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"text": "\n67759\nPathologic complete response with six compared with three cycles of neoadjuvant epirubicin plus docetaxel and granulocyte colony-stimulating factor in operable breast cancer: results of ABCSG-14.\n\nSteger, GG\n\nGalid, A\n\nGnant, M\n\nMlineritsch, B\n\nLang, A\n\nTausch, C\n\nRudas, M\n\nGreil, R\n\nWenzel, C\n\nSinger, CF\n\nHaid, A\n\nPostlberger, S\n\nSamonigg, H\n\nLuschin-Ebengreuth, G\n\nKwasny, W\n\nKlug, E\n\nKubista, E\n\nMenzel, C\n\nJakesz, R\n\nBeiträge in Fachzeitschriften\nISI:000246804200013\n17513805.0\n10.1200/JCO.2006.09.1777\nNone\nPURPOSE: Preoperative (neoadjuvant) chemotherapy for operable breast cancer downstages tumors initially not suitable for breast-conserving surgery. A pathologic complete response (pCR) to neoadjuvant chemotherapy may be a surrogate for longer overall survival, but this beneficial effect remains to be established. This phase III trial evaluated whether doubling the number of cycles of neoadjuvant treatment increased the pCR rate. PATIENTS AND METHODS: Patients with biopsy-proven breast cancer (T1-4a-c, N+/-, M0; stage I to III) were eligible and randomly assigned to either three or six cycles of epirubicin 75 mg/m2 and docetaxel 75 mg/m2 on day 1 and granulocyte colony-stimulating factor on days 3 through 10 (ED+G), every 21 days. The primary end point was the pCR rate of the breast tumor. Secondary end points were pathologic nodal status after surgery and the rate of breast-conserving surgery. RESULTS: A total of 292 patients were accrued, and 288 patients were assessable for efficacy and safety. Groups were well balanced for known prognostic factors. Six cycles of ED+G, compared with three cycles, resulted in a significantly higher pCR rate (18.6% v 7.7%, respectively; P = .0045), a higher percentage of patients with negative axillary status (56.6% v 42.8%, respectively; P = .02), and a trend towards more breast-conserving surgery (75.9% v 66.9%, respectively; P = .10). Rates of adverse events were similar, and no patients died on treatment. CONCLUSION: Doubling the number of neoadjuvant ED+G cycles from three to six results in higher rates of pCR and negative axillary nodal status with no excess of adverse effects. Thus, six cycles of ED+G should be the standard neoadjuvant treatment for operable breast cancer if this combination is chosen.\n\nLuschin-Ebengreuth, Gero\n\nSamonigg, Hellmut\n\n\n"
},
{
"text": "\n86475\nAdverse Events, Quality of Life, and Recurrence Rates after Laparoscopic Adhesiolysis and Recurrent Incisional Hernia Mesh Repair in Patients with Previous Failed Repairs\n\nUranues, S\n\nSalehi, B\n\nBergamaschi, R\n\nBeiträge in Fachzeitschriften\nISI:000260921700006\n18954777.0\n10.1016/j.jamcollsurg.2008.06.330\nNone\nBACKGROUND: The aim of this study was to determine the impact of laparoscopic adhesiolysis and mesh repair on adverse event rates, quality-of-life (QoL) scores, and recurrence rates in patients with recurrent incisional hernia after failed repairs after multiple laparotomies. STUDY DESIGN: Data on consecutive patients were included prospectively. Recurrent incisional hernia was defined as a fascia defect > 5 cm. Adhesions were classified according to time needed for lysis. A standardized repair with IP polytetrafluoroethylene mesh, transabdominal sutures, and tacks was developed by the surgeons during a pretrial routine. QoL was assessed by the Gastrointestinal Quality of Life Index (GIQLI) before operation and at 24-month followup. Values are median (range). RESULTS: There were 85 consecutive patients aged 55 years (range 29 to 93 years); 45% were men; body mass index, 31 (range 23 to 39); American Society of Anesthesiologists grade I: 27%, II: 70%, III: 2%; comorbidity, 75%; previous laparotomies; 5 (range 2 to 18); previous colectomy, 87%; previous failed repairs, 4 (range 2 to 15); previous mesh repair, 98%; and midline hernia site, 98%. Fascia defect was 255 cm(2) (range 48 to 416 cm(2)), mesh size, 600 cm(2) (range 285 to 884 cm(2)), and operating time 145 minutes (80 to 210 minutes). There was one conversion. Length of stay was 2 days (1 to 9 days). A 15.2% adverse event rate included 1% port-site cellulitis, 7% seroma, and 7% persistent pain. Hernia recurrence rate was 3.5% at 41-month (range 24 to 61 months) followup. GIQLI total scores were significantly improved at followup (98 versus 116; p < 0.001). Domain GIQLI scores were improved at followup for symptoms (54 versus 63; p < 0.001), emotional function (12 versus 16; p < 0.001), and physical function (15 versus 21; p < 0.001). CONCLUSIONS: Laparoscopic adhesiolysis and recurrent hernia mesh repair resulted in a low rate of adverse events, a substantially improved health-related QoL, and a risk of recurrence similar to the rates associated with first-time hernia repair.\n\nUranüs, Selman\n\n\n"
},
{
"text": "\n130817\nBody composition in sport: a comparison of a novel ultrasound imaging technique to measure subcutaneous fat tissue compared with skinfold measurement.\n\nMüller, W\n\nHorn, M\n\nFürhapter-Rieger, A\n\nKainz, P\n\nKröpfl, JM\n\nMaughan, RJ\n\nAhammer, H\n\nBeiträge in Fachzeitschriften\nISI:000325530900005\n24055780.0\n10.1136/bjsports-2013-092232\nNone\nExtremely low weight and rapid changes in weight and body composition have become major concerns in many sports, but sufficiently accurate field methods for body composition assessment in athletes are missing. This study aimed to explore the use of ultrasound methods for assessment of body fat content in athletes.\n 19 female athletes (stature: 1.67(± 0.06) m, weight: 59.6(± 7.6) kg; age: 19.5(± 3.3) years) were investigated by three observers using a novel ultrasound method for thickness measurement of uncompressed subcutaneous adipose tissue and of embedded structures. Two observers also measured skinfold thickness at eight International Society for the Advancement of Kinanthrometry (ISAK) sites; mean skinfold values were compared to mean subcutaneous adipose tissue thicknesses measured by ultrasound. Interobserver reliability of imaging and evaluation obtained by this ultrasound technique: intraclass correlation coefficient ICC=0.968 (95% CI 0.957 to 0.977); evaluation of given images: ICC=0.997 (0.993 to 0.999).