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"text": "\n163005\nThe taxonomic composition of the donor intestinal microbiota is a major factor influencing the efficacy of faecal microbiota transplantation in therapy refractory ulcerative colitis.\n\nKump, P\n\nWurm, P\n\nGröchenig, HP\n\nWenzl, H\n\nPetritsch, W\n\nHalwachs, B\n\nWagner, M\n\nStadlbauer, V\n\nEherer, A\n\nHoffmann, KM\n\nDeutschmann, A\n\nReicht, G\n\nReiter, L\n\nSlawitsch, P\n\nGorkiewicz, G\n\nHögenauer, C\n\nBeiträge in Fachzeitschriften\nISI:000417649400008\n29052237.0\n10.1111/apt.14387\nPMC5765501\nFaecal microbiota transplantation is an experimental approach for the treatment of patients with ulcerative colitis. Although there is growing evidence that faecal microbiota transplantation is effective in this disease, factors affecting its response are unknown.\n To establish a faecal microbiota transplantation treatment protocol in ulcerative colitis patients, and to investigate which patient or donor factors are responsible for the treatment success.\n This is an open controlled trial of repeated faecal microbiota transplantation after antibiotic pre-treatment (FMT-group, n = 17) vs antibiotic pre-treatment only (AB-group, n = 10) in 27 therapy refractory ulcerative colitis patients over 90 days. Faecal samples of donors and patients were analysed by 16SrRNA gene-based microbiota analysis.\n In the FMT-group, 10/17 (59%) of patients showed a response and 4/17 (24%) a remission to faecal microbiota transplantation. Response to faecal microbiota transplantation was mainly influenced by the taxonomic composition of the donor's microbiota. Stool of donors with a high bacterial richness (observed species remission 946 ± 93 vs no response 797 ± 181 at 15367 rps) and a high relative abundance of Akkermansia muciniphila (3.3 ± 3.1% vs 0.1 ± 0.2%), unclassified Ruminococcaceae (13.8 ± 5.0% vs 7.5 ± 3.7%), and Ruminococcus spp. (4.9 ± 3.5% vs 1.0 ± 0.7%) were more likely to induce remission. In contrast antibiotic treatment alone (AB-group) was poorly tolerated, probably because of a sustained decrease of intestinal microbial richness.\n The taxonomic composition of the donor's intestinal microbiota is a major factor influencing the efficacy of faecal microbiota transplantation in ulcerative colitis patients. The design of specific microbial preparation might lead to new treatments for ulcerative colitis.\n © 2017 The Authors. Alimentary Pharmacology & Therapeutics Published by John Wiley & Sons Ltd.\n\nEherer, Andreas\n\nGorkiewicz, Gregor\n\nHoegenauer, Christoph\n\nHoffmann, Karl Martin\n\nKump, Patrizia\n\nPetritsch, Wolfgang\n\nStadlbauer-Köllner, Vanessa\n\nWagner, Martin\n\nWurm, Philipp\n\n\n"
},
{
"text": "\n175315\nFast-acting insulin aspart in people with type 2 diabetes: Earlier onset and greater initial exposure and glucose-lowering effect compared with insulin aspart.\n\nPieber, TR\n\nSvehlikova, E\n\nBrunner, M\n\nHalberg, IB\n\nDue Thomsen, KM\n\nHaahr, H\n\nBeiträge in Fachzeitschriften\nISI:000478906100005\n31069935.0\n10.1111/dom.13767\nPMC6771872\nTo investigate the pharmacokinetic/pharmacodynamic properties of fast-acting insulin aspart (faster aspart) versus insulin aspart (IAsp) in people with type 2 diabetes (T2D).\n In a randomized, double-blind, crossover design, 61 people with T2D usually treated with insulin ± oral antidiabetic drug(s) received single-dose faster aspart and IAsp (0.3 U/kg) on separate visits. Blood samples for pharmacokinetic assessment were collected frequently until 12 hours post-dose. Glucose-lowering effect was determined in a euglycaemic clamp lasting up to 12 hours post-dose (target 5.0 mmol/L).\n The serum IAsp pharmacokinetic profile and glucose-lowering effect profile were shifted to the left for faster aspart versus IAsp. Least squares mean (± SE) onset of appearance was 3.3 ± 0.3 minutes for faster aspart, which was 1.2 minutes earlier than for IAsp (95% confidence interval [CI] -1.8;-0.5; P = .001). Onset of action for faster aspart was 8.9 minutes earlier (95% CI -12.1;-5.7; P < .001) than for IAsp. During the first 30 minutes after dosing, 89% larger IAsp exposure (ratio faster aspart/IAsp 1.89 [95% CI 1.56;2.28]; P < .001) and 147% greater glucose-lowering effect (2.47 [95% CI 1.58;6.22]; P < .001) were observed for faster aspart compared with IAsp. Offset of exposure (time to 50% of maximum IAsp concentration in the late part of the pharmacokinetic profile) occurred earlier for faster aspart (difference faster aspart - IAsp -36.4 minutes [95% CI -55.3;-17.6]; P < .001). The treatment difference of faster aspart - IAsp in offset of glucose-lowering effect (time to 50% of maximum glucose infusion rate in the late part of the glucose infusion rate profile) was -14.4 minutes (95% CI -34.4;5.5; P = .152).\n In people with T2D, faster aspart was associated with earlier onset and greater initial exposure and glucose-lowering effect compared with IAsp, as previously shown in people with type 1 diabetes.\n © 2019 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.\n\nBrunner, Martina\n\nPieber, Thomas\n\nSvehlikova, Eva\n\n\n"
},
{
"text": "\n176147\nLong-term denosumab treatment restores cortical bone loss and reduces fracture risk at the forearm and humerus: analyses from the FREEDOM Extension cross-over group.\n\nBilezikian, JP\n\nLin, CJF\n\nBrown, JP\n\nWang, AT\n\nYin, X\n\nEbeling, PR\n\nFahrleitner-Pammer, A\n\nFranek, E\n\nGilchrist, N\n\nMiller, PD\n\nSimon, JA\n\nValter, I\n\nZerbini, CAF\n\nLibanati, C\n\nChines, A\n\nBeiträge in Fachzeitschriften\nISI:000483690500015\n31201481.0\n10.1007/s00198-019-05020-8\nPMC6719332\nUpper limb fractures (including wrist, forearm, and humerus) represent a significant burden among postmenopausal women with osteoporosis. Up to 7 years of treatment with denosumab resulted in an increase in bone mineral density and decrease in fractures in upper limb sites.\n Upper limb (wrist, forearm, and humerus) fractures are a significant burden in osteoporosis, associated with significant morbidity and mortality. Denosumab, a monoclonal antibody against RANK ligand, increases bone mineral density (BMD) and decreases vertebral, nonvertebral, and hip fractures. Here, we evaluated the long-term effect of denosumab treatment on upper limb fracture risk and BMD.