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"text": "\n43828\nAntegrade scrotal sclerotherapy for treating primary varicocele in children.\n\nZaupa, P\n\nMayr, J\n\nHöllwarth, ME\n\nBeiträge in Fachzeitschriften\nISI:000235891400034\n16536779.0\n10.1111/j.1464-410X.2006.06033.x\nNone\nObjective To evaluate the effectiveness and limitations of antegrade sclerotherapy (AS) for the treatment of primary varicocele in childhood. Patients and Methods From December 1996 to December 2004, 88 patients (mean age 13.3 years, range 9-18) with primary varicocele underwent AS (91 varicocele ablations in all). The indications for surgery were testicular pain (16 boys, 18%), a large varicocele with cosmetic implications, testicular hypotrophy (one) and in 71 (81%) the varicocele was detected incidentally during a routine physical examination; all were left-sided. According to the classification used by Tauber, 46 (52%) varicoceles were grade II and 42 (48%) grade III. The clinical and ultrasonography (US) results were evaluated over a median (range) follow-up of 11 (3-60) months, and the operative duration, X-ray exposure time, persistence rate of varicoceles and complications were compared with those using other techniques. Results In 11 patients there was a palpable difference in size between the testicles, but in only five (6%) was testicular hypotrophy (testicular volume (< 75% testicular volume vs the normal side) confirmed by US. The mean (SD) operative duration for AS was 33.2 (2.14) min. In 16 (18%) patients it was necessary to expose a second or third vein because the first vein chosen was unsuitable for sclerotherapy. The mean operative radiation exposure was 2.18 (0.21) s. One patient (1%) was treated with a high ligature of the testicular vein (Palomo procedure) after initial unsuccessful AS, and was excluded from the analysis. Eighty-four (97%) patients were eligible for follow-up: six (7%) had a persistent varicocele (four grade II, two grade III), four of whom had repeat sclerotherapy successfully (no recurrence at follow-up). Fourteen (15%) patients had enlarged testicular veins only on US (varicocele grade 0). No patient developed a hydrocele after AS, There were complications after surgery in three (3%) patients (two superficial wound infections, one scrotal haematoma together with focal testicular necrosis). Conclusions AS is an efficient minimally invasive surgical method for correcting varicoceles in older children, although the operative duration is sometimes longer than in adults, and surgery can be more difficult because of the smaller veins. Partial testicular necrosis, despite correct AS, is a very rare but serious complication.\n\nHöllwarth, Michael\n\nZaupa, Paola\n\n\n"
},
{
"text": "\n60148\nEffect of accommodation and pupil size on the movement of a posterior chamber lens in the phakic eye.\n\nPetternel, V\n\nKöppl, CM\n\nDejaco-Ruhswurm, I\n\nFindl, O\n\nSkorpik, C\n\nDrexler, W\n\nBeiträge in Fachzeitschriften\nISI:000188805100021\n15019383.0\n10.1016/j.ophtha.2003.05.013\nNone\nPURPOSE: Although a posterior chamber phakic intraocular lens provides effective refractive correction of high myopia and hyperopia, mechanical contact between the implantable contact lens (ICL) and the crystalline lens and inadequate aqueous circulation in the prelenticular space could cause subcapsular opacification. To assess whether and to what extent such mechanical contact occurs, changes in the distance between the STAAR Collamer ICL and the crystalline lens under various conditions were investigated. DESIGN: Open pilot study. PARTICIPANTS: Thirteen eyes of 11 myopic and 2 hyperopic patients with a mean age of 38 years (range, 19-53 years) were examined at least 6 months after ICL implantation. METHODS: A noninvasive, high-resolution biometry technique, partial coherence interferometry, was used to measure distance changes between the ICL and the crystalline lens during subjective accommodation, after instillation of pilocarpine, and under changing light conditions. MAIN OUTCOME MEASURES: Mean distance changes from the posterior corneal surface to the ICL, from the posterior corneal surface to the anterior surface of the crystalline lens, and the distance between the ICL and the crystalline lens. RESULTS: In the nonaccommodated state, the mean distance between the ICL and the crystalline lens was 457 microm (range, 123-924 microm). During subjective accommodation, a significant (P<0.01) decrease and, after topical application of pilocarpine, a nonsignificant (P=0.35) decrease of anterior chamber depth was accompanied by a nonsignificant (P = 0.71) reduction of the ICL-crystalline lens distance. Under photopic conditions, a significant mean reduction (P<0.01) of the ICL-crystalline lens distance of -28 microm (range, -16 to -188 microm) was observed. CONCLUSIONS: Partial coherence interferometry biometry enabled noninvasive high-precision investigation of ICL dynamics. No significant changes between the ICL and the crystalline lens were detected during subjective accommodation and after application of pilocarpine. However, under photopic conditions, with constriction of the pupil, the distance between the ICL and the crystalline lens was significantly reduced. This mechanism might cause inadequate aqueous circulation in the prelenticular space and might be one of the causes of subcapsular opacification in some of the eyes after ICL implantation.\n\n\n"
},
{
"text": "\n103193\nThe T-13910C polymorphism in the lactase phlorizin hydrolase gene is associated with differences in serum calcium levels and calcium intake.