anterior ongrowth was observed in 60% in the hydrogel group and in no eye in the silicone group. Anterior capsule fibrosis was observed in 90% in the silicone group and in 20% in the hydrogel group. Total closure of the PCCC was not observed within the first year, but posterior ongrowth was observed in 40% in the hydrogel group and 10% in the silicone group. CONCLUSIONS: Anterior capsulorhexis shrinkage with concomitant posterior capsulorhexis enlargement was observed in eyes with a silicone IOL. The hydrogel IOL induced more ongrowth on the anterior and posterior IOL surfaces, whereas the silicone IOL induced more anterior capsule fibrosis. Total closure of the PCCC was not observed within the first year after surgery.\n\n\n"
},
{
"text": "\n111715\nHeterogeneity in age-related white matter changes.\n\nSchmidt, R\n\nSchmidt, H\n\nHaybaeck, J\n\nLoitfelder, M\n\nWeis, S\n\nCavalieri, M\n\nSeiler, S\n\nEnzinger, C\n\nRopele, S\n\nErkinjuntti, T\n\nPantoni, L\n\nScheltens, P\n\nFazekas, F\n\nJellinger, K\n\nBeiträge in Fachzeitschriften\nISI:000292780500005\n21706175.0\n10.1007/s00401-011-0851-x\nNone\nWhite matter changes occur endemically in routine magnetic resonance imaging (MRI) scans of elderly persons. MRI appearance and histopathological correlates of white matter changes are heterogeneous. Smooth periventricular hyperintensities, including caps around the ventricular horns, periventricular lining and halos are likely to be of non-vascular origin. They relate to a disruption of the ependymal lining with subependymal widening of the extracellular space and have to be differentiated from subcortical and deep white matter abnormalities. For the latter a distinction needs to be made between punctate, early confluent and confluent types. Although punctate white matter lesions often represent widened perivascular spaces without substantial ischemic tissue damage, early confluent and confluent lesions correspond to incomplete ischemic destruction. Punctate abnormalities on MRI show a low tendency for progression, while early confluent and confluent changes progress rapidly. The causative and modifying pathways involved in the occurrence of sporadic age-related white matter changes are still incompletely understood, but recent microarray and genome-wide association approaches increased the notion of pathways that might be considered as targets for therapeutic intervention. The majority of differentially regulated transcripts in white matter lesions encode genes associated with immune function, cell cycle, proteolysis, and ion transport. Genome-wide association studies identified six SNPs mapping to a locus on chromosome 17q25 to be related to white matter lesion load in the general population. We also report first and preliminary data that demonstrate apolipoprotein E (ApoE) immunoreactivity in white matter lesions and support epidemiological findings indicating that ApoE is another factor possibly related to white matter lesion occurrence. Further insights come from modern MRI techniques, such as diffusion tensor and magnetization transfer imaging, as they provide tools for the characterization of normal-appearing brain tissue beyond what can be expected from standard MRI scans. There is a need for additional pre- and postmortem studies in humans, including these new imaging techniques.\n\nCavalieri, Margherita\n\nEnzinger, Christian\n\nFazekas, Franz\n\nHaybäck, Johannes\n\nKoini, Marisa\n\nRopele, Stefan\n\nSchmidt, Helena\n\nSchmidt, Reinhold\n\n\n"
},
{
"text": "\n114972\nPrevalence of apical periodontitis and endodontic treatment in a Kosovar adult population.\n\nKamberi, B\n\nHoxha, V\n\nStavileci, M\n\nDragusha, E\n\nKu\n\nBeiträge in Fachzeitschriften\nISI:000208596800032\n22126237.0\n10.1186/1472-6831-11-32\nPMC3251521\nDespite numerous studies on the prevalence of apical periodontitis (AP) and endodontic treatment in diverse geographical populations, there are currently no data on the prevalence of these conditions in populations of adults native to Kosovo. Therefore, little is known about how widespread these conditions are, and whether there is any correlation between root canal treatment and AP. The purpose of our research was to address this anomaly by investigating AP and endodontic treatment in an adult Kosovar population based on radiographic examination.\n The sample used for this study consisted of randomly selected individuals referred to the University Dentistry Clinical Center of Kosovo in the years 2006-2007. Orthopantomographs of 193 patients were evaluated. The periapical status of all teeth (with the exception of third molars) was examined according to Ørstavik's Periapical Index. The quality of the root canal filling was rated as 'adequate' or 'inadequate' based on whether all canals were filled, the depth of fill relative to the radiographic apex and the quality of compaction (absence/presence of voids). Data were analyzed statistically using the Chi-square test and calculation of odds ratios.\n Out of 4131 examined teeth, the prevalence of apical periodontitis (AP) and endodontic treatment was 12.3% and 2.3%, respectively. Of 95 endodontically-treated teeth, 46.3% were associated with AP. The prevalence of AP increased with age. The prevalence in subjects aged over 60 years old (20.2%) was higher than in other age groups. A statistically significant difference was found for the frequency of endodontically-treated teeth associated with AP in the 40-49 year age group (P < 0.001). Of some concern was the discovery that only 30.5% of the endodontically-treated teeth examined met the criteria of an acceptable root canal filling. Inadequately root-filled teeth were associated with an increased AP risk.\n The prevalence of AP and the frequency of endodontically-treated teeth with AP in this Kosovar population are higher than those found in other countries. Inadequate root canal fillings were associated with an increased prevalence of AP.\n\nKqiku-Biblekaj, Lumnije\n\n\n"
},
{