\n In the FREEDOM trial, subjects were randomized 1:1 to receive every-6-month denosumab 60 mg or placebo subcutaneously for 3 years, after which all subjects could receive denosumab for up to 7 years (Extension). Among placebo subjects who completed FREEDOM and enrolled in the Extension, wrist, forearm, humerus, and upper limb fracture rates and rate ratios between different time periods (FREEDOM years 1-3, Extension years 1-3, and Extension years 4-7) were computed. BMD at the ultradistal radius, 1/3 radius, and total radius was analyzed in a subset of subjects in a BMD substudy.\n This analysis included 2207 subjects (116 in the BMD substudy). Fracture rates decreased over the 7-year Extension; fracture rate ratios between Extension years 4-7 (denosumab) and FREEDOM years 1-3 (placebo) reduced significantly for the wrist (0.57), forearm (0.57), humerus (0.42), and upper limb (0.52; p < 0.05 for all). Percentage increase in BMD from Extension baseline at the ultradistal radius, 1/3 radius, and total radius was significant by Extension year 7 (p < 0.05 for all).\n Long-term treatment with denosumab decreases upper limb fracture risk and increases forearm BMD, suggesting beneficial effects on both cortical and trabecular bone accruing over time.\n\nFahrleitner-Pammer, Astrid\n\n\n"
},
{
"text": "\n177268\nA pilot trial comparing the tear-out behavior in screw-sockets and cemented polyethylene acetabular components - a cadaveric study.\n\nMöbius, R\n\nSchleifenbaum, S\n\nGrunert, R\n\nLöffler, S\n\nWerner, M\n\nPrietzel, T\n\nHammer, N\n\nBeiträge in Fachzeitschriften\nISI:000385269400007\n27478000.0\n10.1016/j.otsr.2016.06.007\nNone\nThe removal of well-fixed acetabular components following THA (total hip arthroplasty) is a difficult operation and could be accompanied by the loss of acetabular bone stock. The optimal method for fixation is still under debate. The aim of this pilot study was to compare the tear-out resistance and failure behavior between osseo-integrated and non-integrated screw cups. Furthermore, we examined whether there are differences in the properties mentioned between screw sockets and cemented polyethylene cups.\n Tear-out resistance and related mechanical work required for the tear-out of osseo-integrated screw sockets are higher than in non-integrated screw sockets.\n Ten human coxal bones from six cadavers with osseo-integrated screw sockets (n=4), non-integrated (implanted post-mortem, n=3) screw sockets and cemented polyethylene cups (n=3) were used for tear-out testing. The parameters axial failure load and mechanical work for tear-out were introduced as measures for determining the stability of acetabular components following THA.\n The osseo-integrated screw sockets yielded slightly higher tear-out resistance (1.61±0.26kN) and related mechanical work compared to the non-integrated screw sockets (1.23±0.39kN, P=0.4). The cemented polyethylene cups yielded the lowest tear-out resistance with a failure load of 1.18±0.24kN. Compared to the screw cups implanted while alive, they also differ on a non-significant level (P=0.1). Osseous failure patterns differed especially for the screw sockets compared to the cemented polyethylene cups.\n Osseo-integration did not greatly influence the tear-out stability in cementless screw sockets following axial loading. Furthermore, the strength of the bone-implant-interface of cementless screw sockets appears to be similar to cemented polyethylene cups. However, given the high failure load, high mechanical load and because of the related bone failure patterns, removal should not be performed by means of tear-out but rather by osteotomes or other curved cutting devices to preserve the acetabular bone stock.\n Level III, case-control-study.\n Copyright © 2016 Elsevier Masson SAS. All rights reserved.\n\nHammer, Niels\n\n\n"
},
{
"text": "\n179855\nSystematic Assessment of the Adsorption of <sup>99m</sup>Tc-Radiopharmaceuticals onto Plastic Syringes.\n\nKvaternik, H\n\nGatterer, J\n\nPlhak, E\n\nSchwarzgruber, JF\n\nAigner, RM\n\nBeiträge in Fachzeitschriften\nISI:000539259000018\n31811065.0\n10.2967/jnmt.119.235432\nNone\nThe phenomenon of adsorption of several 99mTc-radiopharmaceuticals onto disposable syringes is common knowledge and can reach a level of up to 50%, with the result being inadequate dosing. The resulting underdosing has a substantial influence on the quality of imaging, especially in pediatric patients. Therefore, we aimed to establish a standardized in vitro assessment to investigate the adsorption of several 99mTc-radiopharmaceuticals on various brands of syringes. Methods: The 99mTc-radiopharmaceuticals were prepared according to manufacturer instructions. For the assessment, the disposable syringes (n = 3) were filled to one third of capacity with the 99mTc preparation and incubated for 30 min at room temperature. The syringes were emptied into evacuated vials, and the radioactivity of the syringes was measured before and after they were emptied. Furthermore, the dilution effect of 99mTc preparations was studied. We used 2 different brands of syringes and systematically examined 99mTc-pertechnetate, 99mTc-butedronate, 99mTc-oxidronate, 99mTc-medronate, 99mTc-tetrofosmin, 99mTc-sestamibi, 99mTc(V)-dimercaptosuccinic acid, and 99mTc-succimer. Additionally, 99mTc-succimer was retested with 5 brands of syringes. Results:99mTc-pertechnetate, 99mTc-phosphonates, and 99mTc(V)-dimercaptosuccinic acid showed no significant adsorption. The measured radioactive retention of 2%-5% was equivalent to the determined dead volume. Using 99mTc-tetrofosmin, we found a slight but significant adsorption of 4%-7%. The 99mTc-sestamibi preparation showed a nonsignificant retention of 3%-5%. However, when the 99mTc-sestamibi was diluted 1:10 with saline, the adsorption rate increased to 9%-13%. 99mTc-succimer displayed different adsorption levels depending on the brand of syringe and the preparation technique. The adsorption of 99mTc-succimer, prepared from kits according to the instructions, did not exceed 15%. The 1:10 saline dilution of a 99mTc-succimer kit preparation, as well as an in-house preparation, demonstrated a radioactive syringe adsorption rate of more than 30%. Conclusion: The results revealed the significance of syringe adsorption of radiopharmaceuticals in the prevention of underdosing. Therefore, a quality assurance assessment is recommended before the introduction of new brands of plastic syringes or routine application of diluted or in-house radiopharmaceuticals.\n © 2020 by the Society of Nuclear Medicine and Molecular Imaging.\n\nAigner, Reingard\n\nKvaternik, Herbert\n\nPlhak, Elisabeth\n\n\n"