\n\nKoek, WN\n\nvan Meurs, JB\n\nvan der Eerden, BC\n\nRivadeneira, F\n\nZillikens, MC\n\nHofman, A\n\nObermayer-Pietsch, B\n\nLips, P\n\nPols, HA\n\nUitterlinden, AG\n\nvan Leeuwen, JP\n\nBeiträge in Fachzeitschriften\nISI:000281620900010\n20225268.0\n10.1002/jbmr.83\nNone\nThe C-variant of a T-13910C polymorphism (rs4988235; NT_022135.15:g.25316568G > A) upstream of the lactase phlorizin hydrolase (LPH) gene causes lactose intolerance. Association studies with differences in bone parameters and fracture risk have been inconclusive. The objective of this study was to examine the association of LPH rs4988235 with body height and bone parameters and calcium homeostasis in two elderly populations of Dutch Caucasians and assess interaction with vitamin D receptor (VDR) polymorphisms. Genotyping of LPH and VDR polymorphisms was performed in 6367 individuals from the Rotterdam Study and 844 from the Longitudinal Aging Study Amsterdam (LASA). Associations with age, height, weight, bone mineral density (BMD), skeletal morphometric parameters and serum vitamin D and calcium levels, and dietary calcium intake were assessed using ANOVA or analysis of covariance, and allele dose effect was assessed using linear regression analysis. Fracture risk was analyzed using Cox's proportional hazard regression analysis. Associations with body height (p = 2.7 × 10(-8)) and vertebral area (p = .048) found in the Rotterdam Study were explained by population stratification, as assessed by principal-component analyses, and disappeared after additional adjustments. No associations with femoral neck or lumbar spine BMD or with fracture risk were detected. Calcium intake and serum ionized serum calcium were significantly lower in C-homozygotes (p = 9.2 × 10(-7), p = .02, respectively). For none of the parameters studied was interaction between the T-13910C polymorphism and VDR block 5 haplotype 1 observed. We show that the C allele of the T-13910C polymorphism causing lactose intolerance is associated with lower dietary calcium intake and serum calcium levels but not with BMD or fractures. The associations observed with height and vertebral area were the result of population stratification. This demonstrates the impact of population stratification and urges researchers to carefully take this into account in genetic associations, in particular, in dietary intake-related phenotypes, of which LPH and lactose intolerance are a strong example.\n\nObermayer-Pietsch, Barbara\n\n\n"
},
{
"text": "\n114425\nPyridoxine dependent epilepsy and antiquitin deficiency: clinical and molecular characteristics and recommendations for diagnosis, treatment and follow-up.\n\nStockler, S\n\nPlecko, B\n\nGospe, SM\n\nCoulter-Mackie, M\n\nConnolly, M\n\nvan Karnebeek, C\n\nMercimek-Mahmutoglu, S\n\nHartmann, H\n\nScharer, G\n\nStruijs, E\n\nTein, I\n\nJakobs, C\n\nClayton, P\n\nVan Hove, JL\n\nBeiträge in Fachzeitschriften\nISI:000295151300010\n21704546.0\n10.1016/j.ymgme.2011.05.014\nNone\nAntiquitin (ATQ) deficiency is the main cause of pyridoxine dependent epilepsy characterized by early onset epileptic encephalopathy responsive to large dosages of pyridoxine. Despite seizure control most patients have intellectual disability. Folinic acid responsive seizures (FARS) are genetically identical to ATQ deficiency. ATQ functions as an aldehyde dehydrogenase (ALDH7A1) in the lysine degradation pathway. Its deficiency results in accumulation of α-aminoadipic semialdehyde (AASA), piperideine-6-carboxylate (P6C) and pipecolic acid, which serve as diagnostic markers in urine, plasma, and CSF. To interrupt seizures a dose of 100 mg of pyridoxine-HCl is given intravenously, or orally/enterally with 30 mg/kg/day. First administration may result in respiratory arrest in responders, and thus treatment should be performed with support of respiratory management. To make sure that late and masked response is not missed, treatment with oral/enteral pyridoxine should be continued until ATQ deficiency is excluded by negative biochemical or genetic testing. Long-term treatment dosages vary between 15 and 30 mg/kg/day in infants or up to 200 mg/day in neonates, and 500 mg/day in adults. Oral or enteral pyridoxal phosphate (PLP), up to 30 mg/kg/day can be given alternatively. Prenatal treatment with maternal pyridoxine supplementation possibly improves outcome. PDE is an organic aciduria caused by a deficiency in the catabolic breakdown of lysine. A lysine restricted diet might address the potential toxicity of accumulating αAASA, P6C and pipecolic acid. A multicenter study on long term outcomes is needed to document potential benefits of this additional treatment. The differential diagnosis of pyridoxine or PLP responsive seizure disorders includes PLP-responsive epileptic encephalopathy due to PNPO deficiency, neonatal/infantile hypophosphatasia (TNSALP deficiency), familial hyperphosphatasia (PIGV deficiency), as well as yet unidentified conditions and nutritional vitamin B6 deficiency. Commencing treatment with PLP will not delay treatment in patients with pyridox(am)ine phosphate oxidase (PNPO) deficiency who are responsive to PLP only.\n Copyright © 2011 Elsevier Inc. All rights reserved.\n\nPlecko, Barbara\n\n\n"
},
{
"text": "\n161352\nOccupational skin diseases: actual state analysis of patient management pathways in 28 European countries.\n\nMahler, V\n\nAalto-Korte, K\n\nAlfonso, JH\n\nBakker, JG\n\nBauer, A\n\nBensefa-Colas, L\n\nBoman, A\n\nBourke, J\n\nBubaš, M\n\nBulat, P\n\nChaloupka, J\n\nConstandt, L\n\nDanielsen, TE\n\nDarlenski, R\n\nDugonik, A\n\nEttler, K\n\nGimenez-Arnau, A\n\nGonçalo, M\n\nJohansen, JD\n\nJohn, SM\n\nKiec-Swierczynska, M\n\nKoch, P\n\nKohánka, V\n\nKrecisz, B\n\nLarese Filon, F\n\nLjubojević, S\n\nMacan, J\n\nMarinović, B\n\nMatura, M\n\nMihatsch, PW\n\nMijakoski, D\n\nMinov, J\n\nPace, J\n\nPesonen, M\n\nRamada Rodilla, JM\n\nRast, H\n\nReljic, V\n\nSalavastru, C\n\nSchuster, C\n\nSchuttelaar, ML\n\nSimon, D\n\nSpiewak, R\n\nJurakic Tončić, R\n\nUrbanček, S\n\nValiukevičienė, S\n\nWeinert, P\n\nWilkinson, M\n\nUter, W\n\nBeiträge in Fachzeitschriften\nISI:000404366700003\n28656731.0\n10.1111/jdv.14316\nNone\nWork-related skin diseases (WSD) are caused or worsened by a professional activity. Occupational skin diseases (OSD) need to fulfil additional legal criteria which differ from country to country. OSD range amongst the five most frequently notified occupational diseases (musculoskeletal diseases, neurologic diseases, lung diseases, diseases of the sensory organs, skin diseases) in Europe.\n To retrieve information and compare the current state of national frameworks and pathways to manage patients with occupational skin disease with regard to prevention, diagnosis, treatment and rehabilitation in different European countries.\n A questionnaire-based survey of the current situation regarding OSD patient management pathways was carried out with experts on occupational dermatology and/or occupational medicine from 28 European countries contributing to the European Cooperation in Science and Technology (COST) Action TD 1206 (StanDerm) (www.standerm.eu).\n Besides a national health service or a statutory health insurance, most European member states implemented a second insurance scheme specifically geared at occupational diseases [insurance against occupational risks (synonyms: insurance against work accidents and occupational injuries; statutory social accident insurance)]. Legal standards for the assessment of occupationally triggered diseases with a genetic background differ between different countries, however, in most European member states recognition as OSD is possible. In one-third of the countries UV light-induced tumours can be recognized as OSD under specific conditions.\n OSD definitions vary between European countries and are not directly comparable, which hampers comparisons between statistics collected in different countries. Awareness of this fact and further efforts for standardization are necessary.\n © 2017 European Academy of Dermatology and Venereology.\n\nSchuster, Christian Josef\n\n\n"
