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"text": "\n157017\nAllergy immunotherapy across the life cycle to promote active and healthy ageing: from research to policies: An AIRWAYS Integrated Care Pathways (ICPs) programme item (Action Plan B3 of the European Innovation Partnership on active and healthy ageing) and the Global Alliance against Chronic Respiratory Diseases (GARD), a World Health Organization GARD research demonstration project.\n\nCalderon, MA\n\nDemoly, P\n\nCasale, T\n\nAkdis, CA\n\nBachert, C\n\nBewick, M\n\nBilò, BM\n\nBohle, B\n\nBonini, S\n\nBush, A\n\nCaimmi, DP\n\nCanonica, GW\n\nCardona, V\n\nChiriac, AM\n\nCox, L\n\nCustovic, A\n\nDe Blay, F\n\nDevillier, P\n\nDidier, A\n\nDi Lorenzo, G\n\nDu Toit, G\n\nDurham, SR\n\nEng, P\n\nFiocchi, A\n\nFox, AT\n\nvan Wijk, RG\n\nGomez, RM\n\nHaathela, T\n\nHalken, S\n\nHellings, PW\n\nJacobsen, L\n\nJust, J\n\nTanno, LK\n\nKleine-Tebbe, J\n\nKlimek, L\n\nKnol, EF\n\nKuna, P\n\nLarenas-Linnemann, DE\n\nLinneberg, A\n\nMatricardi, M\n\nMalling, HJ\n\nMoesges, R\n\nMullol, J\n\nMuraro, A\n\nPapadopoulos, N\n\nPassalacqua, G\n\nPastorello, E\n\nPfaar, O\n\nPrice, D\n\nDel Rio, PR\n\nRuëff, R\n\nSamolinski, B\n\nScadding, GK\n\nSenti, G\n\nShamji, MH\n\nSheikh, A\n\nSisul, JC\n\nSole, D\n\nSturm, GJ\n\nTabar, A\n\nVan Ree, R\n\nVentura, MT\n\nVidal, C\n\nVarga, EM\n\nWorm, M\n\nZuberbier, T\n\nBousquet, J\n\nBeiträge in Fachzeitschriften\nISI:000390120900001\n27895895.0\n10.1186/s13601-016-0131-x\nPMC5120439\nAllergic diseases often occur early in life and persist throughout life. This life-course perspective should be considered in allergen immunotherapy. In particular it is essential to understand whether this al treatment may be used in old age adults. The current paper was developed by a working group of AIRWAYS integrated care pathways for airways diseases, the model of chronic respiratory diseases of the European Innovation Partnership on active and healthy ageing (DG CONNECT and DG Santé). It considered (1) the political background, (2) the rationale for allergen immunotherapy across the life cycle, (3) the unmet needs for the treatment, in particular in preschool children and old age adults, (4) the strategic framework and the practical approach to synergize current initiatives in allergen immunotherapy, its mechanisms and the concept of active and healthy ageing.\n\nSturm, Gunter\n\nVarga, Eva-Maria\n\n\n"
},
{
"text": "\n174866\nVideo clip assessment of a salivary gland ultrasound scoring system in Sjögren's syndrome using consensual definitions: an OMERACT ultrasound working group reliability exercise.\n\nJousse-Joulin, S\n\nD'Agostino, MA\n\nNicolas, C\n\nNaredo, E\n\nOhrndorf, S\n\nBackhaus, M\n\nTamborrini, G\n\nChary-Valckenaere, I\n\nTerslev, L\n\nIagnocco, A\n\nCollado, P\n\nHernández-Díaz, C\n\nGandjbakhch, F\n\nSchmidt, WA\n\nFilippou, G\n\nDejaco, C\n\nStradner, MH\n\nMortada, MA\n\nHočevar, A\n\nChrysidis, S\n\nEl Mardenly, G\n\nde Agustín, JJ\n\nThiele, R\n\nMacCarter, DK\n\nFinzel, S\n\nHanova, P\n\nZabotti, A\n\nGlaser, C\n\nAlavi, Z\n\nHammenfors, DS\n\nGatineau, F\n\nBruyn, GA\n\nBeiträge in Fachzeitschriften\nISI:000471138100028\n31036626.0\n10.1136/annrheumdis-2019-215024\nNone\nTo develop ultrasound (US) definitions and a US novel scoring system for major salivary gland (SG) lesions in patients with primary Sjögren's syndrome (pSS) and to test their intrareader and inter-reader reliability using US video clips.