\n Skinfold compared to ultrasound thickness showed that compressibility of subcutaneous adipose tissue depends largely on the site and the person: regression slopes ranged from 0.61 (biceps) to 1.59 (thigh) and CIs were large. Limits of agreement ranged from 2.6 to 8.6 mm. Regression lines did not intercept the skinfold axis at zero because of the skin thickness being included in the skinfold. The four ISAK trunk sites caused ultrasound imaging problems in 13 of 152 sites (8 ISAK sites, 19 athletes).\n The ultrasound method allows measurement of uncompressed subcutaneous adipose tissue thickness with an accuracy of 0.1-0.5 mm, depending on the probe frequency. Compressibility of the skinfold depends on the anatomical site, and skin thickness varies by a factor of two. This inevitably limits the skinfold methods for body fat estimation. Ultrasound accuracy for subcutaneous adipose tissue measurement is limited by the plasticity of fat and furrowed tissue borders. Comparative US measurements show that skinfold measurements do not allow accurate assessment of subcutaneous adipose tissue thickness.\n\nAhammer, Helmut\n\nFürhapter-Rieger, Alfred\n\nMüller, Wolfram\n\n\n"
},
{
"text": "\n142877\nNitrofen interferes with trophoblastic expression of retinol-binding protein and transthyretin during lung morphogenesis in the nitrofen-induced congenital diaphragmatic hernia model.\n\nKutasy, B\n\nGosemann, JH\n\nDoi, T\n\nFujiwara, N\n\nFriedmacher, F\n\nPuri, P\n\nBeiträge in Fachzeitschriften\nISI:000300679700006\n22015466.0\n10.1007/s00383-011-2995-0\nNone\nRetinoids play a key role in lung development. Retinoid signaling pathway has been shown to be disrupted in the nitrofen model of congenital diaphragmatic hernia (CDH) but the exact mechanism is not clearly understood. Retinol-binding protein (RBP) and transthyretin (TTR) are transport proteins for delivery of retinol to the tissues via circulation. Previous studies have shown that pulmonary retinol levels are decreased during lung morphogenesis in the nitrofen CDH model. In human newborns with CDH, both retinol and RBP levels are decreased. It has been reported that maternal RBP does not cross the placenta and the fetus produces its own RBP by trophoblast. RBP and TTR synthesized in the fetus are essential for retinol transport to the developing organs including lung morphogenesis. We hypothesized that nitrofen interferes with the trophoblastic expression of RBP and TTR during lung morphogenesis and designed this study to examine the trophoblastic expression of RBP and TTR, and the total level of RBP and TTR in the lung in the nitrofen model of CDH.\n Pregnant rats were exposed to either olive oil or nitrofen on day 9 of gestation (D9). Fetal lungs and placenta harvested on D21 and divided into two groups: control (n = 8) and nitrofen with CDH (n = 8). Total lung RBP and TTR levels using protein extraction were compared with enzyme linked immunoassay (ELISA). Immunohistochemistry was performed to evaluate trophoblastic RBP and TTR expression.\n Total protein levels of lung RBP and TTR were significantly lower in CDH (0.26 ± 0.003 and 6.4 ± 0.5 μg/mL) compared with controls (0.4 ± 0.001 and 9.9 ± 1.6 μg/mL, p < 0.05). In the control group, immunohistochemical staining showed strong immunoreactivity of RBP and TTR in the trophoblast compared to CDH group.\n Decreased trophoblast expression of retinol transport proteins suggest that nitrofen may interfere with the fetal retinol transport resulting in reduced pulmonary RBP and TTR levels and causing pulmonary hypoplasia in CDH.\n\n\n"
},
{
"text": "\n144779\nEpidemiology of congenital diaphragmatic hernia in Europe: a register-based study.\n\nMcGivern, MR\n\nBest, KE\n\nRankin, J\n\nWellesley, D\n\nGreenlees, R\n\nAddor, MC\n\nArriola, L\n\nde Walle, H\n\nBarisic, I\n\nBeres, J\n\nBianchi, F\n\nCalzolari, E\n\nDoray, B\n\nDraper, ES\n\nGarne, E\n\nGatt, M\n\nHaeusler, M\n\nKhoshnood, B\n\nKlungsoyr, K\n\nLatos-Bielenska, A\n\nO'Mahony, M\n\nBraz, P\n\nMcDonnell, B\n\nMullaney, C\n\nNelen, V\n\nQueisser-Luft, A\n\nRandrianaivo, H\n\nRissmann, A\n\nRounding, C\n\nSipek, A\n\nThompson, R\n\nTucker, D\n\nWertelecki, W\n\nMartos, C\n\nBeiträge in Fachzeitschriften\nISI:000350491900012\n25411443.0\n10.1136/archdischild-2014-306174\nNone\nPublished prevalence rates of congenital diaphragmatic hernia (CDH) vary. This study aims to describe the epidemiology of CDH using data from high-quality, population-based registers belonging to the European Surveillance of Congenital Anomalies (EUROCAT).\n Cases of CDH delivered between 1980 and 2009 notified to 31 EUROCAT registers formed the population-based case series. Prevalence over time was estimated using multilevel Poisson regression, and heterogeneity between registers was evaluated from the random component of the intercept.\n There were 3373 CDH cases reported among 12 155 491 registered births. Of 3131 singleton cases, 353 (10.4%) were associated with a chromosomal anomaly, genetic syndrome or microdeletion, 784 (28.2%) were associated with other major structural anomalies. The male to female ratio of CDH cases overall was 1:0.69. Total prevalence was 2.3 (95% CI 2.2 to 2.4) per 10 000 births and 1.6 (95% CI 1.6 to 1.7) for isolated CDH cases. There was a small but significant increase (relative risk (per year)=1.01, 95% credible interval 1.00-1.01; p=0.030) in the prevalence of total CDH over time but there was no significant increase for isolated cases (ie, CDH cases that did not occur with any other congenital anomaly). There was significant variation in total and isolated CDH prevalence between registers. The proportion of cases that survived to 1 week was 69.3% (1392 cases) for total CDH cases and 72.7% (1107) for isolated cases.\n This large population-based study found an increase in total CDH prevalence over time. CDH prevalence also varied significantly according to geographical location. No significant association was found with maternal age.\n Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.\n\n\n"
},
{