},
{
"text": "\n165440\nAssessment of vitamin D status - a changing landscape.\n\nHerrmann, M\n\nFarrell, CL\n\nPusceddu, I\n\nFabregat-Cabello, N\n\nCavalier, E\n\nBeiträge in Fachzeitschriften\nISI:000388930700009\n27362963.0\n10.1515/cclm-2016-0264\nNone\nIn recent years it has been shown that vitamin D deficiency is associated with an increased incidence as well as the progression of a broad range of diseases including osteoporosis, rickets, cardiovascular disease, autoimmune disease, multiple sclerosis and cancer. Consequently, requests for the assessment of vitamin D status have increased dramatically. Despite significant progress in the analysis of vitamin D metabolites and an expansion of our pathophysiological knowledge of vitamin D, the assessment of vitamin D status remains a challenging and partially unresolved issue. Current guidelines from scientific bodies recommend the measurement of 25-hydroxy vitamin D (25-OHD) in blood as the preferred test. However, growing evidence indicates significant limitations of this test, including analytical aspects and interpretation of results. In addition, the relationships between 25-OHD and various clinical indices, such as bone mineral density and fracture risk, are rather weak and not consistent across races. Recent studies have systematically investigated new markers of vitamin D status including the vitamin D metabolite ratio (VMR) (ratio between 25-OHD and 24, 5-dihydroxy vitamin D), bioavailable 25-OHD [25-OHD not bound to vitamin D binding protein (DBP)], and free 25-OHD [circulating 25-OHD bound to neither DBP nor albumin (ALB)]. These parameters may potentially change how we will assess vitamin D status in the future. Although these new biomarkers have expanded our knowledge about vitamin D metabolism, a range of unresolved issues regarding their measurement and the interpretation of results prevent their use in daily practice. It can be expected that some of these issues will be overcome in the near future so that they may be considered for routine use (at least in specialized centers). In addition, genetic studies have revealed several polymorphisms in key proteins of vitamin D metabolism that affect the circulating concentrations of vitamin D metabolites. The affected proteins include DBP, 7-dehydrocholesterol synthase and the vitamin D receptor (VDR). Here we aim to review existing knowledge regarding the biochemistry, physiology and measurement of vitamin D. We will also provide an overview of current and emerging biomarkers for the assessment of vitamin D status, with particular attention methodological aspects and their usefulness in clinical practice.\n\nHerrmann, Markus\n\n\n"
},
{
"text": "\n168358\nThe EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria.\n\nZuberbier, T\n\nAberer, W\n\nAsero, R\n\nAbdul Latiff, AH\n\nBaker, D\n\nBallmer-Weber, B\n\nBernstein, JA\n\nBindslev-Jensen, C\n\nBrzoza, Z\n\nBuense Bedrikow, R\n\nCanonica, GW\n\nChurch, MK\n\nCraig, T\n\nDanilycheva, IV\n\nDressler, C\n\nEnsina, LF\n\nGiménez-Arnau, A\n\nGodse, K\n\nGonçalo, M\n\nGrattan, C\n\nHebert, J\n\nHide, M\n\nKaplan, A\n\nKapp, A\n\nKatelaris, CH\n\nKocatürk, E\n\nKulthanan, K\n\nLarenas-Linnemann, D\n\nLeslie, TA\n\nMagerl, M\n\nMathelier-Fusade, P\n\nMeshkova, RY\n\nMetz, M\n\nNast, A\n\nNettis, E\n\nOude-Elberink, H\n\nRosumeck, S\n\nSaini, SS\n\nSánchez-Borges, M\n\nSchmid-Grendelmeier, P\n\nStaubach, P\n\nSussman, G\n\nToubi, E\n\nVena, GA\n\nVestergaard, C\n\nWedi, B\n\nWerner, RN\n\nZhao, Z\n\nMaurer, M\n\nEndorsed by the following societies: AAAAI, AAD, AAIITO, ACAAI, AEDV, APAAACI, ASBAI, ASCIA, BAD, BSACI, CDA, CMICA, CSACI, DDG, DDS, DGAKI, DSA, DST, EAACI, EIAS, EDF, EMBRN, ESCD, GA²LEN, IAACI, IADVL, JDA, NVvA, MSAI, ÖGDV, PSA, RAACI, SBD, SFD, SGAI, SGDV, SIAAIC, SIDeMaST, SPDV, TSD, UNBB, UNEV and WAO\n\nBeiträge in Fachzeitschriften\nISI:000436104900004\n29336054.0\n10.1111/all.13397\nNone\nThis evidence- and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on 1 December 2016. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.\n © 2018 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.\n\nAberer, Werner\n\n\n"
},
{
"text": "\n183711\nImpact of the Choice of Native T<sub>1</sub> in Pixelwise Myocardial Blood Flow Quantification.\n\nKräuter, C\n\nReiter, U\n\nReiter, C\n\nNizhnikava, V\n\nSchmidt, A\n\nStollberger, R\n\nFuchsjäger, M\n\nReiter, G\n\nBeiträge in Fachzeitschriften\nISI:000576672800001\n33034120.0\n10.1002/jmri.27375\nPMC7891429\nQuantification of myocardial blood flow (MBF) from dynamic contrast-enhanced (DCE) MRI can be performed using a signal intensity model that incorporates T1 values of blood and myocardium.\n To assess the impact of T1 values on pixelwise MBF quantification, specifically to evaluate the influence of 1) study population-averaged vs. subject-specific, 2) diastolic vs. systolic, and 3) regional vs. global myocardial T1 values.\n Prospective.\n Fifteen patients with chronic coronary heart disease.\n 3T; modified Look-Locker inversion recovery for T1 mapping and saturation recovery gradient echo for DCE imaging, both acquired in a mid-ventricular short-axis slice in systole and diastole.\n MBF was estimated using Fermi modeling and signal intensity nonlinearity correction with different T1 values: study population-averaged blood and myocardial, subject-specific systolic and diastolic, and segmental T1 values. Myocardial segments with perfusion deficits were identified visually from DCE series.\n The relationships between MBF parameters derived by different methods were analyzed by Bland-Altman analysis; corresponding mean values were compared by t-test.\n Using subject-specific diastolic T1 values, global diastolic MBF was 0.61 ± 0.13 mL/(min·g). It did not differ from global MBF derived from the study population-averaged T1 (P = 0.88), but the standard deviation of differences was large (0.07 mL/(min·g), 11% of mean MBF). Global diastolic and systolic MBF did not differ (P = 0.12), whereas global diastolic MBF using systolic (0.62 ± 0.13 mL/(min·g)) and diastolic T1 values differed (P < 0.05). If regional instead of global T1 values were used, segmental MBF was lower in segments with perfusion deficits (bias = -0.03 mL/(min·g), -7% of mean MBF, P < 0.05) but higher in segments without perfusion deficits (bias = 0.01 mL/(min·g), 1% of mean MBF, P < 0.05).\n Whereas cardiac phase-specific T1 values have a minor impact on MBF estimates, subject-specific and myocardial segment-specific T1 values substantially affect MBF quantification.\n 3 TECHNICAL EFFICACY STAGE: 3.\n © 2020 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.\n\nFuchsjäger, Michael\n\nKräuter, Corina\n\nReiter, Clemens\n\nReiter, Ursula\n\nSchmidt, Albrecht\n\n\n"