\n Twenty-five rheumatologists were subjected to a three-round, web-based Delphi process in order to agree on (1) definitions and scanning procedure of salivary gland ultrasonography (SGUS): parotid, submandibular and sublingual glands (PG, SMG and SLG); (2) definitions for the elementary SGUS lesions in patients with Sjögren's syndrome; (3) scoring system for grading changes. The experts rated the statements on a 1-5 Likert scale. In the second step, SGUS video clips of patients with pSS and non-pSS sicca cases were collected containing various spectrums of disease severity followed by an intrareader and inter-reader reliability exercise. Each video clip was evaluated according to the agreed definitions.\n Consensual definitions were developed after three Delphi rounds. Among the three selected SGs, US assessment of PGs and SMGs was agreed on. Agreement was reached to score only greyscale lesions and to focus on anechoic/hypoechoic foci in a semiquantitative matter or, if not possible on a qualitatively (present/absent) evaluation of fatty or fibrous lesions. Intrareader reliability for detecting and scoring these lesions was excellent (Cohen's kappa 0.81) and inter-reader reliability was good (Light's kappa 0.66).\n New definitions for developing a novel semiquantitative US score in patients with pSS were developed and tested on video clips. Inter-reader and intrareader reliabilities were good and excellent, respectively.\n © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.\n\nDejaco, Christian\n\nStradner, Martin Helmut\n\n\n"
},
{
"text": "\n177746\nExercise training in patients with a left ventricular assist device (Ex-VAD): rationale and design of a multicentre, prospective, assessor-blinded, randomized, controlled trial.\n\nBobenko, A\n\nSchoenrath, F\n\nKnierim, JH\n\nFriede, T\n\nVerheyen, N\n\nMehra, MR\n\nHaykowsky, M\n\nHerrmann-Lingen, C\n\nDuvinage, A\n\nPieske-Kraigher, E\n\nHalle, M\n\nFalk, V\n\nPieske, B\n\nEdelmann, F\n\nBeiträge in Fachzeitschriften\nISI:000486011600018\n30924265.0\n10.1002/ejhf.1431\nNone\nLeft ventricular assist device (LVAD) therapy is a promising option for patients with advanced heart failure (HF), refractory to guideline-mandated medical treatment either as a bridge to heart transplantation or as lifelong therapy. Functional capacity improves after LVAD implantation but remains reduced in patients with long-term LVAD therapy. Exercise training (ET) improves functional capacity and quality of life (QoL) in HF and may provide incremental benefits in patients supported with LVAD therapy.\n The primary objective of Ex-VAD is to investigate whether a 12-week supervised ET can improve peak oxygen uptake (peakVO2 ) measured by cardiopulmonary exercise testing (CPET) on an ergometer. The study is powered to demonstrate a group difference of 3 mL/min/kg in peakVO2 at week 12, with a power of 0.9 and a standard deviation of 5 mL/min/kg. After baseline assessments to determine whether ET is safe, 66 patients at six trial sites with advanced HF and LVAD therapy will be randomized 2:1 to supervised ET or to the control arm of usual care alone. Patients randomized to ET will perform supervised aerobic endurance and resistance ET (three times/week) for 12 weeks. At baseline and during follow-up, anthropometry, CPET, echocardiography (at rest and exercise), and QoL evaluation will be performed. Blood samples will be collected to examine cardiac-specific relevant biomarkers. Overall physical activity, training sessions, and adherence will be monitored and documented throughout the study using accelerometers and patient diaries.\n The Ex-VAD trial will assess the effects of a supervised ET programme on peakVO2 and QoL in patients with LVAD. As LVAD therapy moves from crisis support to ambulatory functional enhancement, this trial will provide a rationale to improve functional capacity and, in perspective, cardiovascular outcomes in LVAD-supported patients with advanced HF.\n © 2019 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.\n\nVerheyen, Nicolas Dominik\n\n\n"