"text": "\n137452\nToxocarosis and putative DRESS syndrome in an oncological patient: a case report.\n\nWutte, N\n\nPalfner, M\n\nAuer, H\n\nRuckenbauer, G\n\nValentin, T\n\nSeeber, K\n\nAberer, W\n\nKrause, R\n\nHoenigl, M\n\nBeiträge in Fachzeitschriften\nISI:000335246500009\n24249317.0\n10.1007/s00508-013-0444-x\nNone\nToxocarosis is a parasitic infection caused by Toxocara canis or Toxocara cati. Their definite hosts are the domestic dog and cat, where their adult forms live within the lumen of the small intestine. In humans, infective larvae hatch after ingestion of eggs, but the juvenile stages fail to develop into mature adult worms. Instead, they migrate through the body with the potential to affect virtually every body site. DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) is a serious cutaneous drug reaction, which also involves other organ systems. We report on a 45-year-old man who was admitted with fever up to 40 °C, skin rash and pruritus not responding to amoxicillin/clavulanic acid. Laboratory results showed a slightly elevated white blood cell count, with 62 % eosinophils. History revealed contact to roaming cats. Travel history was unremarkable. Extensive diagnostic workup was performed, and the patient was finally diagnosed with DRESS syndrome, responded to systemic corticosteroid therapy and was discharged. Serology for Toxocara came back positive a few days later. Stool was again sent for microscopy and was found positive for Giardia lamblia, which was treated with a 5-day course of metronidazole. The patient had again developed rash and eosinophilia (62 %). Total immunoglobulin (Ig)E was 1, 89 U/l (normal limit: < 100 689 U/l). Follow-up serology showed a marked increase of Toxocara TES ELISA IgG (70 U, normal limit: < 20 U), confirming toxocarosis. Antiparasitic treatment with albendazole 400 mg bid for 5 days was initiated; eosinophilia resolved; and the patient had no further complaints. Although generalized exanthema due to Toxocara has not yet been described in literature, toxocarosis is known to cause a wide spectrum of cutaneous manifestations. Whether our patient had both, a drug reaction with eosinophilia and systemic symptoms and a parasitic infection, or whether a hypersensitivity reaction to Toxocara antigen was mimicking a DRESS syndrome remains unclear.\n\nAberer, Werner\n\nHönigl, Martin\n\nKrause, Robert\n\nPalfner-Wutte, Nora Johanna\n\nRuckenbauer, Gerald\n\nValentin, Thomas\n\n\n"
},
{
"text": "\n150044\nNeutrophil/Lymphocyte ratio has no predictive or prognostic value in breast cancer patients undergoing preoperative systemic therapy.\n\nSuppan, C\n\nBjelic-Radisic, V\n\nLa Garde, M\n\nGroselj-Strele, A\n\nEberhard, K\n\nSamonigg, H\n\nLoibner, H\n\nDandachi, N\n\nBalic, M\n\nBeiträge in Fachzeitschriften\nISI:000367315600010\n26715527.0\n10.1186/s12885-015-2005-3\nPMC4696229\nThe primary goal of preoperative systemic treatment (PST) in patients with breast cancer is downsizing of tumors to enhance the rate of breast conserving surgery. Additionally, preoperative systemic treatment offers the possibility to assess for chemosensitivity of early stage disease. In various cancers the prognostic value of neutrophil/lymphocyte ratio (NLR) was demonstrated, indicating that high NLR determines worse prognosis of the patients. The goal of our study was to evaluate the predictive and prognostic value of NLR in early stage breast cancer patients undergoing PST.\n 247 female patients with histologically proven breast cancer were analysed in this retrospective analysis. The NLR before the initiation of PST was documented. Histopathological response in surgically removed specimens was evaluated using a modified Sinn regression score and the pCR defined as no invasive tumor in primary tumor and lymph nodes. NLR was correlated with response to PST and disease free survival.\n PST was categorized into five groups (anthracycline containing, anthracycline and taxane containing, taxane containing, hormone treatment and other chemotherapies). pCR rate was defined as no invasive rest of tumor either in primary tumor or (ypT0 = Sinn) or in primary tumor and in lymph nodes (ypT0isypN0). Median NLR in patients without any invasive tumor rest was significantly higher than in patients either with some invasive tumor rest or not responding to chemotherapy. Despite this primary difference, the results were not stable across the analysed treatment groups particularly in the group with highest pCR rates (taxane and anthracycline treatment). Further, no association with disease free survival could be observed.\n Although there was a reverse trend with the higher NLR prior to systemic treatment in patients who achieved pCR, we could not demonstrate predictive or prognostic value of NLR in the cohort of early stage breast cancer patients treated with PST.\n\nBalic, Marija\n\nBjelic-Radisic, Vesna\n\nDandachi, Nadia\n\nEberhard, Katharina\n\nGroselj-Strele, Andrea\n\nSamonigg, Hellmut\n\nSuppan, Christoph\n\n\n"
},
{
"text": "\n161229\nRole of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline.\n\nAabakken, L\n\nKarlsen, TH\n\nAlbert, J\n\nArvanitakis, M\n\nChazouilleres, O\n\nDumonceau, JM\n\nFärkkilä, M\n\nFickert, P\n\nHirschfield, GM\n\nLaghi, A\n\nMarzioni, M\n\nFernandez, M\n\nPereira, SP\n\nPohl, J\n\nPoley, JW\n\nPonsioen, CY\n\nSchramm, C\n\nSwahn, F\n\nTringali, A\n\nHassan, C\n\nBeiträge in Fachzeitschriften\nISI:000446891100001\n28420030.0\n10.1055/s-0043-107029\nNone\n1 ESGE/EASL recommend that, as the primary diagnostic modality for PSC, magnetic resonance cholangiography (MRC) should be preferred over endoscopic retrograde cholangiopancreatography (ERCP).Moderate quality evidence, strong recommendation. 2 ESGE/EASL suggest that ERCP can be considered if MRC plus liver biopsy is equivocal or contraindicated in patients with persisting clinical suspicion of PSC. The risks of ERCP have to be weighed against the potential benefit with regard to surveillance and treatment recommendations.Low quality evidence, weak recommendation. 6 ESGE/EASL suggest that, in patients with an established diagnosis of PSC, MRC should be considered before therapeutic ERCP.Weak recommendation, low quality evidence. 