},
{
"text": "\n22071\nAerosolized prostacyclin and iloprost in severe pulmonary hypertension.\n\nOlschewski, H\n\nWalmrath, D\n\nSchermuly, R\n\nGhofrani, A\n\nGrimminger, F\n\nSeeger, W\n\nBeiträge in Fachzeitschriften\nISI:A1996UG25400006\n8610951.0\n10.7326/0003-4819-124-9-199605010-00006\nNone\nOBJECTIVE: To compare the effects of aerosolization of prostacyclin and its stable analog iloprost with those of nasal oxygen, inhaled nitric oxide, and intravenous prostacyclin on hemodynamics and gas exchange in patients with severe pulmonary hypertension. DESIGN: Open uncontrolled trial. SETTING: Justus-Liebig-University, Giessen Germany. PATIENTS: 4 patients with primary pulmonary hypertension and 2 patients with severe pulmonary hypertension associated with calcinosis, the Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia (the CREST syndrome). All were classified as New York Heart Association class III or class IV. INTERVENTION: Short-term applications of O2, inhaled nitric oxide, intravenous prostacyclin, aerosolized prostacyclin, and aerosolized iloprost during repeated catheter investigation of the right side of the heart within a 1-month period. One patient had long-term therapy with inhaled iloprost. RESULTS: Aerosolized prostacyclin decreased pulmonary artery pressure in 6 patients from (mean +/- SE) 62.3 +/- 4.1 mm Hg to 50.8 +/- 5.5 mm Hg and reduced pulmonary vascular resistance from 1721 +/- 253 dyne/s cm-5 to 1019 +/- 203 dyne/s cm-5, and it increased cardiac output from 2.75 +/- 0.21 L/min to 4.11 +/- 0.54 L/min, mixed venous oxygen saturation from 51.1% +/- 3/4% to 66.3% +/- 4.1% and arterial oxygen saturation from 90.6% +/- 2.7% to 93.8% +/- 23% (P<0.05 for all changes). Mean systemic arterial pressure was only slightly affected. The responses lasted for 10 to 30 minutes after inhalation was terminated. Aerosolized iloprost had an identical efficacy profile but was associated with a longer duration of the pulmonary vasodilatory effect (60 min to 120 min). In comparison, intravenous prostacyclin reduced pulmonary vascular resistance with corresponding efficacy but produced a more pronounced decline in systemic artery pressure and no clinically significant decrease in pulmonary artery pressure. Nitric oxide and O2 were less potent pulmonary vasodilators in these patients. In one patient, 1 year of therapy with aerosolized iloprost (100 microgram/d in six aerosol doses) resulted in sustained efficacy of the inhaled vasodilator regimen and clinical improvement. CONCLUSION: Aerosolization of prostacyclin or its stable analog iloprost causes selective pulmonary vasodilatation, increases cardiac output, and improves venous and arterial oxygenation in patients with severe pulmonary hypertension. Thus, it may offer a new strategy for treatment of this disease.\n\nOlschewski, Horst\n\n\n"
},
{
"text": "\n32670\nHyperbaric oxygen therapy for the treatment of brain abscess in children.\n\nKurschel, S\n\nMohia, A\n\nWeigl, V\n\nEder, HG\n\nBeiträge in Fachzeitschriften\nISI:000234395600008\n15875200.0\n10.1007/s00381-005-1147-z\nNone\nThe treatment of brain abscess remains a challenging topic usually involving a multimodal concept.\n We report our experience with hyperbaric oxygen (HBO) therapy in five children presenting with brain abscesses between 1995 and 2002 at the Department of Neurosurgery, Graz. Mean age was 14.8 (range 11-17 years). All abscesses were located supratentorially. One child had a single abscess and one had multilocated abscesses. Two other patients presented with both subdural empyema and brain abscess, one of them showing an epidural empyema as well. In another child, the brain abscess was associated with meningoencephalitis and subdural empyema. In all of them the underlying condition was spread of infection from the paranasal sinuses, except for one, who was immunocompromised due to cytotoxic chemotherapy for acute lymphocytic leukaemia.\n One single brain abscess and one of the multiple abscesses were drained. All subdural/epidural empyemas were treated surgically. Antibiotics were administered intravenously for 13 to 22 days (mean 22 days). All patients underwent HBO therapy; the number of treatments ranged from 26 to 45 "dives" (mean 30). Treatments were given once daily at 2.2 atmosphere absolutes for 60 min at 12 m. During the hospital stay all improved their clinical condition, with continued regression of abnormalities on magnetic resonance imaging (MRI). In the following weeks, other interventions were performed to treat the origin of the infections. At 6 months follow-up they were all in good clinical condition, either symptom free or with minor residual symptoms. MRI at this time showed no evidence of disease in three, a residual dural enhancement in one and a residual shrunken collection in the child with multilocated abscesses. No recurrence was observed during a mean follow-up of 21 months (range from 7 to 72 months).\n HBO therapy in children with brain abscesses seems to be safe and effective, even when they are associated with subdural or epidural empyemas. It provides a helpful adjuvant tool in the usual multimodal treatment of cerebral infections and may reduce the intravenous course of antibiotics and, consequently, the duration of hospitalization. Multidisciplinary management is recommended to optimize care for these critically ill children.\n\nEder, Hans\n\nGellner, Verena\n\nKurschel, Senta\n\nMohia, Amir\n\n\n"
},
{