},
{
"text": "\n183441\nMR 4D flow-based mean pulmonary arterial pressure tracking in pulmonary hypertension.\n\nReiter, U\n\nKovacs, G\n\nReiter, C\n\nKräuter, C\n\nNizhnikava, V\n\nFuchsjäger, M\n\nOlschewski, H\n\nReiter, G\n\nBeiträge in Fachzeitschriften\nISI:000572614000001\n32974687.0\n10.1007/s00330-020-07287-6\nPMC7979582\nLongitudinal hemodynamic follow-up is important in the management of pulmonary hypertension (PH). This study aimed to evaluate the potential of MR 4-dimensional (4D) flow imaging to predict changes in the mean pulmonary arterial pressure (mPAP) during serial investigations.\n Forty-four adult patients with PH or at risk of developing PH repeatedly underwent routine right heart catheterization (RHC) and near-term MR 4D flow imaging of the main pulmonary artery. The duration of vortical blood flow along the main pulmonary artery was evaluated from MR 4D velocity fields using prototype software and converted to an MR 4D flow imaging-based mPAP estimate (mPAPMR) by a previously established model. The relationship of differences between RHC-derived baseline and follow-up mPAP values (ΔmPAP) to corresponding differences in mPAPMR (ΔmPAPMR) was analyzed by means of regression and Bland-Altman analysis; the diagnostic performance of ΔmPAPMR in predicting mPAP increases or decreases was investigated by ROC analysis.\n Areas under the curve for the prediction of mPAP increases and decreases were 0.92 and 0.93, respectively. With the natural cutoff ΔmPAPMR = 0 mmHg, mPAP increases (decreases) were predicted with an accuracy, sensitivity, and specificity of 91% (91%), 85% (89%), and 94% (92%), respectively. For patients in whom 4D flow allowed a point estimate of mPAP (mPAP > 16 mmHg), ΔmPAPMR correlated strongly with ΔmPAP (r = 0.91) and estimated ΔmPAP bias-free with a standard deviation of 5.1 mmHg.\n MR 4D flow imaging allows accurate non-invasive prediction and quantification of mPAP changes in adult patients with PH or at risk of developing PH.\n ClinicalTrials.gov identifier: NCT00575692 and NCT01725763 KEY POINTS: • MR 4D flow imaging allows accurate non-invasive prediction of mean pulmonary arterial pressure increases and decreases in adult patients with or at risk of developing pulmonary hypertension. • In adult patients with mean pulmonary arterial pressure > 16 mmHg, MR 4D flow imaging allows estimation of longitudinal mean pulmonary arterial pressure changes without bias with a standard deviation of 5.1 mmHg.\n\nFuchsjäger, Michael\n\nKovacs, Gabor\n\nKräuter, Corina\n\nOlschewski, Horst\n\nReiter, Clemens\n\nReiter, Ursula\n\n\n"
},
{
"text": "\n185969\nTaking the frozen elephant trunk technique to the next level by a stented side branch for a left subclavian artery connection: a feasibility study.\n\nGrabenwöger, M\n\nMach, M\n\nMächler, H\n\nArnold, Z\n\nPisarik, H\n\nFolkmann, S\n\nHarrer, ML\n\nGeisler, D\n\nMoidl, R\n\nWinkler, B\n\nBonatti, J\n\nCzerny, M\n\nWeiss, G\n\nBeiträge in Fachzeitschriften\nNone\n33486518.0\n10.1093/ejcts/ezaa486\nNone\nOur goal was to develop a modified frozen elephant trunk (FET) prosthesis with a stented left subclavian artery (LSA) side branch for LSA connection and to perform preclinical testing in a human cadaver model.\n We measured aortic diameters, distance between and diameters of supra-aortic vessels and the distance from the LSA offspring to the level of the left vertebral artery offspring in 70 patients. Based on these measurements, a novel FET prosthesis was developed (Cryolife/Jotec, Hechingen, Germany) featuring a stented side branch for an intrathoracic LSA connection. The feasibility and ease of implantation were tested in 2 human cadaver models at the Anatomical Institute of the Medical University Graz. A covered stent graft (Advanta V12™ by Atrium Medical Corp., Hudson, NH, USA) was used for an LSA extension.\n Accurate deployment of the novel FET prosthesis with anatomical orientation of the stented side branch towards the LSA ostium followed by consecutive stent graft deployment was feasible in both cases. Proximalizing the distal anastomosis level from zone 3 to zone 1 not only diminished the complexity of the procedure but substantially facilitated the completion of the distal anastomosis. A 2.5-cm long extension stent graft was sufficient to seal to the LSA and to maintain left vertebral artery patency in both cases.\n This initial study in human anatomical bodies could demonstrate the feasibility of implanting a newly designed FET prosthesis. This evolution of the FET technique has the potential to substantially ease total aortic arch replacement by proximalization of the distal anastomosis into zone 1 and by shortening spinal and lower body hypothermic circulatory arrest times via a stented side branch to the LSA. This direct connection enables early restoration of systemic perfusion.\n © The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.\n\nMächler, Heinrich\n\n\n"
},
{
"text": "\n187537\nQuality of life and healthcare utilisation improvements after atrial fibrillation ablation.\n\nGupta, D\n\nVijgen, J\n\nPotter, T\n\nScherr, D\n\nVan Herendael, H\n\nKnecht, S\n\nKobza, R\n\nBerte, B\n\nSandgaard, N\n\nAlbenque, JP\n\nSzéplaki, G\n\nStevenhagen, Y\n\nTaghji, P\n\nWright, M\n\nDuytschaever, M\n\nBeiträge in Fachzeitschriften\nNone\n33952593.0\n10.1136/heartjnl-2020-318676\nNone\nPulmonary vein isolation (PVI) guided by a standardised CLOSE (contiguous optimised lesions) protocol has been shown to increase clinical success after catheter ablation for paroxysmal atrial fibrillation (PAF). This study analysed healthcare utilisation and quality of life (QOL) outcomes from a large multicentre prospective study, measured association between QOL and atrial fibrillation (AF) burden and identified factors associated with lack of QOL improvement.