"text": "\n147090\nImpact of Maternal Country of Birth on Type-1-Diabetes Therapy and Outcome in 27,643 Children and Adolescents from the DPV Registry.\n\nScheuing, N\n\nWiegand, S\n\nBächle, C\n\nFröhlich-Reiterer, E\n\nHahn, E\n\nIcks, A\n\nLudwig, KH\n\nMönkemöller, K\n\nRazum, O\n\nRosenbauer, J\n\nHoll, RW\n\nDPV initiative\n\nBeiträge in Fachzeitschriften\nISI:000359926900018\n26295472.0\n10.1371/journal.pone.0135178\nPMC4546611\nTo study the impact of maternal country of birth on type-1-diabetes (T1D) therapy and outcome.\n 27, 43 T1D patients aged ≤20 years with documented maternal country of birth from the multicenter German/Austrian diabetes patient registry (DPV) were analyzed. Patients were categorized based on their mother's origin: Germany/Austria (reference), Turkey, Southern Europe, and Eastern Europe. To compare BMI standard deviation score (BMI-SDS), diabetes therapy and outcome between groups, multivariable regression was applied with adjustments for age, sex and duration of diabetes. Based on observed marginal frequencies, adjusted estimates were calculated. Linear regression was used for continuous data, logistic regression for binary data and Poisson regression for count data. All statistical analyses were performed using SAS 9.4. Significance was set at a two-tailed p<0.05.\n 83.3% of patients were offspring of native mothers. A Turkish, Southern or Eastern European background was documented in 2.4%, 1.7% and 4.3% of individuals. After demographic adjustment, patients with migration background had a higher mean BMI-SDS (Turkey, Southern Europe or Eastern Europe vs. Germany/Austria: 0.58±0.03, 0.40±0.04, or 0.37±0.02 vs. 0.31±0.01; ±SE) and a lower use of insulin pumps (26.8%, 27.9%, or 32.6% vs. 37.9%) compared to offspring of native mothers. Mean HbA1c was worst in individuals of Turkish mothers (Turkey vs. Germany/Austria: 69.7±0.7 vs. 66.6±0.1 mmol/mol; ±SE). Patients of Eastern European descent had an increased rate of severe hypoglycemia (22.09±0.13 vs. 16.13±0.02 events per 100 patient-years) and ketoacidosis was more prevalent in offspring of Turkish or Southern European mothers (7.50±0.10, or 7.13±0.11 vs. 6.54±0.02 events per 100 patient-years). Patients of Turkish descent were more often hospitalized (57.2±2.7 vs. 48.5±0.4 per 100 patient-years). All differences were significant.\n The differences in diabetes therapy and outcome among patients with distinct migration background suggest that specific challenges have to be considered in clinical care.\n\nFröhlich-Reiterer, Elke\n\n\n"
},
{
"text": "\n150544\nSimvastatin Efficiently Lowers Small LDL-IgG Immune Complex Levels: A Therapeutic Quality beyond the Lipid-Lowering Effect.\n\nHörl, G\n\nFroehlich, H\n\nFerstl, U\n\nLedinski, G\n\nBinder, J\n\nCvirn, G\n\nStojakovic, T\n\nTrauner, M\n\nKoidl, C\n\nTafeit, E\n\nAmrein, K\n\nScharnagl, H\n\nJürgens, G\n\nHallström, S\n\nBeiträge in Fachzeitschriften\nISI:000369550200098\n26840480.0\n10.1371/journal.pone.0148210\nPMC4739583\nWe investigated a polyethylene glycol non-precipitable low-density lipoprotein (LDL) subfraction targeted by IgG and the influence of statin therapy on plasma levels of these small LDL-IgG-immune complexes (LDL-IgG-IC). LDL-subfractions were isolated from 6 atherosclerotic subjects and 3 healthy individuals utilizing iodixanol density gradient ultracentrifugation. Cholesterol, apoB and malondialdehyde (MDA) levels were determined in each fraction by enzymatic testing, dissociation-enhanced lanthanide fluorescence immunoassay and high-performance liquid chromatography, respectively. The levels of LDL-IgG-IC were quantified densitometrically following lipid electrophoresis, particle size distribution was assessed with dynamic light scattering and size exclusion chromatography. The influence of simvastatin (40 mg/day for three months) on small LDL-IgG-IC levels and their distribution among LDL-subfractions (salt gradient separation) were investigated in 11 patients with confirmed coronary artery disease (CAD). We demonstrate that the investigated LDL-IgG-IC are small particles present in atherosclerotic patients and healthy subjects. In vitro assembly of LDL-IgG-IC resulted in particle density shifts indicating a composition of one single molecule of IgG per LDL particle. Normalization on cholesterol levels revealed MDA values twice as high for LDL-subfractions rich in small LDL-IgG-IC if compared to dominant LDL-subfractions. Reactivity of affinity purified small LDL-IgG-IC to monoclonal antibody OB/04 indicates a high degree of modified apoB and oxidative modification. Simvastatin therapy studied in the CAD patients significantly lowered LDL levels and to an even higher extent, small LDL-IgG-IC levels without affecting their distribution. In conclusion simvastatin lowers levels of small LDL-IgG-IC more effectively than LDL-cholesterol and LDL-apoB levels in atherosclerotic patients. This antiatherogenic effect may additionally contribute to the known beneficial effects of this drug in the treatment of atherosclerosis.\n\nAmrein, Karin\n\nBinder, Josepha Stephanie\n\nCvirn, Gerhard\n\nFerstl, Ulrika\n\nHallström, Seth\n\nHörl, Gerd\n\nJürgens, Günther\n\nKoidl, Christoph\n\nLedinski, Gerhard\n\nScharnagl, Hubert\n\nTafeit, Erwin\n\n\n"
},
{
"text": "\n150585\n9B.05: ASSOCIATION OF PLASMA PARATHYROID HORMONE WITH NIGHTTIME BLOOD PRESSURE IN PRIMARY HYPERPARATHYROIDISM-THE "EPLERENONE IN PRIMARY HYPERPARATHYROIDISM" TRIAL.\n\nVerheyen, N\n\nWetzel, J\n\nMartensen, J\n\nBelyavskiy, E\n\nSchmidt, A\n\nColantonio, C\n\nCatena, C\n\nGaksch, M\n\nGrübler, MR\n\nKraigher-Krainer, E\n\nPieske, B\n\nMeinitzer, A\n\nRus-Machan, J\n\nFahrleitner-Pammer, A\n\nPilz, S\n\nTomaschitz, A\n\nPublizierte (zitierfähige) Beiträge für wissenschaftliche Veranstaltungen\nISI:000440358700328\n26102713.0\n10.1097/01.hjh.0000467677.24307.ad\nNone\nHigh parathyroid hormone (PTH) is a cardiovascular risk factor. Elevated plasma PTH levels are independently linked with high nighttime blood pressure (BP) in hypertensive patients. We therefore investigated the association between PTH and nighttime BP in patients with primary hyperparathyroidism (pHPT).\n We analyzed patients with pHPT who participated in the "Eplerenone in Primary Hyperparathyroidism" (EPATH) Trial. Blood sampling was performed after an overnight fast and all laboratory parameters were determined immediately after blood sampling. 24-hour ambulatory BP monitoring was performed using a certified device (Mobil-O-Graph, I.E.M., Stolberg, Germany). Patients with regular use of the PTH modifying drug cinacalcet or with a reduced left ventricular ejection fraction <= 45% were excluded.