"text": "\n53325\nCentral role of the adipocyte in the metabolic syndrome.\n\nBergman, RN\n\nVan Citters, GW\n\nMittelman, SD\n\nDea, MK\n\nHamilton-Wessler, M\n\nKim, SP\n\nEllmerer, M\n\nBeiträge in Fachzeitschriften\nISI:000166649600018\n11217141.0\n10.2310/6650.2001.34108\nNone\nInsulin resistance is associated with a plethora of chronic illnesses, including Type 2 diabetes, dyslipidemia, clotting dysfunction, and colon cancer. The relationship between obesity and insulin resistance is well established, and an increase in obesity in Western countries is implicated in increased incidence of diabetes and other diseases. Central, or visceral, adiposity has been particularly associated with insulin resistance; however, the mechanisms responsible for this association are unclear. Our laboratory has been studying the physiological mechanisms relating visceral adiposity and insulin resistance. Moderate fat feeding of the dog yields a model reminiscent of the metabolic syndrome, including visceral adiposity, hyperinsulinemia, and insulin resistance. We propose that insulin resistance of the liver derives from a relative increase in the delivery of free fatty acids (FFA) from the omental fat depot to the liver (via the portal vein). Increased delivery results from 1) more stored lipids in omental depot, 2) severe insulin resistance of the central fat depot, and 3) possible regulation of visceral lipolysis by the central nervous system. The significance of portal FFA delivery results from the importance of FFA in the control of liver glucose production. Insulin regulates liver glucose output primarily via control of adipocyte lipolysis. Thus, because FFA regulate the liver, it is expected that visceral adiposity will enhance delivery of FFA to the liver and make the liver relatively insulin resistant. It is of interest how the intact organism compensates for insulin resistance secondary to visceral fat deposition. While part of the compensation is enhanced B-cell sensitivity to glucose, an equally important component is reduced liver insulin clearance, which allows for a greater fraction of B-cell insulin secretion to bypass liver degradation, to enter the systemic circulation, and to result in hyperinsulinemic compensation. The signal(s) resulting in B-cell up-regulation and reduced liver insulin clearance with visceral adiposity is (are) unknown, but it appears that the glucagon-like peptide (GLP-1) hormone plays an important role. The integrated response of the organism to central adiposity is complex, involving several organs and tissue beds. An investigation into the integrated response may help to explain the features of the metabolic syndrome.\n\n\n"
},
{
"text": "\n62934\nBone marrow edema of the mandibular condyle related to internal derangement, osteoarthrosis, and joint effusion.\n\nEmshoff, R\n\nBrandlmaier, I\n\nSchmid, C\n\nBertram, S\n\nRudisch, A\n\nBeiträge in Fachzeitschriften\nISI:000180143100007\n12524605.0\n10.1053/joms.2003.50006\nNone\nPURPOSE: The purpose of this prospective study was to evaluate whether common magnetic resonance imaging (MRI) variables such as temporomandibular joint (TMJ) internal derangement, osteoarthrosis, and effusion may predict the diagnostic group of bone marrow edema of the mandibular condyle. MATERIALS AND METHODS: The relationship between bone marrow edema and TMJ disc displacement, osteoarthrosis, and effusion was analyzed in MRIs of 120 TMJs in 73 consecutive patients with TMJ pain and/or a clinical diagnosis of TMJ internal derangement type III (disc displacement without reduction). The diagnostic bone marrow edema group was comprised of 54 TMJs in 40 patients with a unilateral or bilateral MRI diagnosis of bone marrow edema. The control group consisted of 66 non-bone marrow edema TMJs in 33 patients with a bilateral MRI finding of an absence of bone marrow edema. A logistic regression analysis was used to compute the odds ratios for internal derangement, osteoarthrosis, and effusion for non-bone marrow edema TMJs (n = 66) versus TMJs with bone marrow edema (n = 54). RESULTS: Using Chi;(2) analysis for pair-wise comparison, the TMJ-related data showed a significant relationship between the MR imaging findings of TMJ bone marrow edema and those of internal derangement (P = .000), osteoarthrosis (P = .000), and effusion (P = .010). Of the MRI variables considered simultaneously in the multiple logistic regression analysis, osteoarthrosis (P = .107) and effusion (P = .102) dropped out as nonsignificant in the diagnostic bone marrow edema group when compared with the control group. The odds ratio for individuals with an internal derangement showing bone marrow edema was strong (3.6:1) and highly significant (P = .000). Significant increases in risk of bone marrow edema occurred with disc displacement without reduction and osteoarthrosis (9.2:1) (P = .000) and disc displacement without reduction and effusion (6.4:1) (P = .002). CONCLUSIONS: The results suggest that the MR imaging findings for TMJ bone marrow edema are related to those of internal derangement, osteoarthrosis, and effusion. However, the data re-emphasize the aspect that internal derangement, osteoarthrosis, and effusion may not be regarded as the unique and dominant factors in defining TMJ bone marrow edema instances.\n\n\n"
},
{
"text": "\n71007\nLocal calcium gradients during excitation-contraction coupling and alternans in atrial myocytes.\n\nBlatter, LA\n\nKockskämper, J\n\nSheehan, KA\n\nZima, AV\n\nHüser, J\n\nLipsius, SL\n\nBeiträge in Fachzeitschriften\nISI:000183569400004\n12509476.0\n10.1113/jphysiol.2002.025239\nPMC2342467\nSubcellular Ca(2+) signalling during normal excitation-contraction (E-C) coupling and during Ca(2+) alternans was studied in atrial myocytes using fast confocal microscopy and measurement of Ca(2+) currents (I(Ca)). Ca(2+) alternans, a beat-to-beat alternation in the amplitude of the [Ca(2+)](i) transient, causes electromechanical alternans, which has been implicated in the generation of cardiac fibrillation and sudden cardiac death. Cat atrial myocytes lack transverse tubules and contain sarcoplasmic reticulum (SR) of the junctional (j-SR) and non-junctional (nj-SR) types, both of which have ryanodine-receptor calcium release channels. During E-C coupling, Ca(2+) entering through voltage-gated membrane Ca(2+) channels (I(Ca)) triggers Ca(2+) release at discrete peripheral j-SR release sites. The discrete Ca(2+) spark-like increases of [Ca(2+)](i) then fuse into a peripheral 'ring' of elevated [Ca(2+)](i), followed by propagation (via calcium-induced