7 ESGE/EASL suggest performing endoscopic treatment with concomitant ductal sampling (brush cytology, endobiliary biopsies) of suspected significant strictures identified at MRC in PSC patients who present with symptoms likely to improve following endoscopic treatment.Strong recommendation, low quality evidence. 9 ESGE/EASL recommend weighing the anticipated benefits of biliary papillotomy/sphincterotomy against its risks on a case-by-case basis.Strong recommendation, moderate quality evidence.Biliary papillotomy/sphincterotomy should be considered especially after difficult cannulation.Strong recommendation, low quality evidence. 16 ESGE/EASL suggest routine administration of prophylactic antibiotics before ERCP in patients with PSC.Strong recommendation, low quality evidence. 17 EASL/ESGE recommend that cholangiocarcinoma (CCA) should be suspected in any patient with worsening cholestasis, weight loss, raised serum CA19-9, and/or new or progressive dominant stricture, particularly with an associated enhancing mass lesion.Strong recommendation, moderate quality evidence. 19 ESGE/EASL recommend ductal sampling (brush cytology, endobiliary biopsies) as part of the initial investigation for the diagnosis and staging of suspected CCA in patients with PSC.Strong recommendation, high quality evidence.\n © Georg Thieme Verlag KG Stuttgart · New York.\n\nFickert, Peter\n\n\n"
},
{
"text": "\n161347\nIdentification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting.\n\nKanis, JA\n\nCooper, C\n\nRizzoli, R\n\nAbrahamsen, B\n\nAl-Daghri, NM\n\nBrandi, ML\n\nCannata-Andia, J\n\nCortet, B\n\nDimai, HP\n\nFerrari, S\n\nHadji, P\n\nHarvey, NC\n\nKraenzlin, M\n\nKurth, A\n\nMcCloskey, E\n\nMinisola, S\n\nThomas, T\n\nReginster, JY\n\nEuropean Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)\n\nBeiträge in Fachzeitschriften\nISI:000404237600001\n28451733.0\n10.1007/s00198-017-4009-0\nPMC5483332\nOsteoporosis represents a significant and increasing healthcare burden in Europe, but most patients at increased risk of fracture do not receive medication, resulting in a large treatment gap. Identification of patients who are at particularly high risk will help clinicians target appropriate treatment more precisely and cost-effectively, and should be the focus of future research.\n The purpose of the study was to review data on the identification and treatment of patients with osteoporosis at increased risk of fracture.\n A working group convened by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis met to review current data on the epidemiology and burden of osteoporosis and the patterns of medical management throughout Europe.\n In Europe in 2010, the cost of managing osteoporosis was estimated at €37 billion and notably the costs of treatment and long-term care of patients with fractures were considerably higher than the costs for pharmacological prevention. Despite the availability of effective treatments, the uptake of osteoporosis therapy is low and declining, in particular for secondary fracture prevention where the risk of a subsequent fracture following a first fracture is high. Consequently, there is a significant treatment gap between those who would benefit from treatment and those who receive it, which urgently needs to be addressed so that the burden of disease can be reduced.\n Implementation of global fracture prevention strategies is a critical need. Future research should focus on identifying specific risk factors for imminent fractures, periods of high fracture risk, patients who are at increased risk of fracture and therapies that are most suited to such high-risk patients and optimal implementation strategies in primary, secondary and tertiary care.\n\nDimai, Hans\n\n\n"
},
{
"text": "\n164497\nDefining the Key Competencies in Radiation Protection for Endovascular Procedures: A Multispecialty Delphi Consensus Study.\n\nDoyen, B\n\nMaurel, B\n\nCole, J\n\nMaertens, H\n\nMastracci, T\n\nVan Herzeele, I\n\nPRET (Principles of Radiation protection within Endovascular Team) group\n\nBeiträge in Fachzeitschriften\nISI:000426344500024\n29310896.0\n10.1016/j.ejvs.2017.11.020\nNone\nRadiation protection training courses currently focus on broad knowledge topics which may not always be relevant in daily practice. The goal of this study was to determine the key competencies in radiation protection that every endovascular team member should possess and apply routinely, through multispecialty clinical content expert consensus.\n Consensus was obtained through a two round modified Delphi methodology. The expert panel consisted of European vascular surgeons, interventional radiologists, and interventional cardiologists/angiologists experienced in endovascular procedures. An initial list of statements, covering knowledge skills, technical skills and attitudes was created, based on a literature search. Additional statements could be suggested by the experts in the first Delphi round. Each of the statements had to be rated on a 5- point Likert scale. A statement was considered to be a key competency when the internal consistency was greater than alpha = 0.80 and at least 80% of the experts agreed (rating 4/5) or strongly agreed (rating 5/5) with the statement. Questionnaires were emailed to panel members using the Surveymonkey service.\n Forty-one of 65 (63.1%) invited experts agreed to participate in the study. The response rates were 36 out of 41 (87.8%): overall 38 out of 41(92.6%) in the first round and 36 out of 38 (94.7%) in the second round. The 71 primary statements were supplemented with nine items suggested by the panel. The results showed excellent consensus among responders (Cronbach's alpha = 0.937 first round; 0.958 s round). Experts achieved a consensus that 30 of 33 knowledge skills (90.9%), 23 of 27 technical skills (82.1%), and 15 of 20 attitudes (75.0%) should be considered as key competencies.\n A multispecialty European endovascular expert panel reached consensus about the key competencies in radiation protection. These results may serve to create practical and relevant radiation protection training courses in the future, enhancing radiation safety for both patients and the entire endovascular team.\n Copyright © 2017 European Society for Vascular Surgery. All rights reserved.\n\nCohnert, Tina Ulrike\n\n\n"