\n CLOSE-guided ablation was performed in 329 consecutive patients (age 61.4 years, 60.8% male) with drug-refractory PAF in 17 European centres. QOL was measured at baseline and 12 months post-ablation via Atrial Fibrillation Effect on QualiTy of Life Survey (AFEQT) and EuroQoL EQ-5D-5L questionnaires. All-cause and cardiovascular hospitalisations and cardioversions over 12 months pre-ablation and post-ablation were recorded. Rhythm monitoring included weekly and symptom-driven trans-telephonic monitoring, plus ECG and Holter monitoring at 3, 6 and 12 months. AF burden was defined as the percentage of postblanking tracings with an atrial tachyarrhythmia ≥30 s. Continuous measures across multiple time points were analysed using paired t-tests, and associations between various continuous measures were analysed using independent sample t-tests. Each statistical test used two-sided p values with a significance level of 0.05.\n Both QOL instruments showed significant 12-month improvements across all domains: AFEQT score increased 25.1-37.5 points and 33.3%-50.8% fewer patients reporting any problem across EuroQoL EQ-5D-5L domains. Overall, AFEQT improvement was highly associated with AF burden (p=0.009 for <10% vs ≥10% burden, p<0.001 for <20% vs ≥20% burden). Cardiovascular hospitalisations were significantly decreased after ablation (42%, p=0.001). Patients without substantial improvement in AFEQT (55/301, 18.2%) had higher AFEQT and CHA2DS2-VASc scores at baseline, and higher AF burden following PVI.\n QOL improved and healthcare utilisation decreased significantly after ablation with a standardised CLOSE protocol. QOL improvement was significantly associated with impairment at baseline and AF burden after ablation.\n NCT03062046.\n © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.\n\nScherr, Daniel\n\n\n"
},
{
"text": "\n13430\nTransition zone cancers undermine the predictive accuracy of Partin table stage predictions.\n\nSteuber, T\n\nKarakiewicz, PI\n\nAugustin, H\n\nErbersdobler, A\n\nLange, I\n\nHaese, A\n\nChun, KH\n\nWalz, J\n\nGraefen, M\n\nHuland, H\n\nBeiträge in Fachzeitschriften\nISI:000227075500016\n15711259.0\n10.1097/01.ju.0000152591.33259.f9\nNone\nPURPOSE: The Partin tables represent the most widely used predictor of pathological stage in men with localized prostate cancer (PCa). The accuracy and performance of the tables have been tested across different populations. However, to our knowledge the potential limitations that may stem from differences between transition zone (TZ) and peripheral zone (PZ) prostate cancers has not been explored. We tested the predictive accuracy and performance of the Partin tables according to TZ vs PZ tumor predominance. MATERIALS AND METHODS: Preoperative serum prostate specific antigen, clinical stage and biopsy Gleason sum data on 1, 90 patients treated with radical retropubic prostatectomy were used to define the 2001 Partin probabilities of organ confinement and seminal vesicle invasion (SVI). Data on 1, 20 patients who underwent staging pelvic lymphadenectomy and radical retropubic prostatectomy were used to define the probabilities of lymph node invasion (LNI) and organ confined disease (OC). ROC area under the curve was used to assess the predictive accuracy of the 2001 Partin tables relative to observed extracapsular extension (ECE), SVI, LNI and OC. Performance characteristics for each prediction were explored graphically with local regression, nonparametric smoothing plots. Results were compared between 222 TZ cancers and 1, 68 PZ cancers. RESULTS: The 1, 90 radical retropubic prostatectomy specimens demonstrated ECE in 689 cases (34.6%) (TZ in 58 or 27.1% and PZ in 631 or 35.8%) and SVI in 224 (TZ in 13 or 6.1% and PZ in 211 or 11.9%). The 1, 20 lymphadenectomy specimens demonstrated LNI in 56 cases (TZ in 2 or 0.9% and PZ in 54 or 4.6%). OC was found in 784 cases (59.4%) (TZ in 95 or 69.9% and PZ in 689 or 58.2%). Predictive accuracy was for ECE 76.4% (TZ 69.0% and PZ 77.2%), 78.0% for SVI (TZ 73.5% and PZ 78.3%), 78.6% for LNI (TZ 44.5% and PZ 79.9%) and 79.4% for OC (TZ 73.8% and PZ 80.0%). CONCLUSIONS: The biological tumor characteristics of TZ PCa differ from those of PZ PCa. These differences appear to undermine the accuracy of pathological stage predictions.\n\nAugustin, Herbert\n\n\n"
},
{
"text": "\n17545\nRisk factors for progression of brain atrophy in aging: six-year follow-up of normal subjects.\n\nEnzinger, C\n\nFazekas, F\n\nMatthews, PM\n\nRopele, S\n\nSchmidt, H\n\nSmith, S\n\nSchmidt, R\n\nBeiträge in Fachzeitschriften\nISI:000229312900010\n15911795.0\n10.1212/01.WNL.0000161871.83614.BB\nNone\nOBJECTIVES: To determine the rate of brain atrophy in neurologically asymptomatic elderly and to investigate the impact of baseline variables including conventional cerebrovascular risk factors, APOE epsilon4, and white matter hyperintensity (WMH) on its progression. METHODS: We assessed the brain parenchymal fraction at baseline and subsequent annual brain volume changes over 6 years for 201 participants (F/M = 96/105; 59.8 +/- 5.9 years) in the Austrian Stroke Prevention Study from 1.5-T MRI scans using SIENA (structural image evaluation using normalization of atrophy)/SIENAX (an adaptation of SIENA for cross-sectional measurement)(www.fmrib.ox.ac.uk/fsl). Hypertension, cardiac disease, diabetes mellitus, smoking, and regular alcohol intake were present in 64 (31.8%), 60 (29.9%), 5 (2.5%), 70 (39.3%), and 40 (20.7%) subjects, respectively. Plasma levels of fasting glucose (93.7 +/- 18.6 mg/dL), glycated hemoglobin A (HbA1c; 5.6 +/- 0.7%), total cholesterol (228.3 +/- 40.3 mg/dL), and triglycerides (127.0 +/- 75.2 mg/dL) were determined. WMH was rated as absent (n = 56), punctate (n = 120), early confluent (n = 14), and confluent (n = 11). RESULTS: The baseline brain parenchymal fraction of the entire cohort was 0.80 +/- 0.02 with a mean annual brain volume change of -0.40 +/- 0.29%. Univariate analysis demonstrated a higher rate of brain atrophy in older subjects (p = 0.0001), in those with higher HbA1c (p = 0.0001), higher body mass index (p = 0.02), high alcohol intake (p = 0.04), severe WMH (p = 0.03), and in APOE epsilon4 carriers (p = 0.07). Multivariate analysis suggested that baseline brain parenchymal fraction, HbA1c, and WMH score explain a major proportion of variance in the rates of brain atrophy in the cohort (corrected R2 = 0.27; p = 0.0001). CONCLUSIONS: Neurologically asymptomatic elderly experience continuing brain volume loss, which appears to accelerate with age. Glycated hemoglobin A (HbA1c) was identified as a risk factor for a greater rate of brain atrophy. Clustering of factors associated with the so-called metabolic syndrome in subjects with high HbA1c suggests a link between this syndrome and late-life brain tissue loss.\n\nEnzinger, Christian\n\nFazekas, Franz\n\nRopele, Stefan\n\nSchmidt, Helena\n\nSchmidt, Reinhold\n\n\n"