Ca(2+) release, CICR) to the cell centre, resulting in contraction. Interrupting I(Ca) instantaneously terminates j-SR Ca(2+) release, whereas nj-SR Ca(2+) release continues. Increasing the stimulation frequency or inhibition of glycolysis elicits Ca(2+) alternans. The spatiotemporal [Ca(2+)](i) pattern during alternans shows marked subcellular heterogeneities including longitudinal and transverse gradients of [Ca(2+)](i) and neighbouring subcellular regions alternating out of phase. Moreover, focal inhibition of glycolysis causes spatially restricted Ca(2+) alternans, further emphasising the local character of this phenomenon. When two adjacent regions within a myocyte alternate out of phase, delayed propagating Ca(2+) waves develop at their border. In conclusion, the results demonstrate that (1) during normal E-C coupling the atrial [Ca(2+)](i) transient is the result of the spatiotemporal summation of Ca(2+) release from individual release sites of the peripheral j-SR and the central nj-SR, activated in a centripetal fashion by CICR via I(Ca) and Ca(2+) release from j-SR, respectively, (2) Ca(2+) alternans is caused by subcellular alterations of SR Ca(2+) release mediated, at least in part, by local inhibition of energy metabolism, and (3) the generation of arrhythmogenic Ca(2+) waves resulting from heterogeneities in subcellular Ca(2+) alternans may constitute a novel mechanism for the development of cardiac dysrhythmias.\n\n\n"
},
{
"text": "\n126920\nRemission in rheumatoid arthritis: a comparison of the 2 newly proposed ACR/EULAR remission criteria with the rheumatoid arthritis disease activity index-5, a patient self-report disease activity index.\n\nRintelen, B\n\nSautner, J\n\nHaindl, P\n\nMai, H\n\nBrezinschek, HP\n\nLeeb, BF\n\nBeiträge in Fachzeitschriften\nISI:000317540600010\n23378466.0\n10.3899/jrheum.120952\nNone\nObjective. We analyzed whether a patient self-report remission criterion, such as that according to the Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5), meets the criteria of the 2011 proposed American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) definition of remission. Methods. The 2 approaches of the ACR/EULAR proposal [Boolean- and Simplified Disease Activity Index (SDAI)-based] as well as the RADAI-5 were used to assess whether patients with RA are in remission. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), and kappa analyses were performed to illustrate the relationship among the different approaches defining remission at a group level. Results. In total, 705 patients' assessments were included. Eighty-nine patients were classified as being in remission according to the Boolean-based and 169 according to the SDAI-based definition of the ACR/EULAR proposals, and 154 according to the RADAI-5. Sixty-eight assessments were classified as being in remission according to all 3 definitions. In the case of RADAI-5 remission, sensitivity was 78%, specificity 86%, PPV 45%, and NPV 96%, indicating remission according to the Boolean-based definition; and 60%, 92%, 66%, and 90%, respectively, indicating remission according to the SDAI-based definition. In the case of remission according to the SDAI-based ACR/EULAR definition, sensitivity was 52%, specificity 100%, PPV 98%, and NPV 87%, also indicating remission according to the Boolean definition; while according to the Boolean definition the values were 98%, 87%, 52%, and 100%, respectively. Kappa statistics showed fair to good agreement for all 3 definitions. Conclusion. Nearly twice as many assessments were classified as being in remission using the SDAI-based or the RADAI-5 definitions when compared to the Boolean-based definition. Remission according to the RADAI-5 also was highly specific for both ACR/EULAR criteria. Sensitivity for the RADAI-5 criterion was even better for the Boolean-based definition than that for the SDAI-based definition. (First Release Feb 1 2013; J Rheumatol 2013;40:394-400; doi:10.3899/jrheum.120952)\n\nBrezinsek, Hans-Peter\n\n\n"
},
{
"text": "\n152143\n[Validation of a 4-Item-Questionnaire on Familial and Hereditary Colorectal Cancer Risk in General Practice].\n\nKoné, I\n\nSiebenhofer, A\n\nHartig, J\n\nPlath, J\n\nBeiträge in Fachzeitschriften\nISI:000428862600016\n27097310.0\n10.1055/s-0042-100625\nNone\nA 4-item-questionnaire has been developed by the "Netzwerk gegen Darmkrebs e. V." (Network against colorectal cancer) to identify familial or hereditary susceptibility to colorectal cancer. The aim of this inquiry was to validate the questionnaire in 40 to 54 year old persons in a general practice setting.\n Four general practices from the "Forschungsnetzwerk Allgemeinmedizin Frankfurt" database generated a sample of 100 index patients whose first-degree relatives were known to the general practitioner. The general practitioners prepared pedigrees in accordance with the four items of the questionnaire. Subsequently, the index patients were surveyed by a healthcare assistant on the basis of the questionnaire. The level of agreement between the patients' and general practitioners' responses was measured using Cohen's kappa coefficient.\n An almost perfect level of agreement was found for question 1 on whether a first-degree relative had been diagnosed with colorectal cancer (kappa coefficient 0, 2; CI: 0, 8-1, 0). Question 2 on the existence of a first-degree relative under the age of 50 diagnosed with colorectal cancer was not answered positively by general practitioners for any patient, whereas one patient answered the question positively. Interpreting the level of agreement using the kappa coefficient was meaningless in this case. General practitioners did not have information to answer question 3 on the occurrence of a colorectal polyp in a first-degree relative under the age of 50. Likewise, it was impossible to find the necessary information on second-degree relatives in practice files (question 4). Overall, 18, % of all patients (15/80) answered "yes" to one or more questions on the existence of a hereditary colorectal cancer risk.\n Question 1 allows the identification of a familial colorectal cancer risk among 40 to 54 year old persons in a general practice setting. Questions 2 to 4 of the questionnaire could not be validated using the chosen methodology. However, the valid answer of 40 to 54 year old persons to question 1 allows familial risk to be identified. More detailed family history-taking regarding hereditary risk should be conducted in this group.\n © Georg Thieme Verlag KG Stuttgart · New York.\n\nSiebenhofer-Kroitzsch, Andrea\n\n\n"