},
{
"text": "\n164827\nPotential Benefit of Lymph Node Dissection During Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the European Association of Urology Guidelines Panel on Non-muscle-invasive Bladder Cancer.\n\nDominguez-Escrig, JL\n\nPeyronnet, B\n\nSeisen, T\n\nBruins, HM\n\nYuan, CY\n\nBabjuk, M\n\nBöhle, A\n\nBurger, M\n\nCompérat, EM\n\nGontero, P\n\nLam, T\n\nMacLennan, S\n\nMostafid, H\n\nPalou, J\n\nvan Rhijn, BWG\n\nSylvester, RJ\n\nZigeuner, R\n\nShariat, SF\n\nRouprêt, M\n\nBeiträge in Fachzeitschriften\nISI:000486153200023\n29158169.0\n10.1016/j.euf.2017.09.015\nNone\nThe oncological efficacy of routine lymphadenectomy (lymph node dissection [LND]) at the time of radical nephroureterectomy (RNU) remains controversial.\n To systematically review the available literature assessing the impact of LND in upper tract urothelial carcinoma (UTUC) patients.\n Embase, Medline, and Cochrane databases were searched for all studies comparing outcomes of patients undergoing RNU without LND versus any form of LND. We identified nine retrospective studies eligible for inclusion in this systematic review. We took cancer-specific survival (CSS) as the primary end point, and performed a narrative review and risk of bias assessment.\n Six studies compared outcomes of no LND versus LND. Three studies compared complete LND versus incomplete LND versus no LND. The incidence of pN+ in patients with high-stage (≥pT2) tumours ranged from 14.3% to 40%. Pre- and postoperative characteristics differed among the study groups, potentially biasing the results, as demonstrated by the risk of bias assessment, potentially favouring the LND group. Oncological outcomes such as cancer-specific, overall, recurrence-free, and metastasis-free survival were reviewed, demonstrating a survival benefit with LND in high-stage disease of the renal pelvis.\n Template-based and complete LND improves CSS in patients with high-stage (≥pT2) UTUC and reduces the risk of local recurrence. The impact of LND in ureteral tumours remains uncertain.\n Studies comparing radical nephroureterectomy with or without the removal of nodes (lymph node dissection [LND]) were analysed. LND improves survival in patients with high-stage disease of the renal pelvis, if it is performed according to an anatomical template-based approach.\n Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.\n\nZigeuner, Richard\n\n\n"
},
{
"text": "\n169743\nExploring the surgical landscape of pancreatic neuroendocrine neoplasia in Austria: Results from the ASSO pNEN study group.\n\nPrimavesi, F\n\nKlieser, E\n\nCardini, B\n\nMarsoner, K\n\nFröschl, U\n\nThalhammer, S\n\nFischer, I\n\nHauer, A\n\nUrbas, R\n\nKiesslich, T\n\nNeureiter, D\n\nZitt, M\n\nKlug, R\n\nWundsam, H\n\nSellner, F\n\nKarner, J\n\nFügger, R\n\nCakar-Beck, F\n\nKornprat, P\n\nÖfner, D\n\nStättner, S\n\nASSO pNEN Study Group\n\nBeiträge in Fachzeitschriften\nISI:000458224600018\n30262324.0\n10.1016/j.ejso.2018.08.016\nNone\nPancreatic neuroendocrine neoplasia (pNEN) show increasing incidence and management is complex due to biological heterogeneity. Most publications report isolated high-volume single-centre data. This Austrian multi-centre study on surgical management of pNENs provides a comprehensive real-life picture of quality indicators, recurrence-patterns, survival factors and systemic treatments.\n Retrospective, national cohort-study from 7 medium-/high-volume centres in Austria, coordinated under the auspices of the Austrian Society of Surgical Oncology (ASSO).\n Two-hundred patients underwent resection for pNEN, 177 had non-functioning tumours and 31 showed stage 4 disease. Participating centres were responsible for 2/3 of pNEN resections in Austria within the last years. The mean rate of completeness of variables was 98.6%. Ninety-days mortality was 3.5%, overall rate of complications was 42.5%. Morbidity did not influence long-term survival. The 5-year overall-survival (OS) was 81.3%, 10-year-OS 52.5% and 5-year recurrence-free-survival (RFS) 69.8%. Recurrence was most common in the liver (68.1%). Four out of five patients with recurrence underwent further treatment, most commonly with medical therapy or chemotherapy. Multivariable analysis revealed grading (HR:2.7) and metastasis (HR:2.5) as significant factors for relapse. Tumours-size ≥2 cm (HR:5.9), age ≥60 years (HR:3.1), metastasis (HR:2.3) and grading (HR:2.0) were associated with OS. Tumours <2 cm showed 93.9% 10-year-OS, but 33% had G2/G3 grading, 12.5% positive lymph-nodes and 4.7% metastasis at diagnosis, each associated with significant worse survival.\n Resection of pNENs in Austria is performed with internationally comparable safety. Analysed factors allow for risk-stratification in clinical treatment and future prospective trials. A watch-and-wait strategy purely based on tumour-size cannot be recommended.\n Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.\n\nKornprat, Peter\n\nMarsoner, Katharina\n\n\n"
},
{