\n We enrolled 120 patients (mean age: 66 +/- 10 years, 98 were females [82%]). Median PTH (IQR) was 94 pg/mL (79 - 113), mean systolic and diastolic nighttime BP were 117 +/- 17 mmHg and 68 +/- 10 mmHg, respectively. PTH was directly correlated with mean systolic and mean diastolic nighttime BP (Spearman rho = 0.246, p = 0.007; rho = 0.214, p = 0.019, respectively). In multivariate linear regression analyses adjusted for age, sex, cholesterol, HbA1c, intake of antihypertensive drugs, 25-hydroxy vitamin D and glomerular filtration rate (CKDEPI), PTH remained significantly related to mean systolic nighttime BP (adjusted beta-coefficient = 0.194, p = 0.047), while the relationship with mean diastolic nighttime BP was not significant (beta = 0.260, p = 0.109).\n Plasma PTH was associated with mean systolic nighttime BP in patients with pHPT, independently of potential confounders. These novel data from the EPATH Trial further support the notion that PTH directly interferes with nighttime BP regulation. Whether lowering circulating PTH concentrations reduces the burden of high BP remains to be shown in future studies.\n\nColantonio, Caterina\n\nFahrleitner-Pammer, Astrid\n\nMartensen, Johann\n\nMeinitzer, Andreas\n\nPilz, Stefan\n\nSchmidt, Albrecht\n\nVerheyen, Nicolas Dominik\n\n\n"
},
{
"text": "\n155979\nThe vital threat of an upper gastrointestinal bleeding: Risk factor analysis of 121 consecutive patients.\n\nSchemmer, P\n\nDecker, F\n\nDei-Anane, G\n\nHenschel, V\n\nBuhl, K\n\nHerfarth, C\n\nRiedl, S\n\nBeiträge in Fachzeitschriften\nISI:000239997400017\n16773718.0\n10.3748/wjg.v12.i22.3597\nPMC4087577\nTo analyze the importance in predicting patients risk of mortality due to upper gastrointestinal (UGI) bleeding under today's therapeutic regimen.\n From 1998 to 2001, 121 patients with the diagnosis of UGI bleeding were treated in our hospital. Based on the patients' data, a retrospective multivariate data analysis with initially more than 270 single factors was performed. Subsequently, the following potential risk factors underwent a logistic regression analysis: age, gender, initial hemoglobin, coumarines, liver cirrhosis, prothrombin time (PT), gastric ulcer (small curvature), duodenal ulcer (bulbus back wall), Forrest classification, vascular stump, variceal bleeding, Mallory-Weiss syndrome, RBC substitution, recurrent bleeding, conservative and surgical therapy.\n Seventy male (58%) and 51 female (42%) patients with a median age of 70 (range: 21-96) years were treated. Their in-hospital mortality was 14%. While 12% (11/91) of the patients died after conservative therapy, 20% (6/30) died after undergoing surgical therapy. UGI bleeding occurred due to duodenal ulcer (n = 36; 30%), gastric ulcer (n = 35; 29%), esophageal varicosis (n = 12; 10%), Mallory-Weiss syndrome (n = 8; 7%), erosive lesions of the mucosa (n = 20; 17%), cancer (n = 5; 4%), coagulopathy (n = 4; 3%), lymphoma (n = 2; 2%), benign tumor (n = 2; 2%) and unknown reason (n = 1; 1%). A logistic regression analysis of all aforementioned factors revealed that liver cirrhosis and duodenal ulcer (bulbus back wall) were associated risk factors for a fatal course after UGI bleeding. Prior to endoscopy, only liver cirrhosis was an assessable risk factor. Thereafter, liver cirrhosis, the location of a bleeding ulcer (bulbus back wall) and patients' gender (male) were of prognostic importance for the clinical outcome (mortality) of patients with a bleeding ulcer.\n Most prognostic parameters used in clinical routine today are not reliable enough in predicting a patient's vital threat posed by an UGI bleeding. Liver cirrhosis, on the other hand, is significantly more frequently associated with an increased risk to die after bleeding of an ulcer located at the posterior duodenal wall.\n\nSchemmer, Peter\n\n\n"
},
{
"text": "\n158679\nInternational Osteoporosis Foundation and European Calcified Tissue Society Working Group. Recommendations for the screening of adherence to oral bisphosphonates.\n\nDiez-Perez, A\n\nNaylor, KE\n\nAbrahamsen, B\n\nAgnusdei, D\n\nBrandi, ML\n\nCooper, C\n\nDennison, E\n\nEriksen, EF\n\nGold, DT\n\nGuañabens, N\n\nHadji, P\n\nHiligsmann, M\n\nHorne, R\n\nJosse, R\n\nKanis, JA\n\nObermayer-Pietsch, B\n\nPrieto-Alhambra, D\n\nReginster, JY\n\nRizzoli, R\n\nSilverman, S\n\nZillikens, MC\n\nEastell, R\n\nAdherence Working Group of the International Osteoporosis Foundation and the European Calcified Tissue Society\n\nBeiträge in Fachzeitschriften\nISI:000394258000003\n28093634.0\n10.1007/s00198-017-3906-6\nPMC5302161\nAdherence to oral bisphosphonates is low. A screening strategy is proposed based on the response of biochemical markers of bone turnover after 3 months of therapy. If no change is observed, the clinician should reassess the adherence to the treatment and also other potential issues with the drug.\n Low adherence to oral bisphosphonates is a common problem that jeopardizes the efficacy of treatment of osteoporosis. No clear screening strategy for the assessment of compliance is widely accepted in these patients.\n The International Osteoporosis Foundation and the European Calcified Tissue Society have convened a working group to propose a screening strategy to detect a lack of adherence to these drugs. The question to answer was whether the bone turnover markers (BTMs) PINP and CTX can be used to identify low adherence in patients with postmenopausal osteoporosis initiating oral bisphosphonates for osteoporosis. The findings of the TRIO study specifically address this question and were used as the basis for testing the hypothesis.\n Based on the findings of the TRIO study, specifically addressing this question, the working group recommends measuring PINP and CTX at baseline and 3 months after starting therapy to check for a decrease above the least significant change (decrease of more than 38% for PINP and 56% for CTX). Detection rate for the measurement of PINP is 84%, for CTX 87% and, if variation in at least one is considered when measuring both, the level of detection is 94.5%.\n If a significant decrease is observed, the treatment can continue, but if no decrease occurs, the clinician should reassess to identify problems with the treatment, mainly low adherence.\n\nObermayer-Pietsch, Barbara\n\n\n"
},
{