},
{
"text": "\n155933\nComparison of the laparoscopic versus open live donor nephrectomy: an overview of surgical complications and outcome.\n\nFonouni, H\n\nMehrabi, A\n\nGolriz, M\n\nZeier, M\n\nMüller-Stich, BP\n\nSchemmer, P\n\nWerner, J\n\nBeiträge in Fachzeitschriften\nISI:000337153900001\n24770877.0\n10.1007/s00423-014-1196-4\nNone\nKidney transplantation (KTx) is considered to be the treatment of choice for end stage renal disease. One of the most challenging dilemmas in KTx is the shortage of suitable organs. The live donor nephrectomy is considered a unique operation performed on healthy donors, which provides a superior outcome in the recipients. Several surgical techniques have been developed so far to minimize donor postoperative complications as much as possible without compromising the quality of the kidney. The development of a minimally invasive surgery, laparoscopic live donor nephrectomy (LDN), was based on this concept.\n By searching the pubmed, we reviewed the most evidence based clinical studies specifically randomized clinical trials and meta-analyses to give an overview of the efficacy and safety of LDN versus ODN.\n The advantages of a LDN vs. a conventional open donor nephrectomy (ODN) are a smaller incision, better wound cosmetics, a lower rate of incisional hernia and adhesion, less postoperative pain, shorter hospitalization, and earlier return to work. Some concerns are longer operative and warm ischemic times, long-term learning curve for surgeons, and the risk of more serious complications than during an ODN.\n Overall, the review of literature shows that a LDN provides less postoperative pain, a shorter hospital stay, a shorter period of rehabilitation, and earlier return to normal work and physical activities in comparison to the conventional open flank nephrectomy but is comparable to the mini muscle splitting approach. The complication rate is generally lower in centers accustomed to performing LDNs; however, complications can be life threatening and could impose significant costs to the health system. Weighing the longer operation and warm ischemic time, as well as the risk of more serious complications against the advantages of a LDN mandates a precise indication. The risk-benefit assessment for choosing one procedure should be done meticulously. Even though the short-term graft function in both techniques is comparable, there is a lack of enough long-term outcome analyses. Finally, in any transplant center, the cost of the laparoscopic procedure should be considered.\n\nSchemmer, Peter\n\n\n"
},
{
"text": "\n174063\nAssociations between maternal physical activity in early and late pregnancy and offspring birth size: remote federated individual level meta-analysis from eight cohort studies\n\nPastorino, S\n\nBishop, T\n\nCrozier, SR\n\nGranstrom, C\n\nKordas, K\n\nKupers, LK\n\nO'Brien, EC\n\nPolanska, K\n\nSauder, KA\n\nZafarmand, MH\n\nWilson, RC\n\nAgyemang, C\n\nBurton, PR\n\nCooper, C\n\nCorpeleijn, E\n\nDabelea, D\n\nHanke, W\n\nInskip, HM\n\nMcAuliffe, FM\n\nOlsen, SF\n\nVrijkotte, TG\n\nBrage, S\n\nKennedy, A\n\nO'Gorman, D\n\nScherer, P\n\nWijndaele, K\n\nWareham, NJ\n\nDesoye, G\n\nOng, KK\n\nBeiträge in Fachzeitschriften\nISI:000458702400008\n30230190.0\n10.1111/1471-0528.15476\nPMC6330060\nEvidence on the impact of leisure time physical activity (LTPA) in pregnancy on birth size is inconsistent. We aimed to examine the association between LTPA during early and late pregnancy and newborn anthropometric outcomes.\n Individual level meta-analysis, which reduces heterogeneity across studies.\n A consortium of eight population-based studies (seven European and one US) comprising 72 694 participants.\n Generalised linear models with consistent inclusion of confounders (gestational age, sex, parity, maternal age, education, ethnicity, BMI, smoking, and alcohol intake) were used to test associations between self-reported LTPA at either early (8-18 weeks gestation) or late pregnancy (30+ weeks) and the outcomes. Results were pooled using random effects meta-analyses.\n Birth weight, large-for-gestational age (LGA), macrosomia, small-for-gestational age (SGA), % body fat, and ponderal index at birth.\n Late, but not early, gestation maternal moderate to vigorous physical activity (MVPA), vigorous activity, and LTPA energy expenditure were modestly inversely associated with BW, LGA, macrosomia, and ponderal index, without heterogeneity (all: I2 = 0%). For each extra hour/week of MVPA, RR for LGA and macrosomia were 0.97 (95% CI: 0.96, 0.98) and 0.96 (95% CI: 0.94, 0.98), respectively. Associations were only modestly reduced after additional adjustments for maternal BMI and gestational diabetes. No measure of LTPA was associated with risk for SGA.\n Physical activity in late, but not early, pregnancy is consistently associated with modestly lower risk of LGA and macrosomia, but not SGA.\n In an individual participant meta-analysis, late pregnancy moderate to vigorous physical activity modestly reduced birth size outcomes.\n © 2018 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.\n\nDesoye, Gernot\n\n\n"
},
{
"text": "\n186663\nHybrid closed-loop glucose control with faster insulin aspart (Fiasp) compared with standard insulin aspart in adults with type 1 diabetes: a double-blind, multicentre, multinational, randomised, crossover study.\n\nBoughton, CK\n\nHartnell, S\n\nThabit, H\n\nPoettler, T\n\nHerzig, D\n\nWilinska, ME\n\nAshcroft, NL\n\nSibayan, J\n\nCohen, N\n\nCalhoun, P\n\nBally, L\n\nMader, JK\n\nEvans, M\n\nLeelarathna, L\n\nHovorka, R\n\nBeiträge in Fachzeitschriften\nISI:000626152800001\n33606901.0\n10.1111/dom.14355\nNone\nWe evaluated hybrid closed-loop glucose control with faster-acting insulin aspart (Fiasp) in adults with type 1 diabetes (T1D). We hypothesised that closed-loop with Fiasp provides similar efficacy as closed-loop with standard insulin aspart.\n In a double-blind, multinational, randomised, crossover study, 25 adults with T1D using insulin pump therapy (mean ± SD, age 38 ± 9 years, HbA1c 7.4 ± 0.8% [57 ± 8 mmol/mol]) underwent two 8-week periods of unrestricted living comparing hybrid closed-loop with Fiasp and hybrid closed-loop with standard insulin aspart in random order. During both interventions, the CamAPS FX closed-loop system incorporating Cambridge model predictive control algorithm was used.