},
{
"text": "\n34314\nAnterior segment changes in rabbits after experimental aqueous replacement with various amounts of different perfluorocarbon liquids.\n\nStolba, U\n\nKrepler, K\n\nVelikay, M\n\nBinder, S\n\nBeiträge in Fachzeitschriften\nISI:000080597000013\n10379612.0\n10.1007/s004170050269\nNone\nBACKGROUND: We evaluated biomicroscopic and histological effects on the anterior segment in the rabbit eye after temporary aqueous substitution with various amounts (0.2 cc and 0.025 cc) of perfluorodecaline (PFD) and perfluorophenanthrene (PFP). METHODS: A quantity of 0.2 cc of the two perfluorocarbon (PFC) liquids was exchanged simultaneously with about 50% of the aqueous in 15 rabbit eyes each for periods of 1, 2, or 4 weeks. At these points some eyes were enucleated for histological examination. After 2 and 4 weeks the substances were removed from the remaining eyes, which were then followed up for 8-10 weeks. In an additional 8 eyes, 0.025 cc PFD or PFP was injected and left for 8 weeks. Four eyes received balanced salt solution and served as controls. Beside biomicroscopic evaluation and measurement of the intraocular pressure, endothelial cell counts and corneal pachymetry were performed regularly during follow-up. RESULTS: The postoperative results were well comparable for PFD and PFP eyes. Within the first 2 weeks postoperatively corneal edema with endothelial cell loss was observed in both groups. Thereafter regression of the edema started independently of whether the substances were removed or not. IOP was not elevated at any time. At the end of follow-up central corneal thickness was the same as initially. In the inferior corneal endothelium cell density decreased to 45-50% of that in normals. Histologically, vacuoles in the iris and chamber angle were found inferiorly after 4 weeks. Chamber angle closures were present between 5 and 7 o'clock in those eyes where the PFC liquids had been removed after 2 and 4 weeks. Eyes with 0.025 cc PFD or PFP droplets showed vacuolization of the inferior trabecular meshwork 8 weeks postoperatively that was comparable with eyes which had a 50% aqueous replacement for 4 weeks. Control eyes remained unchanged in all aspects. CONCLUSION: Anterior segment damage caused by PFC liquids is a contact-dependent effect seen in the early observation period. Experimentally there was no difference between the products used or between 2 and 4 weeks' duration of the tamponade.\n\n\n"
},
{
"text": "\n93771\nAMS INSIGHT--absorbable metal stent implantation for treatment of below-the-knee critical limb ischemia: 6-month analysis.\n\nBosiers, M\n\nPeeters, P\n\nD'Archambeau, O\n\nHendriks, J\n\nPilger, E\n\nDüber, C\n\nZeller, T\n\nGussmann, A\n\nLohle, PN\n\nMinar, E\n\nScheinert, D\n\nHausegger, K\n\nSchulte, KL\n\nVerbist, J\n\nDeloose, K\n\nLammer, J\n\nAMS INSIGHT Investigators\n\nBeiträge in Fachzeitschriften\nISI:000266074500006\n19093148.0\n10.1007/s00270-008-9472-8\nPMC2700251\nEndoluminal treatment of infrapopliteal artery lesions is a matter of controversy. Bioabsorbable stents are discussed as a means to combine mechanical prevention of vessel recoil with the advantages of long-term perspectives. The possibility of not having a permanent metallic implant could permit the occurrence of positive remodeling with lumen enlargement to compensate for the development of new lesions. The present study was designed to investigate the safety of absorbable metal stents (AMSs) in the infrapopliteal arteries based on 1- and 6-month clinical follow-up and efficacy based on 6-month angiographic patency. One hundred seventeen patients with 149 lesions with chronic limb ischemia (CLI) were randomized to implantation of an AMS (60 patients, 74 lesions) or stand-alone percutaneous transluminal angioplasty (PTA; 57 patients, 75 lesions). Seven PTA-group patients "crossed over" to AMS stenting. The study population consisted of patients with symptomatic CLI (Rutherford categories 4 and 5) and de novo stenotic (>50%) or occlusive atherosclerotic disease of the infrapopliteal arteries who presented with a reference diameter of between 3.0 and 3.5 mm and a lesion length of <15 mm. The primary safety endpoint was defined as absence of major amputation and/or death within 30 days after index intervention and the primary efficacy endpoint was the 6-month angiographic patency rate as confirmed by core-lab quantitative vessel analysis. The 30-day complication rate was 5.3% (3/57) and 5.0% (3/60) in patients randomized for PTA alone and PTA followed by AMS implantation, respectively. On an intention-to-treat basis, the 6-month angiographic patency rate for lesions treated with AMS (31.8%) was significantly lower (p = 0.013) than the rate for those treated with PTA (58.0%). Although the present study indicates that the AMS technology can be safely applied, it did not demonstrate efficacy in long-term patency over standard PTA in the infrapopliteal vessels.\n\nPilger, Ernst\n\n\n"
},
{
"text": "\n104932\nEURObservational Research Programme: the Heart Failure Pilot Survey (ESC-HF Pilot).\n\nMaggioni, AP\n\nDahlström, U\n\nFilippatos, G\n\nChioncel, O\n\nLeiro, MC\n\nDrozdz, J\n\nFruhwald, F\n\nGullestad, L\n\nLogeart, D\n\nMetra, M\n\nParissis, J\n\nPersson, H\n\nPonikowski, P\n\nRauchhaus, M\n\nVoors, A\n\nNielsen, OW\n\nZannad, F\n\nTavazzi, L\n\non behalf of the Heart Failure Association of the ESC (HFA)\n\nBeiträge in Fachzeitschriften\nISI:000282172000013\n20805094.0\n10.1093/eurjhf/hfq154\nNone\nThe primary objective of the new ESC-HF Pilot Survey was to describe the clinical epidemiology of outpatients and inpatients with heart failure (HF) and the diagnostic/therapeutic processes applied across 12 participating European countries. This pilot study was specifically aimed at validating the structure, performance, and quality of the data set, for continuing the survey into a permanent registry. The ESC-HF Pilot study is a prospective, multicentre, observational survey conducted in 136 cardiology centres from 12 European countries selected to represent the different health systems and care attitudes across Europe. All outpatients with HF and patients admitted for acute