"text": "\n166656\nWhole blood microRNAs as potential biomarkers in post-operative early breast cancer patients.\n\nAlunni-Fabbroni, M\n\nMajunke, L\n\nTrapp, EK\n\nTzschaschel, M\n\nMahner, S\n\nFasching, PA\n\nFehm, T\n\nSchneeweiss, A\n\nBeck, T\n\nLorenz, R\n\nFriedl, TWP\n\nJanni, W\n\nRack, B\n\nSUCCESS Study Group\n\nBeiträge in Fachzeitschriften\nISI:000424775700003\n29409452.0\n10.1186/s12885-018-4020-7\nPMC5802058\nmicroRNAs (miRNAs) are considered promising cancer biomarkers, showing high reliability, sensitivity and stability. Our study aimed to identify associations between whole blood miRNA profiles, presence of circulating tumor cells (CTCs) and clinical outcome in post-operative early breast cancer patients (EBC) to assess the utility of miRNAs as prognostic markers in this setting.\n A total of 48 post-operative patients, recruited in frame of the SUCCESS A trial, were included in this retrospective study and tested with a panel of 8 miRNAs (miR-10b, -19a, - 21, - 22, -20a, - 127, - 155, -200b). Additional 17 female healthy donors with no previous history of cancer were included in the study as negative controls. Blood samples were collected at different time points (pre-adjuvant therapy, post-adjuvant therapy, 2 years follow up), total RNA was extracted and the relative concentration of each miRNA was measured by quantitative PCR and compared in patients stratified on blood collection time or CTC detection. Furthermore, we compared miRNA profiles of patients, for each time point separately, and healthy donors. CTCs were visualized and quantified with immunocytochemistry analysis. Data were analyzed using non-parametric statistical tests.\n In our experimental system, miR-19a, miR-22 and miR-127 showed the most promising results, differentiating patients at different time points and from healthy controls, while miR-20a, miR-21 and miR-200b did not show any difference among the different groups. miR-10b and miR-155 were never detectable in our experimental system. With respect to patients' clinical characteristics, we found a significant correlation between miR-200b and lymph node status and between miR-20a and tumor type. Furthermore, miR-127 correlated with the presence of CTCs. Finally, we found a borderline significance between Progression Free Survival and miR-19a levels.\n This pilot study suggests that profiling whole blood miRNAs could help to better stratify post-operative EBC patients without any sign of metastasis to prevent later relapse or metastatic events.\n\nTrapp, Elisabeth Katharina\n\n\n"
},
{
"text": "\n171181\nHistological processing of un-/cellularized thermosensitive electrospun scaffolds.\n\nFuchs, J\n\nMueller, M\n\nDaxböck, C\n\nStückler, M\n\nLang, I\n\nLeitinger, G\n\nBock, E\n\nEl-Heliebi, A\n\nMoser, G\n\nGlasmacher, B\n\nBrislinger, D\n\nBeiträge in Fachzeitschriften\nISI:000464888600007\n30560287.0\n10.1007/s00418-018-1757-7\nPMC6469612\nHistological processing of thermosensitive electrospun poly(ε-caprolactone)/poly(L-lactide) (PCL/PLA) scaffolds fails, as poly(ε-caprolactone) (PCL) is characterized by its low-melting temperature (Tm = 60 °C). Here, we present an optimized low-temperature preparation method for the histological processing of un-/cellularized thermosensitive PCL/PLA scaffolds.Our study is aimed at the establishment of an optimized dehydration and low-melting-point paraffin-embedding method of electrospun PCL/PLA scaffolds (un-/cellularized). Furthermore, we compared this method with (a) automatized dehydration and standard paraffin embedding, (b) gelatin embedding followed by automatized dehydration and standard paraffin embedding, (c) cryofixation, and (d) acrylic resin embedding methods. We investigated pepsin and proteinase K antigen retrieval for their efficiency in epitope demasking at low temperatures and evaluated protocols for immunohistochemistry and immunofluorescence for cytokeratin 7 (CK7) and in situ padlock probe technology for beta actin (ACTB). Optimized dehydration and low-melting-point paraffin embedding preserved the PCL/PLA scaffold, as the diameter and structure of its fibers were unchanged. Cells attached to the PCL/PLA scaffolds showed limited alterations in size and morphology compared to control. Epitope demasking by enzymatic pepsin digestion and immunostaining of CK7 displayed an invasion of attached cells into the scaffold. Expression of ACTB and CK7 was shown by a combination of mRNA-based in situ padlock probe technology and immunofluorescence. In contrast, gelatin stabilization followed by standard paraffin embedding led to an overall shrinkage and melting of fibers, and therefore, no further analysis was possible. Acrylic resin embedding and cyrofixation caused fiber structures that were nearly unchanged in size and diameter. However, acrylic resin-embedded scaffolds are limited to 3 µm sections, whereas cyrofixation led to a reduction of the cell size by 14% compared to low-melting paraffin embedding. The combination of low-melting-point paraffin embedding and pepsin digestion as an antigen retrieval method offers a successful opportunity for histological investigations in thermosensitive specimens.\n\nBrislinger, Dagmar\n\nDaxboeck, Christine\n\nEl-Heliebi, Amin\n\nFuchs, Julia\n\nLang-Olip, Ingrid\n\nLeitinger, Gerd\n\nMoser, Gerit\n\nStückler, Manuela\n\n\n"
},
{
"text": "\n173473\nCA27.29 as a tumour marker for risk evaluation and therapy monitoring in primary breast cancer patients.\n\nRack, B\n\nJückstock, J\n\nTrapp, E\n\nWeissenbacher, T\n\nAlunni-Fabbroni, M\n\nSchramm, A\n\nWidschwendter, P\n\nLato, K\n\nZwingers, T\n\nLorenz, R\n\nTesch, H\n\nSchneeweiss, A\n\nFasching, P\n\nMahner, S\n\nBeckmann, MW\n\nLichtenegger, W\n\nJanni, W\n\nSUCCESS Study Group\n\nBeiträge in Fachzeitschriften\nISI:000387538700077\n27481512.0\n10.1007/s13277-016-5171-2\nNone\nSeveral trials showed that tumour markers are associated with an impaired prognosis for breast cancer. Whether earlier treatment can improve the course of the disease remains controversial. The SUCCESS Trial compares FEC (500/100/500)-docetaxel (100) vs. FEC (500/100/500)-docetaxel/gemcitabine (75/2000) as well as 2 vs. 5 years of zoledronate in high-risk primary breast cancer patients. In 2669 patients, CA27.29 was measured before and after chemotherapy with the ST AIA-PACK CA27.29 reagent for the AIA-600II automated enzyme immunoassay (Tosoh Bioscience, Belgium). Values above 31 U/ml were considered positive. Of the patients, 7.6 % (n = 202, mean 19, range 3-410) and 19.1 % (n = 511, mean 21, range 3-331) had elevated marker levels