\n In an intention-to-treat analysis, the proportion of time sensor glucose was in target range (3.9-10.0 mmol/L; primary endpoint) was not different between interventions (75 ± 8% vs. 75 ± 8% for hybrid closed-loop with Fiasp vs. hybrid closed-loop with standard insulin aspart; mean-adjusted difference - 0.6 [95%CI -1.8 to 0.7%]; P < 0.001 for non-inferiority [non-inferiority margin 5%]). The proportion of time with sensor glucose <3.9 mmol/L (median [IQR] 2.4 [1.2-3.2%] vs. 2.9 [1.7-4.0%]; P = 0.01) and < 3.0 mmol/L (median [IQR] 0.4 [0.2-0.7%] vs. 0.7 [0.2-0.9%]; P = 0.03) was reduced with Fiasp vs. standard insulin aspart. There was no difference in mean glucose (8.1 ± 0.8 vs. 8.0 ± 0.8 mmol/L; P = 0.13) or glucose variability (SD of sensor glucose 2.9 ± 0.5 vs. 2.9 ± 0.5 mmol/L; P = 0.90). Total daily insulin requirements did not differ (49 ± 15 vs. 49 ± 15 units/day; P = 0.45). No severe hypoglycaemia or ketoacidosis occurred.\n The use of Fiasp in CamAPS FX closed-loop system may reduce hypoglycaemia without compromising glucose control compared to standard insulin aspart in adults with T1D. This article is protected by copyright. All rights reserved.\n This article is protected by copyright. All rights reserved.\n\nMader, Julia\n\nPöttler, Tina\n\n\n"
},
{
"text": "\n187754\nAdipose Triglyceride Lipase Loss Promotes a Metabolic Switch in A549 Non-Small Cell Lung Cancer Cell Spheroids.\n\nHoneder, S\n\nTomin, T\n\nNebel, L\n\nGindlhuber, J\n\nFritz-Wallace, K\n\nSchinagl, M\n\nHeininger, C\n\nSchittmayer, M\n\nGhaffari-Tabrizi-Wizsy, N\n\nBirner-Gruenberger, R\n\nBeiträge in Fachzeitschriften\nNone\n33992777.0\n10.1016/j.mcpro.2021.100095\nNone\nCancer cells undergo complex metabolic adaptations in order to survive and thrive in challenging environments. This is particularly prominent for solid tumors, where cells in the core of the tumor are under severe hypoxia and nutrient deprivation. However, such conditions are often not recapitulated in the typical 2D in vitro cancer models, where oxygen as well as nutrient exposure is quite uniform. The aim of this study was to investigate the role of a key neutral lipid hydrolase - adipose triglyceride lipase (ATGL) in cancer cells that are exposed to more tumor-like conditions. To that end, we cultured lung cancer cells lacking ATGL as multicellular spheroids in 3D and subjected them to comprehensive proteomics analysis and metabolic phenotyping. Proteomics data are available via ProteomeXchange with identifier PXD021105.As a result, we report that loss of ATGL enhanced growth of spheroids and facilitated their adaptation to hypoxia, by increasing the influx of glucose and endorsing a pro-Warburg effect. This was followed by changes in lipid metabolism and an increase in protein production. Interestingly, the observed phenotype was also recapitulated in an even more "in vivo like" setup, when cancer spheroids were grown on chick chorioallantoic membrane (CAM), but not when cells were cultured as a 2D monolayer. In addition, we demonstrate that according to the publicly available cancer databases, an inverse relation between ATGL expression and higher glucose dependence can be observed. In conclusion, we provide indications that ATGL is involved in regulation of glucose metabolism of cancer cells when grown in 3D (mimicking solid tumors), and as such could be an important factor of the treatment outcome for some cancer types. Lastly, we also ratify the need for alternative cell culture models, as the majority of phenotypes observed in 3D and spheroids grown on CAM were not observed in 2D cell culture.\n Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.\n\nBirner-Grünberger, Ruth\n\nGhaffari Tabrizi-Wizsy, Nassim\n\nGindlhuber, Jürgen\n\nHeininger, Christoph\n\nHoneder, Sophie\n\nSchinagl, Maximilian\n\nSchittmayer-Schantl, Matthias\n\nTomin, Tamara\n\n\n"
},
{
"text": "\n5214\nAngiotensin receptor blockers as anti-hypertensive treatment for patients with diabetes mellitus: meta-analysis of controlled double-blind randomized trials.\n\nSiebenhofer, A\n\nPlank, J\n\nHorvath, K\n\nBerghold, A\n\nSutton, AJ\n\nSommer, R\n\nPieber, TR\n\nBeiträge in Fachzeitschriften\nISI:000187849100003\n14706049.0\n10.1111/j.1464-5491.2004.01122.x\nNone\nAIMS: To assess the evidence for possible reduction of all-cause mortality, cardiovascular morbidity and mortality, and end-stage renal disease in diabetic patients treated with angiotensin II type 1 receptor blockers (ARBs) as an anti-hypertensive treatment. METHODS: Systematic review and meta-analysis of randomized, double-blind controlled trials of at least 1 year's duration. ARBs were used in the intervention group vs. placebo or standard anti-hypertensive treatment in the control group. The main outcome measures were all-cause mortality, cardiovascular morbidity and mortality, and end-stage renal disease. RESULTS: Three studies fulfilled the inclusion criteria. Separate analyses were conducted for comparisons of ARBs with groups given placebo and those given standard anti-hypertensive treatment. There was no significant difference in mortality between the ARBs and placebo groups, with an estimated odds ratio (OR) of 0.99 [95% confidence interval (CI) 0.81, 1.20]. There was a non-significant difference in patients treated with ARBs compared with standard anti-hypertensive treatment, with an OR of 0.78 (95% CI 0.45, 1.36). No statistically significant difference in cardiovascular morbidity and mortality between the intervention and placebo groups was found, with an OR of 0.91 (95% CI 0.77, 1.08). When ARBs were compared with standard treatment, the OR was estimated at 0.85 (0.54, 1.33). Data on end-stage renal disease were available for two studies comparing ARBs vs. placebo and showed a statistically significant advantage of ARBs, with an OR of 0.73 (95% CI 0.6, 0.89). As only one study compared end-stage renal disease outcome for ARBs vs. standard treatment, a meta-analysis was not possible. This study reported a considerable benefit of ARBs [OR = 0.73 (0.54, 1.01)] compared with the calcium channel blocker amlodipine. CONCLUSIONS: ARBs failed to show significant reduction in total mortality and cardiovascular morbidity and mortality in diabetic patients. The only statistical benefit was the reduction of end-stage renal disease compared with placebo. Therefore, at this time ARBs have not proved to be superior to standard anti-hypertensive treatment in diabetic patients.\n\nBerghold, Andrea\n\nHorvath, Karl\n\nPieber, Thomas\n\nSiebenhofer-Kroitzsch, Andrea\n\n\n"
}
]
}