HF were included during the enrolment period (1 day per week for 8 consecutive months). From October 2009 to May 2010, 5118 patients were included in this pilot survey, of which 1892 (37%) were admitted for acute HF and 3226 (63%) for chronic HF. Ischaemic aetiology was reported in about half of the patients. In patients admitted for acute HF, the most frequent clinical profile was decompensated HF (75% of cases), whereas pulmonary oedema and cardiogenic shock were reported, respectively, in 13.3 and 2.3% of the cases. The total in-hospital mortality rate was 3.8% and was cardiovascular in 90.1% of the cases. Lowest and highest mortality rates were observed in hypertensive HF and in cardiogenic shock, respectively. More than 80% of patients with chronic HF were treated with renin-angiotensin-aldosterone system blockers and beta-adrenergic blockers. However, target doses of such drugs were reached in one-third to one-fourth of the patients only. The ESC-HF Pilot Survey is an example of the possibility of utilizing an observational methodology to get insights into the current clinical practice in Europe, whose picture will be completed by the 1-year follow-up. Moreover, this study offered the opportunity to refine the organizational structure of a long-term, extended European network.\n\nFruhwald, Friedrich\n\n\n"
},
{
"text": "\n109323\nPrimary central nervous system primitive neuroectodermal tumors (CNS-PNETs) of the spinal cord in children: four cases from the German HIT database with a critical review of the literature.\n\nBenesch, M\n\nSperl, D\n\nvon Bueren, AO\n\nSchmid, I\n\nvon Hoff, K\n\nWarmuth-Metz, M\n\nFerrari, R\n\nLassay, L\n\nKortmann, RD\n\nPietsch, T\n\nRutkowski, S\n\nBeiträge in Fachzeitschriften\nISI:000293648100029\n21181235.0\n10.1007/s11060-010-0485-1\nNone\nApproximately 30-50% of patients with intracranial primitive neuroectodermal tumors (PNETs) of the central nervous system (CNS) develop spinal metastases. In contrast, primary spinal CNS-PNETs are extremely uncommon. The database and study records of the German/Austrian brain tumor trials HIT 91, HIT SKK 92, and HIT 2000 were retrospectively reviewed to describe clinical features, treatment modalities, and outcome of children with primary CNS-PNETs of the spinal cord who were registered as observational patients. Out of 1, 48 patients with medulloblastomas or CNS-PNETs registered in the HIT database four patients (female, n = 3) with primary CNS-PNETs of the spinal cord were identified. Age at diagnosis was 10, 16, 23, and 174 months. Location of primary tumors was medulla oblongata-T3, C2-T1, T10-L2, T7-T10. Two patients had metastatic disease at diagnosis. Complete and incomplete resection was performed in one patient each, whereas two patients underwent a biopsy only. Two patients received chemotherapy only, in accordance with the HIT 91 trial (sandwich chemotherapy arm). They developed disease progression and died six months after diagnosis. One patient was given chemotherapy in accordance with the HIT 2000 trial followed by craniospinal radiotherapy and four courses of maintenance chemotherapy. The patient is in complete remission almost four years after diagnosis. The fourth patient developed disease progression while receiving induction chemotherapy. Hence, chemotherapy was switched to a modified Head Start protocol. After three cycles he underwent double autologous stem cell transplantation and craniospinal irradiation. Forty months after diagnosis the patient is alive and well, but surveillance MRIs still show nodular enhancing lesions in the area of the primary tumor and intracranial meningeal enhancement. Primary CNS-PNETs of the spinal cord probably require multimodal treatment including radiotherapy to achieve sustained tumor control.\n\nBenesch, Martin\n\nSperl, Daniela Ingrid\n\n\n"
},
{
"text": "\n120275\nCurrent patch test results with the European baseline series and extensions to it from the 'European Surveillance System on Contact Allergy' network, 2007-2008.\n\nUter, W\n\nAberer, W\n\nArmario-Hita, JC\n\nFernandez-Vozmediano, JM\n\nAyala, F\n\nBalato, A\n\nBauer, A\n\nBallmer-Weber, B\n\nBeliauskiene, A\n\nFortina, AB\n\nBircher, A\n\nBrasch, J\n\nChowdhury, MMU\n\nCoenraads, PJ\n\nSchuttelaar, ML\n\nCooper, S\n\nCzarnecka-Operacz, M\n\nZmudzinska, M\n\nElsner, P\n\nEnglish, JSC\n\nFrosch, PJ\n\nFuchs, T\n\nGarcia-Gavin, J\n\nFernandez-Redondo, V\n\nGawkrodger, DJ\n\nGimenez-Arnau, A\n\nGreen, CM\n\nHorne, HL\n\nJohansen, JD\n\nJolanki, R\n\nPesonen, M\n\nKing, CM\n\nKrecisz, B\n\nChomiczewska, D\n\nKiec-Swierczynska, M\n\nLarese, F\n\nMahler, V\n\nOrmerod, AD\n\nPeserico, A\n\nRantanen, T\n\nRustemeyer, T\n\nSanchez-Perez, J\n\nSansom, JE\n\nSilvestre, JF\n\nSimon, D\n\nSpiewak, R\n\nStatham, BN\n\nStone, N\n\nWilkinson, M\n\nSchnuch, A\n\n\n\nBeiträge in Fachzeitschriften\nISI:000304993100003\n22500724.0\n10.1111/j.1600-0536.2012.02070.x\nNone\nBackground. The pattern of contact sensitization to the supposedly most important allergens assembled in the baseline series differs between countries, presumably at least partly because of exposure differences. Objectives. To describe the prevalence of contact sensitization to allergens tested in consecutive patients in the years 2007 and 2008, and to discuss possible differences. Methods. Data from the 39 departments in 11 European countries comprising the European Surveillance System on Contact Allergy network () in this period have been pooled and analysed according to common standards. Results. Patch test results with the European baseline series, and country-specific or department-specific additions to it, obtained in 25 181 patients, showed marked international variation. Metals and fragrances are still the most frequent allergens across Europe. Some allergens tested nationally may be useful future additions to the European baseline series, for example methylisothiazolinone, whereas a few long-term components of the European baseline series, namely primin and clioquinol, no longer warrant routine testing. Conclusions. The present analysis points to excess prevalences of specific contact sensitization in some countries, although interpretation must be cautious if only few, and possibly specialized, centres are representing one country. A comparison as presented may help to target in-depth research into possible causes of excess exposure, and/or consideration of methodological issues, including modifications to the baseline series.\n\nAberer, Werner\n\n\n"