"text": "\n174227\nLower plasma insulin levels during overnight closed-loop in school children with type 1 diabetes: Potential advantage? A randomized cross-over trial.\n\nSchierloh, U\n\nWilinska, ME\n\nPit-Ten Cate, IM\n\nBaumann, P\n\nHovorka, R\n\nDe Beaufort, C\n\nSpidiman Study Group: Single Port Insulin Infusion for Improved Diabetes Management\n\nBeiträge in Fachzeitschriften\nISI:000460640900007\n30849076.0\n10.1371/journal.pone.0212013\nPMC6408001\nStudies have shown that overnight closed-loop insulin delivery can improve glucose control and reduce the risk of hypoglycemia and hence may improve metabolic outcomes and reduce burden for children with type 1 diabetes and their families. However, research so far has not reported insulin levels while comparing closed-loop to open-loop insulin delivery in children. Therefore, in this study we obtained glucose levels as well as plasma insulin levels in children with type 1 diabetes to evaluate the efficacy of a model-based closed-loop algorithm compared to an open-loop administration.\n Fifteen children with type 1 diabetes, 6-12 years, participated in this open-label single center study. We used a randomized cross over design in which we compared overnight closed-loop insulin delivery with sensor augmented pump therapy for two nights in both the hospital and at home (i.e., 1 night in-patient stay and at home per treatment condition). Only during the in-patient stay, hourly plasma insulin and blood glucose levels were assessed and are reported in this paper.\n Results of paired sample t-tests revealed that although plasma insulin levels were significantly lower during the closed-loop than in the open-loop (Mean difference 36.51 pmol/l; t(13) = 2.13, p = .03, effect size d = 0.57), blood glucose levels did not vary between conditions (mean difference 0.76 mmol/l; t(13) = 1.24, p = .12, d = 0.37). The administered dose of insulin was significantly lower during the closed-loop compared with the open-loop (mean difference 0.10 UI; t(12) = 2.45, p = .02, d = 0.68).\n Lower insulin doses were delivered in the closed-loop, resulting in lower plasma insulin levels, whereby glucose levels were not affected negatively. This suggests that the closed-loop administration is better targeted and hence could be more effective.\n\nBaumann, Petra Martina\n\nMader, Julia\n\nPieber, Thomas\n\nTreiber, Gerlies\n\n\n"
},
{
"text": "\n176284\nUsing Interleukin 6 and 8 in Blood and Bronchoalveolar Lavage Fluid to Predict Survival in Hematological Malignancy Patients With Suspected Pulmonary Mold Infection.\n\nRawlings, SA\n\nHeldt, S\n\nPrattes, J\n\nEigl, S\n\nJenks, JD\n\nFlick, H\n\nRabensteiner, J\n\nPrüller, F\n\nWölfler, A\n\nNeumeister, P\n\nStrohmaier, H\n\nKrause, R\n\nHoenigl, M\n\nBeiträge in Fachzeitschriften\nISI:000478584300001\n31428097.0\n10.3389/fimmu.2019.01798\nPMC6687868\nBackground: Molds and other pathogens induce elevated levels of several cytokines, including interleukin (IL)-6 and IL-8. The objective of this study was to investigate the prognostic value of IL-6 and IL-8 as well as fungal biomarkers in blood and bronchoalveolar lavage fluid (BAL) for overall survival in patients with underlying hematological malignancies and suspected mold infection. Methods: This cohort study included 106 prospectively enrolled adult cases undergoing bronchoscopy. Blood samples were collected within 24 h of BAL sampling and, in a subset of 62 patients, serial blood samples were collected up until 4 days after bronchoscopy. IL-6, IL-8, and other cytokines as well as galactomannan (GM) and β-D-glucan (BDG) were assayed in blood and BAL fluid and associations with overall mortality were assessed at the end of the study using receiver operating characteristic (ROC) curve analysis. Results: Both blood IL-8 (AUC 0.731) and blood IL-6 (AUC 0.699) as well as BAL IL-6 (AUC 0.763) and BAL IL-8 (AUC 0.700) levels at the time of bronchoscopy were predictors of 30-day all-cause mortality. Increasing blood IL-6 levels between bronchoscopy and day four after bronchoscopy were significantly associated with higher 90-day mortality, with similar findings for increasing IL-8 levels. In ROC analysis the difference of blood IL-8 levels between 4 days after bronchoscopy and the day of bronchoscopy had an AUC of 0.829 (95%CI 0.71-0.95; p < 0.001) for predicting 90-day mortality. Conclusions: Elevated levels of IL-6 and IL-8 in blood or BAL fluid at the time of bronchoscopy, and rising levels in blood 4 days following bronchoscopy were predictive of mortality in these patients with underlying hematological malignancy who underwent bronchoscopy for suspected mold infection.\n\nFlick, Holger\n\nHönigl, Martin\n\nKrause, Robert\n\nNeumeister, Peter\n\nPrattes, Jürgen\n\nPrüller, Florian\n\nRabensteiner, Jasmin\n\nStrohmaier, Heimo\n\nWoelfler, Albert\n\n\n"
},
{
"text": "\n176287\nDissections After Infrainguinal Percutaneous Transluminal Angioplasty: A Systematic Review and Current State of Clinical Evidence.\n\nArmstrong, EJ\n\nBrodmann, M\n\nDeaton, DH\n\nGray, WA\n\nJaff, MR\n\nLichtenberg, M\n\nRundback, JH\n\nSchneider, PA\n\nBeiträge in Fachzeitschriften\nISI:000475502000009\n31204592.0\n10.1177/1526602819855396\nNone\nPurpose: To systematically review the literature and extract information on the definitions, prevalence, implications, and treatment of dissections after infrainguinal balloon angioplasty, with a goal of summarizing current data and identifying gaps in knowledge to help direct future research. Materials and Methods: A systematic review was performed according to the PRISMA guidelines. Medline (PubMed), Scopus, and Cochrane CENTRAL databases were reviewed for prospective and retrospective studies reporting dissection identification, characterization, incidence, severity, and/or outcomes after infrainguinal balloon angioplasty up to January 30, 2019. The electronic search resulted in 288 studies. From these, 153 full-text articles were assessed, and 51 published from 1964 to 2018 were selected as relevant to this systematic review. Because of the significant between-study differences in lesion characteristics, reporting methods, and lack of core laboratory adjudication, the findings were summarized from each study, but the results were not pooled. Results: The mechanism of percutaneous transluminal angioplasty (PTA) consists of adventitial stretching, medial necrosis, and controlled dissection or plaque fracture. PTA-induced dissections can precipitate pathological high and low shear hemodynamic defects and have been implicated as a contributing factor in procedural complications as well as restenosis at the treatment site. The development of significant dissection after PTA often leads to the use of adjunctive therapies, including stent placement. Despite the ubiquitous nature of dissection after balloon angioplasty (incidence 7.4% to 84%), limited data are available to categorize dissections in the peripheral arteries and direct subsequent treatments to improve vessel patency. With the increased utilization of drug-coated balloon angioplasty, understanding the outcomes of postangioplasty dissection has become increasingly important, as the decision to treat dissections with additional strategies has therapeutic and economic implications. Conclusion: All post-PTA dissections in the femoropopliteal arteries may benefit from a treatment approach that ensures optimal hemodynamics with long-term durability in treated lesions. Further understanding the importance of postangioplasty dissections, along with the development of new technologies, will help optimize the patency of endovascular interventions.\n\nBrodmann, Marianne\n\n\n"