before and after chemotherapy, respectively. Of the patients, 4.9 and 78 % showed elevated and low CA27.29, respectively, at both time points. After treatment, 35 % of the pre-therapy positive patients were negative, and 15 % of the initially negative patients became positive. The correlation between both time points was significant (p < 0.0001). No correlations among nodal status, grading, hormonal status, HER2 status and CA27.29 levels were found. However, tumour size (p = 0.02), older age (p < 0.001) and post-menopausal status (p = 0.006) were significantly associated with higher CA27.29 levels. Before treatment, the prevalence of elevated CA27.29 was equally distributed between both treatment arms, whereas after chemotherapy, 13.7 % of the patients in the FEC-doc arm showed an increased level vs. 25.4 % of the patients in the FEC-doc/gemcitabine arm (p < 0.0001). However, we could not show a significant association between the G-CSF application (yes vs. no) and CA27.29 status before/after chemotherapy (p = 0.75). These results indicate a close relationship between CA27.29 levels and tumour mass. Increased values after the completion of chemotherapy might be attributed to treatment effects and should be considered with caution.\n\nTrapp, Elisabeth Katharina\n\n\n"
},
{
"text": "\n182629\nSerum Ferritin Correlates With Liver Fat in Male Adolescents With Obesity.\n\nMörwald, K\n\nAigner, E\n\nBergsten, P\n\nBrunner, SM\n\nForslund, A\n\nKullberg, J\n\nAhlström, H\n\nManell, H\n\nRoomp, K\n\nSchütz, S\n\nZsoldos, F\n\nRenner, W\n\nFurthner, D\n\nMaruszczak, K\n\nZandanell, S\n\nWeghuber, D\n\nMangge, H\n\nBeiträge in Fachzeitschriften\nISI:000546855700001\n32625166.0\n10.3389/fendo.2020.00340\nPMC7314945\nNon-alcoholic fatty liver disease (NAFLD) contributes essentially to the burden of obesity and can start in childhood. NAFLD can progress to cirrhosis and hepatocellular carcinoma. The early phase of NAFLD is crucial because during this time the disease is fully reversible. Pediatric NAFLD shows unique features of histology and pathophysiology compared to adults. Changes in serum iron parameters are common in adult NAFLD and have been termed dysmetabolic iron overload syndrome characterized by increased serum ferritin levels and normal transferrin saturation; however, the associations of serum ferritin, inflammation, and liver fat content have been incompletely investigated in children. As magnetic resonance imaging (MRI) is an excellent measure for the degree of liver steatosis, we applied this method herein to clarify the interaction between ferritin and fatty liver in male adolescents. For this study, one hundred fifty male pediatric patients with obesity and who are overweight were included. We studied a subgroup of male patients with (n = 44) and without (n = 18) NAFLD in whom we determined liver fat content, visceral adipose tissue, and subcutaneous adipose tissue extent with a 1.5T MRI (Philips NL). All patients underwent a standardized oral glucose tolerance test. We measured uric acid, triglycerides, HDL-, LDL-, total cholesterol, liver transaminases, high sensitive CRP (hsCRP), interleukin-6, HbA1c, and insulin. In univariate analysis, ferritin was associated with MRI liver fat, visceral adipose tissue content, hsCRP, AST, ALT, and GGT, while transferrin and soluble transferrin receptor were not associated with ferritin. Multivariate analysis identified hsCRP and liver fat content as independent predictors of serum ferritin in the pediatric male patients. Our data indicate that serum ferritin in male adolescents with obesity is mainly determined by liver fat content and inflammation but not by body iron status.\n Copyright © 2020 Mörwald, Aigner, Bergsten, Brunner, Forslund, Kullberg, Ahlström, Manell, Roomp, Schütz, Zsoldos, Renner, Furthner, Maruszczak, Zandanell, Weghuber and Mangge.\n\nMangge, Harald\n\nRenner, Wilfried\n\n\n"
},
{
"text": "\n186671\nAddition of Rituximab in Reduced Intensity Conditioning Regimens for B-Cell Malignancies Does Not Influence Transplant Outcomes: EBMT Registry Analyses Following Allogeneic Stem Cell Transplantation for B-Cell Malignancies.\n\nTomaszewska, A\n\nJagasia, M\n\nBeohou, E\n\nvan der Werf, S\n\nBlaise, D\n\nKanfer, E\n\nMilpied, N\n\nReményi, P\n\nCiceri, F\n\nBourhis, JH\n\nChevallier, P\n\nSolano, C\n\nSocié, G\n\nBruno, B\n\nRambaldi, A\n\nCastagna, L\n\nKröger, N\n\nCorradini, P\n\nAfanasyev, B\n\nLadetto, M\n\nNiederwieser, D\n\nScheid, C\n\nSengeloev, H\n\nKroschinsky, F\n\nYakoub-Agha, I\n\nSchoemans, H\n\nKoenecke, C\n\nPenack, O\n\nPerić, Z\n\nGreinix, H\n\nDuarte, RF\n\nBasak, GW\n\nBeiträge in Fachzeitschriften\nISI:000618222400001\n33603743.0\n10.3389/fimmu.2020.613954\nPMC7884746\nRituximab (R) is increasingly incorporated in reduced intensity conditioning (RIC) regimens for allogeneic hematopoietic cell transplantation (alloHCT) in patients with B-cell malignancies, not only to improve disease control, but also to prevent graft-versus-host disease (GVHD). There are no randomized prospective data to validate this practice, although single center data and the CIBMTR analysis have shown promising results. We aimed at validation of these findings in a large registry study. We conducted a retrospective analysis using the EBMT registry of 3, 03 adult patients with B-cell malignancies undergoing alloHCT (2001-2013) with either rituximab (R-RIC-9%) or non-rituximab (RIC-91%) reduced intensity regimens respectively. Median age and median follow up were 55 years (range 19.1-77.3) and 43.2 months (range 0.3-179.8), respectively. There was no difference in transplant outcomes (R-RIC vs RIC), including 1-year overall survival (69.9% vs 70.7%), 1-year disease-free survival (64.4% vs 62.2%), 1-year non-relapse mortality (21% vs 22%), and day-100 incidence of acute GVHD 2-4° (12% vs 12%). In summary, we found that addition of rituximab in RIC regimens for B-cell malignancies had no significant impact on major transplant outcome variables. Of note, data on chronic GVHD was not available, limiting the conclusions that can be drawn from the present study.\n Copyright © 2021 Tomaszewska, Jagasia, Beohou, van der Werf, Blaise, Kanfer, Milpied, Reményi, Ciceri, Bourhis, Chevallier, Solano, Socié, Bruno, Rambaldi, Castagna, Kröger, Corradini, Afanasyev, Ladetto, Niederwieser, Scheid, Sengeloev, Kroschinsky, Yakoub-Agha, Schoemans, Koenecke, Penack, Perić, Greinix, Duarte and Basak.\n\nGreinix, Hildegard\n\n\n"