},
{
"text": "\n129249\nA comparison of the steady-state pharmacokinetic and pharmacodynamic profiles of 100 and 200 U/mL formulations of ultra-long-acting insulin degludec.\n\nKorsatko, S\n\nDeller, S\n\nKoehler, G\n\nMader, JK\n\nNeubauer, K\n\nAdrian, CL\n\nThomsen, H\n\nHaahr, H\n\nPieber, TR\n\nBeiträge in Fachzeitschriften\nISI:000320882900007\n23749405.0\n10.1007/s40261-013-0096-7\nNone\nInsulin degludec (IDeg) is a new-generation basal insulin that forms soluble multi-hexamers upon subcutaneous injection, resulting in a depot from which IDeg monomers are slowly and continuously absorbed to provide an ultra-long action profile. This double-blind, crossover, randomized study compared the pharmacokinetic and pharmacodynamic properties between IDeg 100 U/mL (U100) and IDeg 200 U/mL (U200) under steady-state (SS) conditions in subjects with type 1 diabetes mellitus. Participants (n = 33 adults) underwent 8-day treatment periods with 0.4 U/kg IDeg U100 and IDeg U200 given once daily with insulin aspart at mealtimes. On day 8, a 26-h euglycaemic glucose clamp (5.5 mmol/L) was performed. The concentration-time profiles of IDeg U100 and IDeg U200 were similar, and a post-hoc analysis showed bioequivalence between these formulations, as the 90 % confidence intervals (CIs) of the U200/U100 ratios for area under the steady-state serum IDeg concentration-time curve during a dosing interval (tau; 0-24 h) (AUC(tau, S, Deg)) (0.99 [0.91-1.07]) and maximum steady-state IDeg concentration during a dosing interval (tau) (C (max, S, Deg)) (0.93 [0.84-1.02]) were within the interval 0.80-1.25. Comparable glucose infusion rates (GIR) were observed for IDeg U100 and IDeg U200 (AUC(tau, S, IR) [mg/kg]: 2, 55 vs. 2, 23) and the mean ratio (95 % CI) of IDeg U200/U100 for the primary endpoint (AUC(tau, S, IR)) was 0.94 [0.86-1.03]. For both formulations, the glucose-lowering effect of IDeg was evenly distributed between the first and second 12 h post-dosing (U100: AUC(12, S, IR)/AUC(24, S, IR) = 48 %; U200: AUC(12, S, IR)/AUC(24, S, IR) = 46 %). Both formulations were well tolerated, and no safety events of significance were identified. IDeg U100 and U200 formulations are bioequivalent and have similar pharmacodynamic profiles at SS, implying that they can be used interchangeably in clinical practice.\n\nDeller, Sigrid\n\nKöhler, Gerd\n\nKorsatko, Stefan\n\nLichtenegger, Katharina\n\nMader, Julia\n\nPieber, Thomas\n\n\n"
},
{
"text": "\n138359\nEsophagus tissue engineering: designing and crafting the components for the "hybrid construct" approach.\n\nSaxena, AK\n\nBeiträge in Fachzeitschriften\nISI:000339058900008\n24918402.0\n10.1055/s-0034-1382261\nNone\nAlthough being a tubular structure, the esophagus is an extremely complex organ to engineer. To engineer an organ, its components and their structure and function must be well understood. With regards to esophagus, extensive investigations have been performed in experimental models to understand the nature of the esophageal epithelial cells with regards to their isolation, culture, and growth on scaffolds to generate epithelium. Special subpopulations of these cells have been identified that possess proliferative capabilities with subsequent differentiative capacity to generate epithelium. Studies have also been performed to obtain data on the possibilities of utilizing esophageal biopsies from esophagus damaged after caustic exposure for tissue engineering applications. Subsequently, attention is being paid to the esophageal smooth muscle which is an extremely complex structure responsible for the propulsive activities. In addition to the muscle complex, proper functioning of the esophagus will require understanding of the enteric nervous system (ENS) that controls the propulsive activity in a coordinated manner. Investigations have been performed to better understand the esophageal ENS and to isolate and maintain these cells under tissue culture conditions. Besides the cellular elements, studies have also been performed to seed these cells on scaffolds and study the constructs with regards to cell attachment and viability under tissue culture conditions. Tests have also been performed on native esophageal tissue to understand the functioning of this tissue under the effect of pharmacological agents and to establish norms to compare engineered esophageal tissue. Vascularization, which is a limiting factor in tissue engineering, has been approached with the in situ bioreactor concept using the omentum not only to provide vascular ingrowth but also to offer a pedicle for the engineered esophagus to enable its surgical transposition. This review offers an insight into the advances in esophagus tissue engineering in a large experimental model using the "hybrid construct" approach which advocates the precise engineering of the tubular gastrointestinal organs based on growth of specific cells on specially designed scaffolds and amalgamating them to create the desired complex tissue structure. \n Georg Thieme Verlag KG Stuttgart · New York.\n\n\n"
},
{
"text": "\n157056\nContinuous exposure of pancreatic cancer cells to dietary bioactive agents does not induce drug resistance unlike chemotherapy.\n\nFan, P\n\nZhang, Y\n\nLiu, L\n\nZhao, Z\n\nYin, Y\n\nXiao, X\n\nBauer, N\n\nGladkich, J\n\nMattern, J\n\nGao, C\n\nSchemmer, P\n\nGross, W\n\nHerr, I\n\nBeiträge in Fachzeitschriften\nISI:000377502400008\n27253410.0\n10.1038/cddis.2016.157\nPMC5143386\nThe repeated treatment of cancer cells with chemo- or radiotherapy induces therapy resistance, but it was previously unknown whether the same effect occurs upon continuous exposure of cancer cells to diet-derived chemopreventive agents. We elucidated this interesting question in pancreatic ductal adenocarcinoma, which is a highly aggressive cancer entity with a marked resistance toward gemcitabine and other cytotoxic drugs. The isothiocyanate sulforaphane, present in cruciferous vegetables, and the polyphenol quercetin, present in many fruits and vegetables induced apoptosis and reduced viability in gemcitabine-sensitive BxPC-3 cells but not in non-malignant ductal pancreas cells and mesenchymal stromal cells. In turn, BxPC-3 cells were treated with increasing concentrations of gemcitabine, sulforaphane