},
{
"text": "\n177290\nLigamentous influence in pelvic load distribution.\n\nHammer, N\n\nSteinke, H\n\nLingslebe, U\n\nBechmann, I\n\nJosten, C\n\nSlowik, V\n\nBöhme, J\n\nBeiträge in Fachzeitschriften\nISI:000327430300031\n23755919.0\n10.1016/j.spinee.2013.03.050\nNone\nThe influence of the posterior pelvic ring ligaments on pelvic stability is poorly understood. Low back pain and sacroiliac joint (SIJ) pain are described being related to these ligaments. Computational approaches involving finite element (FE) modeling may aid to determine their influence. Previous FE models lacked in precise ligament geometries and material properties, which might have influence on the results.\n The aim of this study is to investigate ligamentous influence in pelvic stability by means of FE using precise ligament material properties and morphometries.\n An FE model of the pelvis bones was created from computer tomography, including the pubic symphysis joint (PSJ) and the SIJ. Ligament data were used from 55 body donors: anterior (ASL), interosseous (ISL), and posterior (PSL) sacroiliac ligaments; iliolumbar (IL), inguinal (IN), pubic (PL), sacrospinous (SS), and sacrotuberous (ST) ligaments; and obturator membrane (OM). Stress-strain data were gained from iliotibial tract specimens. A vertical load of 600 N was applied. Pelvic motion related to altered ligament and cartilage stiffness was determined in a range of 50% to 200%. Ligament strain was investigated in the standing and sitting positions.\n Tensile and compressive stresses were found at the SIJ and the PSJ. The center of sacral motion was at the level of the second sacral vertebra. At the acetabula and the PSJ, higher ligament and cartilage stiffnesses decrease pelvic motion in the following order: SIJ cartilage>ISL>ST+SS>IL+ASL+PSL. Similar effects were found for the sacrum (SIJ cartilage>ISL>IL+ASL+PSL) but increased ST+SS stiffnesses increased sacral motion. The influence of the IN, OM, and PL was less than 0.1%. Compared with standing, total ligament strain was reduced to 90%. Increased strains were found for the IL, ISL, and PSL.\n Posterior pelvic ring cartilage and ligaments significantly contribute to pelvic stability. Their effects are region- and stiffness dependent. While sitting, load concentrations occur at the IL, ISL, and PSL, which goes in coherence with the clinical findings of these ligaments serving as generators of low back pain.\n Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.\n\nHammer, Niels\n\n\n"
},
{
"text": "\n178647\nRespiratory Syncytial Virus Prophylaxis with Palivizumab 2019 Update of the Recommendations of the Austrian Association of Pediatric and Adolescent Medicine\n\nResch, B\n\nEber, E\n\nEhringer-Schetitska, D\n\nKiechl-Kohlendorfer, U\n\nMichel-Behnke, I\n\nPopow-Kraupp, T\n\nRedlberger-Fritz, M\n\nSeidel, M\n\nStrenger, V\n\nWald, M\n\nZacharasiewicz, A\n\nBerger, A\n\nBeiträge in Fachzeitschriften\nISI:000495927200001\nNone\n10.1007/s00608-019-00725-9\nNone\nDuring a round-table discussion by independent experts the 2008 recommendations for respiratory syncytial virus (RSV) prophylaxis with palivizumab by the Austrian Society of Pediatric and Adolescent Medicine were revised and an update for 2019 was created using the Delphi method. Preterm (PT) infants <= 28 (+6 days) weeks' gestational age (GA) should receive palivizumab for the first season (<9 months of age at the beginning of the season) with cessation at the end of the season. Infants at 29 (+0)-32 (+6) weeks' GA receive palivizumab for a first season (<6 months of age) if there is a positive RSV risk score of at least 4 points; and infants 33 (+0) to 35 (+6) weeks' GA (<3 months of age at the beginning of the season) for the first season if there is a positive RSV risk score of at least 4 points. Infants with bronchopulmonary dysplasia (BPD; oxygen requirement or need for ventilator support at 36 weeks' GA) should receive palivizumab for the first season, and in the case of BPD requiring treatment in the second year of life, also for a second season. All children with hemodynamically significant congenital heart disease (CHD) receive palivizumab prophylaxis for the first season, and only after discussion of the individual cases (partially corrected CHD or heart transplant), for a second season. Beyond the regulations, the experts recommend palivizumab for pulmonary indications, neuromuscular impairment, Down syndrome, immune deficiency syndromes, and severe immune suppression for the first RSV season. Palivizumab is given intramuscularly at a dosage of 15 & x202f;mg/kg a maximum of five times from the middle to end of November until March at intervals of 28 to 30 days. Common colds are not a contraindication to immunization. Palivizumab does not suppress the immune response following active immunization either.\n\nEber, Ernst\n\nResch, Bernhard\n\nSeidel, Markus\n\nStrenger, Volker\n\n\n"
},
{