},
{
"text": "\n3262\nAllogeneic transplantation of G-CSF mobilized peripheral blood stem cells from unrelated donors: a retrospective analysis.\n\nBornhäuser, M\n\nTheuser, C\n\nSoucek, S\n\nHölig, K\n\nKlingebiel, T\n\nBlau, W\n\nFauser, A\n\nRunde, V\n\nSchwinger, W\n\nRutt, C\n\nEhninger, G\n\nBeiträge in Fachzeitschriften\nISI:000089284300010\n10942931.0\nNone\nNone\nBACKGROUND AND OBJECTIVES: Allogeneic peripheral blood stem cell transplantation (PBSCT) from matched siblings has lead to clinical results comparable to those of standard bone marrow transplantation (BMT). We report the outcome of 79 patients transplanted with PBSC from unrelated donors. DESIGN AND METHODS: In 61 cases PBSC were used for primary transplantation whereas 18 patients were treated for relapse or graft-failure. In 35 patients receiving primary transplants, T-cell depletion (TCD) using CD34 positive selection of PBSC with or without additional T-cell depletion had been performed to reduce the risk of graft-versus-host-disease (GvHD). RESULTS: The rate of primary graft-failure was higher (20%) in the TCD group than in that receiving unmanipulated grafts (UM) (5%, p=0.007). Patients with standard risk (n=34) receiving first transplants had a significantly better overall (60.4% vs. 24%, p=0.02) and disease-free survival (57.2% vs. 22.3%, p=0.006) compared to a high risk group of patients (n=21). There were no differences in the speed of neutrophil and platelet engraftment between TCD and UM transplants. As expected, the cumulative risk for acute GvHD grade II.-IV was significantly higher in the patients who had received UM grafts (71.8% vs. 38.1%, p=0.005). Although a trend towards a better survival rate was observed after TCD transplantation (52.2%) compared to the UM group (38.1%), this difference was not statistically significant. The probability of relapse was significantly higher in patients after UM transplants (38.8% vs. 8. 4%). This apparent paradox is explained by the higher number of high-risk patients in this group (p=0.03). Multivariable analysis of disease-free survival revealed risk category (p=0.02) and use of ATG (p=0.03) to be of significant impact. All patients (n=6) with non-malignant diseases are alive with full donor chimerism. INTERPRETATION AND CONCLUSIONS: These data show that PBSC from unrelated donors can be transplanted either unmanipulated or CD34 selected. Prospective studies comparing BMT with PBSCT from unrelated donors are needed in defined disease categories.\n\nSchwinger, Wolfgang\n\n\n"
},
{
"text": "\n21939\nPharmacodynamics and pharmacokinetics of inhaled iloprost, aerosolized by three different devices, in severe pulmonary hypertension.\n\nOlschewski, H\n\nRohde, B\n\nBehr, J\n\nEwert, R\n\nGessler, T\n\nGhofrani, HA\n\nSchmehl, T\n\nBeiträge in Fachzeitschriften\nISI:000186002500018\n14555558.0\n10.1378/chest.124.4.1294\nNone\nBACKGROUND: Inhalation of iloprost, a stable prostacyclin analog, is an effective therapy for pulmonary hypertension with few side effects. This approach may, however, be handicapped by limitations of currently available nebulization devices. We assessed whether the physical characterization of a device is sufficient to predict drug deposition and pharmacologic effects. METHODS: We investigated the effects of a standardized iloprost aerosol dose (5 micro g; inhaled within approximately 10 min) in 12 patients with severe pulmonary hypertension in a crossover design employing three well-characterized nebulizers. The nebulizers use different techniques to increase efficiency and alveolar targeting (Ilo-Neb/Aerotrap [Nebu-Tec; Elsenfeld, Germany], Ventstream [MedicAid; Bognor Regis, UK], and HaloLite [Profile Therapeutics; Bognor Regis, UK]). Measurements were performed using a Swan-Ganz catheter and determination of arterial iloprost plasma levels. RESULTS: During inhalation of iloprost, the pulmonary vascular resistance decreased substantially (baseline, approximately 1, 50 dyne.s.cm(-5); decrease, - 35.5 to - 38.0%) and pulmonary artery pressure decreased substantially (baseline, approximately 58 mm Hg; decline, - 18.4 to -21.8%), whereas the systemic arterial pressure was largely unaffected. Cardiac output and mixed venous and arterial oxygen saturation displayed a marked increase. The pharmacodynamic profiles with the three devices were superimposable. Moreover, rapid entry of iloprost into the systemic circulation was noted, peaking immediately after termination of the inhalation maneuver, with very similar maximum serum concentrations (158 pg/mL, 155 pg/mL, and 157 pg/mL), and half-lives of serum levels (6.5 min, 9.4 min, and 7.7 min) for the three nebulizers, respectively. Interestingly, the "half-life" of the pharmacodynamic effects in the pulmonary vasculature (eg, decrease in pulmonary vascular resistance, ranging between 21 and 25 min) clearly outlasted this serum level-based pharmacokinetic half-life. CONCLUSIONS: A standardized dose of aerosolized iloprost delivered by different nebulizer types induces comparable pharmacodynamic and pharmacokinetic responses. Pulmonary vasodilation, persisting after disappearance of the drug from the systemic circulation, supports the hypothesis that local drug deposition largely contributes to the preferential pulmonary vasodilation in response to inhaled iloprost.\n\nOlschewski, Horst\n\n\n"
},
{