or quercetin for more than 1 year and the surviving subclones Bx-GEM, Bx-SF and Bx-Q were selected, respectively. While Bx-GEM cells acquired a total resistance, Bx-SF or Bx-Q cells largely kept their sensitivity as proved by MTT assay, annexin staining and FACS analysis. The evaluation of the self-renewal-, differentiation- and migration-potential by colony formation, differentiation or migration assays demonstrated that cancer stem cell features were enriched in gemcitabine-resistant cells, but decreased in sulforaphane- and quercetin-long time-treated cells. These results were confirmed by orthotopic xenotransplantation of cancer cells to the mouse pancreas, where Bx-GEM formed large, Bx-Q small and Bx-SF cells almost undetectable tumors. An mRNA expression profiling array and subsequent gene set enrichment analysis and qRT-PCR confirmed that tumor progression markers were enriched in Bx-GEM, but reduced in Bx-SF and Bx-Q cells. This study demonstrates that the continuous exposure of pancreatic cancer cells to sulforaphane or quercetin does not induce resistance in surviving cells but reduces tumorigenicity by inhibition of tumor progression markers. These results highlight that cancer cells may not adapt to the preventive and therapeutic effects of a regular fruit- and vegetable-based diet.\n\nSchemmer, Peter\n\n\n"
},
{
"text": "\n161795\nVenous thromboembolism and vascular access thrombosis in patients with end-stage renal disease on maintenance hemodialysis: Cross-sectional results of the Vienna InVestigation of AtriaL fibrillation and thromboembolism in patients on hemoDIalysis (VIVALDI).\n\nKönigsbrügge, O\n\nLorenz, M\n\nAuinger, M\n\nSchmaldienst, S\n\nKlauser-Braun, R\n\nKletzmayr, J\n\nGrilz, E\n\nPosch, F\n\nAntlanger, M\n\nPabinger, I\n\nSäemann, M\n\nAy, C\n\nBeiträge in Fachzeitschriften\nISI:000416505400011\n28843824.0\n10.1016/j.thromres.2017.08.011\nNone\nPatients with end-stage renal disease (ESRD) on maintenance hemodialysis (HD) are at risk for occurrence of vascular access thrombosis and venous thromboembolism (VTE). Understanding the extent of these complications and identifying risk factors can help improve management strategies.\n Adult HD patients were cross-sectionally recruited into the Vienna InVestigation of AtriaL fibrillation and thromboembolism in patients on hemoDIalysis (VIVALDI). In this investigation, retrospective data on the incidence and risk of VTE and vascular access thrombosis was analyzed using logistic regression and negative binomial regression for counts of vascular access thrombosis episodes.\n The analysis includes 626 patients on HD, which constitutes 73% of the total HD population in Vienna, Austria. One-hundred-seventy-eight patients (28.4%) had 275 vascular access thrombosis events during 2463.1 patient-years on HD, corresponding to an incidence rate (IR) of 111.6 events per 1000 patient-years on HD. In the multivariable negative binomial regression model, we found that patients suffered from vascular access thrombosis 2.5 times more often (IR ratio 2.63, 95% confidence interval [CI] 1.48-4.68, p=0.001) if toxic nephropathy was their cause of ESRD (n=28, 4.5%) compared to patients with other causes of ESRD. Sixty-one patients (9.7%) had a history of VTE and the IR of VTE events during the time on HD was 10.9 per 1000 patient-years on HD (women: IR 15.1, men IR 8.6). Female sex (odds ratio [OR] 1.90, 95%CI 1.07-3.36, p=0.029) and atrial fibrillation (OR 2.00, 95%CI 1.10-3.64, p=0.023) were independently associated with VTE.\n Thromboembolic events including vascular access thrombosis and VTE are frequent complications in patients on HD. Risk evaluation for thromboembolism, including sex and clinical parameters, may identify high-risk patients and improve their clinical management.\n Copyright © 2017 Elsevier Ltd. All rights reserved.\n\nPosch, Florian\n\n\n"
},
{
"text": "\n169845\nThe impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation among patients undergoing transcatheter aortic valve implantation in Germany.\n\nKaier, K\n\nReinecke, H\n\nNaci, H\n\nFrankenstein, L\n\nBode, M\n\nVach, W\n\nHehn, P\n\nZirlik, A\n\nZehender, M\n\nReinöhl, J\n\nBeiträge in Fachzeitschriften\nISI:000425118200006\n28229254.0\n10.1007/s10198-017-0877-7\nNone\nThe impact of various post-procedural complications after transcatheter aortic valve implantation (TAVI) on resource use and their consequences in the German reimbursement system has still not been properly quantified.\n In a retrospective observational study, we use data from the German DRG statistic on patient characteristics and in-hospital outcomes of all isolated TAVI procedures in 2013 (N = 9147). The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation was analyzed using both unadjusted and risk-adjusted linear and logistic regression analyses.\n A total of 235 (2.57%) strokes, 583 (6.37%) bleeding events, 474 (5.18%) cases of acute kidney injury and 1428 (15.61%) pacemaker implantations were documented. The predicted reimbursement of an uncomplicated TAVI procedure was €33, 72, and bleeding events were associated with highest additional reimbursement (€12, 39, p < 0.001), extra length of stay (14.58 days, p < 0.001), and increased likelihood of mechanical ventilation for more than 48 h (OR 17.91, p < 0.001). A more moderate complication-related impact on resource use and reimbursement was found for acute kidney injury (additional reimbursement: €5963, p < 0.001; extra length of stay: 7.92 days, p < 0.001; ventilation >48 h: OR 6.93, p < 0.001) as well as for stroke (additional reimbursement: €4125, p < 0.001; extra length of stay: 4.68 days, p < 0.001; ventilation >48 h: OR 5.73, p < 0.001). Pacemaker implantations, in contrast, were associated with comparably small increases in reimbursement (€662, p = 0.006) and length of stay (3.54 days, p = 0.006) and no impaired likelihood of mechanical ventilation more than 48 h (OR 1.22, p = 0.156). Interestingly, these complication-related consequences remain mostly unchanged after baseline risk-adjustment.\n Post procedural complications such as bleeding events, acute kidney injuries and strokes are associated with increased resource use and substantial amounts of additional reimbursement in Germany, which has important implications for decision making outside of the usual clinical sphere.\n\nZirlik, Andreas\n\n\n"
}
]
}