"text": "\n184291\nPROVIT: Supplementary Probiotic Treatment and Vitamin B7 in Depression-A Randomized Controlled Trial.\n\nReininghaus, EZ\n\nPlatzer, M\n\nKohlhammer-Dohr, A\n\nHamm, C\n\nMörkl, S\n\nBengesser, SA\n\nFellendorf, FT\n\nLahousen-Luxenberger, T\n\nLeitner-Afschar, B\n\nSchöggl, H\n\nAmberger-Otti, D\n\nWurm, W\n\nQueissner, R\n\nBirner, A\n\nFalzberger, VS\n\nPainold, A\n\nFitz, W\n\nWagner-Skacel, J\n\nBrunnmayr, M\n\nRieger, A\n\nMaget, A\n\nUnterweger, R\n\nSchwalsberger, K\n\nReininghaus, B\n\nLenger, M\n\nBastiaanssen, TFS\n\nDalkner, N\n\nBeiträge in Fachzeitschriften\nISI:000593839100001\n33171595.0\n10.3390/nu12113422\nPMC7695208\nGut microbiota are suspected to affect brain functions and behavior as well as lowering inflammation status. Therefore, an effect on depression has already been suggested by recent research. The aim of this randomized double-blind controlled trial was to evaluate the effect of probiotic treatment in depressed individuals. Within inpatient care, 82 currently depressed individuals were randomly assigned to either receive a multistrain probiotic plus biotin treatment or biotin plus placebo for 28 days. Clinical symptoms as well as gut microbiome were analyzed at the begin of the study, after one and after four weeks. After 16S rRNA analysis, microbiome samples were bioinformatically explored using QIIME, SPSS, R and Piphillin. Both groups improved significantly regarding psychiatric symptoms. Ruminococcus gauvreauii and Coprococcus 3 were more abundant and β-diversity was higher in the probiotics group after 28 days. KEGG-analysis showed elevated inflammation-regulatory and metabolic pathways in the intervention group. The elevated abundance of potentially beneficial bacteria after probiotic treatment allows speculations on the functionality of probiotic treatment in depressed individuals. Furthermore, the finding of upregulated vitamin B6 and B7 synthesis underlines the connection between the quality of diet, gut microbiota and mental health through the regulation of metabolic functions, anti-inflammatory and anti-apoptotic properties. Concluding, four-week probiotic plus biotin supplementation, in inpatient individuals with a major depressive disorder diagnosis, showed an overall beneficial effect of clinical treatment. However, probiotic intervention compared to placebo only differed in microbial diversity profile, not in clinical outcome measures.\n\nBengesser, Susanne\n\nBirner, Armin\n\nDalkner, Nina\n\nFellendorf, Frederike\n\nFitz, Werner\n\nHamm, Carlo\n\nKohlhammer-Dohr, Alexandra\n\nLahousen-Luxenberger, Theresa\n\nLenger, Melanie\n\nMaget, Alexander\n\nMörkl, Sabrina\n\nPainold, Annamaria\n\nPlatzer, Martina\n\nQueissner, Robert\n\nReininghaus, Eva\n\nRieger, Alexandra\n\nUnterweger, Renate\n\nWagner-Skacel, Jolana\n\nWurm, Walter Ernst\n\n\n"
},
{
"text": "\n185021\nQuantitative analysis of dynamic computed tomography angiography for the detection of endoleaks after abdominal aorta aneurysm endovascular repair: A feasibility study.\n\nApfaltrer, G\n\nLavra, F\n\nSchoepf, UJ\n\nScarabello, M\n\nYamada, R\n\nvan Assen, M\n\nVarga-Szemes, A\n\nJacobs, BE\n\nBauer, MJ\n\nGreenberg, WT\n\nGuimaraes, M\n\nSaba, L\n\nDe Cecco, CN\n\nBeiträge in Fachzeitschriften\nISI:000608044300098\n33411747.0\n10.1371/journal.pone.0245134\nPMC7790279\nTo assess the feasibility of quantitative analysis of dynamic computed tomography angiography (dCTA) for the detection of endoleaks in patients who underwent endovascular repair of abdominal aortic aneurysms (EVAR).\n Twenty patients scheduled for contrast-enhanced CT angiography (CTA) of the abdominal aorta post-EVAR were prospectively enrolled. All patients received a standard triphasic CTA protocol, followed by an additional dCTA. The dCTA acquisition enabled reconstruction of color-coded maps depicting blood perfusion and a dCTA dataset of the aneurysm sac. Observers assessed the dCTA and dynamic CT perfusion (dCTP) images for the detection of endoleaks, establishing diagnostic confidence based on a modified 5-point Likert scale. An index was calculated for the ratio between the endoleak and aneurysm sac using blood flow for dCTP and Hounsfield units (HU) for dCTA. The Wilcoxon test compared the endoleak index and the diagnostic confidence of the observers.\n In total, 19 patients (18 males, median age 74 years [70.5-75.7]) were included for analysis. Nine endoleaks were detected in 7 patients using triphasic CTA as the reference standard. There was complete agreement for endoleak detection between the two techniques on a per-patient basis. Both dCTA and dCTP identified an additional endoleak in one patient. The diagnostic confidence using dCTP for detection of endoleaks was not significantly superior to dCTA (5.0 [5-5] vs. 4.5 [4-5], respectively; p = 0.11); however, dCTP demonstrated superior diagnostic confidence for endoleak exclusion compared to dCTA (1.0 [1-1] vs 1.5 [1.5-1.5], respectively; p <0.01). Moreover, the dCTP endoleak index was significantly higher than the dCTA index (18.5 [10.8-20.5] vs. 3.5 [5-2.7], respectively; p = 0.02).\n Quantitative analysis of dCTP imaging can aid in the detection of endoleaks and demonstrates a higher endoleak detection rate than triphasic CTA, as well as a strong correlation with visual assessment of dCTA images.\n\nApfaltrer, Georg\n\n\n"
},
{
"text": "\n187019\nExtent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin adjustments in individuals with type 1 diabetes.\n\nMcCarthy, O\n\nDeere, R\n\nChurm, R\n\nDunseath, GJ\n\nJones, C\n\nEckstein, ML\n\nWilliams, DM\n\nHayes, J\n\nPitt, J\n\nBain, SC\n\nMoser, O\n\nBracken, RM\n\nBeiträge in Fachzeitschriften\nISI:000613804800028\n33012641.0\n10.1016/j.numecd.2020.07.043\nNone\nTo detail the extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin dose adjustments in individuals with type 1 diabetes (T1D) using multiple daily injections of insulins aspart (IAsp) and degludec (IDeg).