"text": "\n64591\nModulation of costimulation by CD28 and CD154 alters the kinetics and cellular characteristics of corneal allograft rejection.\n\nArdjomand, N\n\nMcAlister, JC\n\nRogers, NJ\n\nTan, PH\n\nGeorge, AJ\n\nLarkin, DF\n\nBeiträge in Fachzeitschriften\nISI:000184994900025\n12939307.0\n10.1167/iovs-03-0084\nNone\nPURPOSE: To examine the effect of modulating the lymphocyte costimulation pathways through CD28 and CD154 (CD40 ligand) in a model of corneal allograft rejection, with particular interest in changes in the observed features of rejection. METHODS: CD28 knock-out (CD28KO) and wild-type BALB/c control mice received corneal grafts from fully major histocompatibility complex (MHC)-mismatched C3H donors and were treated with CTLA4-Ig and/or anti-CD154 Ab on days 0, 2, and 4 after transplantation. Proliferation of BALB/c and CD28KO T cells in response to C3H stimulators was examined in a mixed lymphocyte reaction (MLR) in the presence of CTLA4-Ig or anti-CD154 Ab. RESULTS: Corneal allograft survival in wild-type BALB/c mice (median survival time [MST] 14 days) was significantly prolonged by blockade of the costimulatory pathways with CTLA4-Ig or anti-CD154 Ab (MST 21 days and 25 days respectively). MST in recipients treated with CTLA4-Ig and anti-CD154 Ab in combination was 29 days, not significantly longer than graft survival in single-treatment groups. MST in CD28KO recipients was 46 days and was not prolonged after treatment with anti-CD154 Ab (MST, 43 days). A similar result was found in the MLR, in which anti-CD154 Ab had no effect on proliferation of CD28KO compared with wild-type T cells. In CTLA4-Ig-treated CD28KO, grafts were rejected at an accelerated tempo, similar to that in wild-type BALB/c recipients (MST 16 days). More severe graft injury after the onset of rejection in untreated allograft recipients was accompanied by a higher number of graft-infiltrating CD45(+) cells, but similar proportions of CD4(+) and CD8(+) cells. CONCLUSIONS: CD28- and CD154-mediated costimulation have significant functional roles in corneal allograft rejection. Agents that modulate CD28 and CD154 pathways delay onset and reduce the severity of observed allograft rejection. However, their use in combination did not have an additive effect, MLR data indicating that the CD40-CD154 system depends on a functioning CD28 costimulatory pathway.\n\nArdjomand, Navid\n\n\n"
},
{
"text": "\n70119\nPrognostic impact of tumor size on pT2 renal cell carcinoma: an international multicenter experience.\n\nKlatte, T\n\nPatard, JJ\n\nGoel, RH\n\nKleid, MD\n\nGuille, F\n\nLobel, B\n\nAbbou, CC\n\nDe La Taille, A\n\nTostain, J\n\nCindolo, L\n\nAltieri, V\n\nFicarra, V\n\nArtibani, W\n\nPrayer-Galetti, T\n\nAllhoff, EP\n\nSchips, L\n\nZigeuner, R\n\nFiglin, RA\n\nKabbinavar, FF\n\nPantuck, AJ\n\nBelldegrun, AS\n\nLam, JS\n\nBeiträge in Fachzeitschriften\nISI:000247197000008\n17521678.0\n10.1016/j.juro.2007.03.046\nNone\nPURPOSE: The current tumor classification for renal cell carcinoma classifies pT2 tumors as larger than 7 cm in greatest dimension and limited to the kidney. We examined the current pT2 tumor classification of renal cell carcinoma and determined whether a tumor size cutoff exists that would improve prognostic accuracy. MATERIALS AND METHODS: We studied 706 patients with pT2 renal cell carcinoma treated with surgical extirpation at 9 international academic centers. Data collected from each patient included age at diagnosis, gender, 2002 TNM (tumor, node, metastasis) stage, tumor size, nuclear grade, performance status, histological subtype and disease specific survival. Disease specific survival was evaluated with univariate and multivariate analysis. RESULTS: Median followup was 52 months. Univariate Cox regression analysis showed a significant association of tumor size with disease specific survival (HR 1.11, p<0.001). An ideal tumor size cutoff of 11 cm was identified, which led to the stratification of 2 groups with respect to disease specific survival (p<0.0001) with 5 and 10-year survival rates of 73% and 65% for pT2 11 cm or less, and 57% and 49% for pT2 larger than 11 cm, respectively. The incidence of metastases was significantly greater in the larger than 11 cm group, while Eastern Cooperative Oncology Group performance status, Fuhrman grade and histological subtype were similar. Multivariate Cox regression analysis retained tumor size as an independent prognostic factor and as the strongest prognostic factor for patients with pT2N0M0 disease. CONCLUSIONS: Our data suggest that the current pT2 classification can be improved by subclassification into pT2a and pT2b based on a tumor size cutoff of 11 cm. Patients in the proposed pT2bN0M0 group are at higher risk for death from renal cell carcinoma and should be considered for adjuvant therapies. External validation is warranted before suggesting change to the TNM classification.\n\nZigeuner, Richard\n\n\n"
},
{
"text": "\n91294\nIncidence and predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation.\n\nScherr, D\n\nSharma, K\n\nDalal, D\n\nSpragg, D\n\nChilukuri, K\n\nCheng, A\n\nDong, J\n\nHenrikson, CA\n\nNazarian, S\n\nBerger, RD\n\nCalkins, H\n\nMarine, JE\n\nBeiträge in Fachzeitschriften\nISI:000272129600009\n19572951.0\n10.1111/j.1540-8167.2009.01540.x\nNone\nCerebrovascular accident (CVA) is a serious complication of catheter ablation of atrial fibrillation (AF). The incidence and clinical predictors of periprocedural CVA in patients undergoing AF ablation are not fully understood.\n This study included 721 cases (age 57 +/- 11 years; 23% female; 345 persistent AF) in 579 consecutive patients referred for AF ablation. Periprocedural CVA was defined as onset of a new neurologic deficit that occurred anytime between the start of the procedure and 30 days after the AF ablation, and was confirmed by a neurologist. Cranial imaging with CT and/or MRI was performed in each case. Patients were anticoagulated with warfarin for at least 4 weeks pre- and immediately postprocedure and were bridged with enoxaparin. Transesophageal echocardiography was performed within 24 hours prior to ablation in all cases.\n Periprocedural CVA occurred in 10 of 721 cases (1.4%). The risk of periprocedural CVA did not vary significantly during the course of the study. Among these 10 patients (age 62 +/- 11 years; 1 female; 5 persistent AF), 6 manifested neurological deficits within 24 hours, 3 after 24-48 hours, and 1 patient had a CVA 6 days following AF ablation despite a therapeutic INR level. All CVAs were ischemic. Five patients had residual deficits after 30 days. Four of 43 patients (9.3%) with a prior history of CVA had periprocedural CVA. Periprocedural CVA occurred in 0.3%, 1.0%, and 4.7% of patients with CHADS(2) scores of 0, 1, and > or = 2 (P < 0.001). In 2 separate multivariate analyses, a CHADS(2) score > or = 2 (OR 7.1, P = 0.02) and history of CVA (OR 9.5, P < 0.01) remained independent predictors of periprocedural CVA.\n Despite periprocedural anticoagulation and transesophageal echocardiography, we found a 1.4% incidence of periprocedural CVA in AF ablation patients. A CHADS(2) score > or = 2 and a history of CVA are independent predictors of CVA after AF ablation. The CVA risk is low in patients with CHADS(2) score of 0.\n\nScherr, Daniel\n\n\n"
}
]
}