\n Sixteen individuals with T1D, completed a single-centred, randomised, four-period crossover trial consisting of 23-h inpatient phases. Participants administered either a regular (100%) or reduced (50%) dose (100%; 5.1 ± 2.4, 50%; 2.6 ± 1.2 IU, p < 0.001) of individualised IAsp 1 h before and after 45-min of evening exercise at 60 ± 6% V̇O2max. An unaltered dose of IDeg was administered in the morning. Metabolic, physiological and hormonal responses during exercise, recovery and nocturnal periods were characterised. The primary outcome was the number of trial day occurrences of hypoglycemia (venous blood glucose ≤ 3.9 mmol L -1). Inclusion of a 50% IAsp dose reduction strategy prior to evening exercise reduced the occurrence of in-exercise hypoglycemia (p = 0.023). Mimicking this reductive strategy in the post-exercise period decreased risk of nocturnal hypoglycemia (p = 0.045). Combining this strategy to reflect reductions either side of exercise resulted in higher glucose concentrations in the acute post-exercise (p = 0.034), nocturnal (p = 0.001), and overall (p < 0.001) periods. Depth of hypoglycemia (p = 0.302), as well as ketonic and counter-regulatory hormonal profiles were similar.\n These findings demonstrate the glycemic safety of peri-exercise bolus dose reduction strategies in minimising the prevalence of acute and nocturnal hypoglycemia following evening exercise in people with T1D on MDI. Use of newer background insulins with current bolus insulins demonstrates efficacy and advances current recommendations for safe performance of exercise.\n DRKS00013509.\n Copyright © 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.\n\nMoser, Othmar\n\n\n"
},
{
"text": "\n4525\nABCA1 and scavenger receptor class B, type I, are modulators of reverse sterol transport at an in vitro blood-brain barrier constituted of porcine brain capillary endothelial cells.\n\nPanzenboeck, U\n\nBalazs, Z\n\nSovic, A\n\nHrzenjak, A\n\nLevak-Frank, S\n\nWintersperger, A\n\nMalle, E\n\nSattler, W\n\nBeiträge in Fachzeitschriften\nISI:000179081200048\n12202492.0\n10.1074/jbc.M207601200\nNone\nThe objective of the present study was to investigate the involvement of key players in reverse cholesterol/24(S)OH-cholesterol transport in primary porcine brain capillary endothelial cells (pBCEC) that constitute the BBB. We identified that, in addition to scavenger receptor class B, type I (SR-BI), pBCEC express ABCA1 and apolipoprotein A-I (apoA-I) mRNA and protein. Studies on the regulation of ABCA1 by the liver X receptor agonist 24(S)OH-cholesterol revealed increased ABCA1 expression and apoA-I-dependent [3H]cholesterol efflux from pBCEC. In unpolarized pBCEC, high density lipoprotein, subclass 3 (HDL3)-dependent [3H]cholesterol efflux, was unaffected by 24(S)OH-cholesterol treatment but was enhanced 5-fold in SR-BI overexpressing pBCEC. Efflux of cellular 24(S)-[3H]OH-cholesterol was highly efficient, independent of ABCA1, and correlated with SR-BI expression. Polarized pBCEC were cultured on porous membrane filters that allow separate access to the apical and the basolateral compartment. Addition of cholesterol acceptors to the apical compartment resulted in preferential [3H]cholesterol efflux to the basolateral compartment. HDL3 was a better promoter of basolateral [3H]cholesterol efflux than lipid-free apoA-I. Basolateral pretreatment with 24(S)OH-cholesterol enhanced apoA-I-dependent basolateral cholesterol efflux up to 2-fold along with the induction of ABCA1 at the basolateral membrane. Secretion of apoA-I also occurred preferentially to the basolateral compartment, where the majority of apoA-I was recovered in an HDL-like density range. In contrast, 24(S)-[3H]OH-cholesterol was mobilized efficiently to the apical compartment of the in vitro BBB by HDL3, low density lipoprotein, and serum. These results suggest the existence of an autoregulatory mechanism for removal of potentially neurotoxic 24(S)OH-cholesterol. In conclusion, the apoA-I/ABCA1- and HDL/SR-BI-dependent pathways modulate polarized sterol mobilization at the BBB.\n\nHrzenjak, Andelko\n\nLevak, Sanja\n\nMalle, Ernst\n\nSattler, Wolfgang\n\nWintersperger, Andrea\n\n\n"
},
{
"text": "\n9079\nModulation of cardiac impulse generation and conduction by nifedipine and verapamil analyzed by a refined surface ECG technique in Langendorff perfused guinea pig hearts.\n\nStark, G\n\nStark, U\n\nTritthart, HA\n\nBeiträge in Fachzeitschriften\nISI:A1988N277100011\n3395317.0\n10.1007/BF01907274\nNone\nUsing a modified Langendorff system, a special ECG recording technique and appropriate placement of two silver wire electrodes, early atrial and His bundle activity can be detected continuously from the surface of intact and spontaneously beating guinea pig hearts. This new method was applied to measure the direct and inhibitory effects of nifedipine and verapamil on impulse generation and conduction in isolated and perfused guinea pig hearts. Depression of sinoatrial conduction was the most prominent effect of nifedipine. In all concentrations applied (10(-7) M, 10(-6) M, 10(-5) M) nifedipine predominantly led to sinoatrial blocks of different degrees. Heart rate decreased slightly in a dose-dependent manner. PQ and HV duration remained essentially constant. In the highest concentration of nifedipine (10-5) M), sinus node activity was so depressed that AV dissociation or ventricular rhythm developed. Only in one out of eight experiments with cumulative increase of nifedipine concentrations to 10(-5) M was the AV node affected by nifedipine and a second-degree AV block developed (10(-6) M). Verapamil's inhibitory effects on the rate of impulse initiation in the sinus node were more pronounced than those of nifedipine, but the inhibition of sinoatrial conduction by verapamil was less marked. At 10(-6) M verapamil, the incidence of sinoatrial blocks and of ventricular rhythm was similar to the incidence of first degree AV blocks. PQ time (+14%) but also HV time (+12%) were prolonged under the influence of this concentration of verapamil. At the highest concentration of verapamil (10(-5) M) applied for 10 min, ventricular rhythm developed in five out of eight experiments, as well as one second and two third-degree AV blocks. The results confirm that the simultaneous measurements of sinus node activity of sinoatrial and atrioventricular conduction and of HV duration is feasible with this ECG technique, to evaluate the inhibitory effects of Ca-antagonists on sinus and AV node activity in the intact heart.\n\nTritthart, Helmut\n\n\n"
}
]
}