},
{
"text": "\n182189\nAssociation of Serum Ferritin Levels Before Start of Conditioning With Mortality After alloSCT - A Prospective, Non-interventional Study of the EBMT Transplant Complications Working Party.\n\nPenack, O\n\nPeczynski, C\n\nvan der Werf, S\n\nFinke, J\n\nGanser, A\n\nSchoemans, H\n\nPavlu, J\n\nNiittyvuopio, R\n\nSchroyens, W\n\nKaynar, L\n\nBlau, IW\n\nvan der Velden, WJFM\n\nSierra, J\n\nCortelezzi, A\n\nWulf, G\n\nTurlure, P\n\nRovira, M\n\nOzkurt, Z\n\nPascual-Cascon, MJ\n\nMoreira, MC\n\nClausen, J\n\nGreinix, H\n\nDuarte, RF\n\nBasak, GW\n\nBeiträge in Fachzeitschriften\nISI:000530485200001\n32351502.0\n10.3389/fimmu.2020.00586\nPMC7174614\nElevated serum ferritin levels occur due to iron overload or during inflammation and macrophage activation. A correlation of high serum ferritin levels with increased mortality after alloSCT has been suggested by several retrospective analyses as well as by two smaller prospective studies. This prospective multicentric study aimed to study the association of ferritin serum levels before start of conditioning with alloSCT outcome. Patients with acute leukemia, lymphoma or MDS receiving a matched sibling alloSCT for the first time were considered for inclusion, regardless of conditioning. A comparison of outcomes between patients with high and low ferritin level was performed using univariate analysis and multivariate analysis using cause-specific Cox model. Twenty centers reported data on 298 alloSCT recipients. The ferritin cut off point was determined at 1500 μg/l (median of measured ferritin levels). In alloSCT recipients with ferritin levels above cut off measured before the start of conditioning, overall survival (HR = 2.5, CI = 1.5-4.1, p = 0.0005) and progression-free survival (HR = 2.4, CI = 1.6-3.8, p < 0.0001) were inferior. Excess mortality in the high ferritin group was due to both higher relapse incidence (HR = 2.2, CI = 1.2-3.8, p = 0.007) and increased non-relapse mortality (NRM) (HR = 3.1, CI = 1.5-6.4, p = 0.002). NRM was driven by significantly higher infection-related mortality in the high ferritin group (HR = 3.9, CI = 1.6-9.7, p = 0.003). Acute and chronic GVHD incidence or severity were not associated to serum ferritin levels. We conclude that ferritin levels can serve as routine laboratory biomarker for mortality risk assessment before alloSCT.\n Copyright © 2020 Penack, Peczynski, van der Werf, Finke, Ganser, Schoemans, Pavlu, Niittyvuopio, Schroyens, Kaynar, Blau, van der Velden, Sierra, Cortelezzi, Wulf, Turlure, Rovira, Ozkurt, Pascual-Cascon, Moreira, Clausen, Greinix, Duarte and Basak.\n\nGreinix, Hildegard\n\n\n"
},
{
"text": "\n182417\nDefining the characteristics of intermediate care models including transitional care: an international Delphi study.\n\nSezgin, D\n\nO'Caoimh, R\n\nO'Donovan, MR\n\nSalem, MA\n\nKennelly, S\n\nSamaniego, LL\n\nCarda, CA\n\nRodriguez-Acuña, R\n\nInzitari, M\n\nHammar, T\n\nHolditch, C\n\nBettger, JP\n\nVernon, M\n\nCarroll, Á\n\nGradinger, F\n\nPerman, G\n\nWilson, M\n\nVella, A\n\nCherubini, A\n\nTucker, H\n\nFantini, MP\n\nOnder, G\n\nRoller-Wirnsberger, R\n\nGutiérrez-Robledo, LM\n\nCesari, M\n\nBertoluci, P\n\nKieliszek, M\n\nvan der Vlegel-Brouwer, W\n\nNelson, M\n\nMañas, LR\n\nAntoniadou, E\n\nBarriere, F\n\nLindblom, S\n\nPark, G\n\nPérez, I\n\nAlguacil, D\n\nLowdon, D\n\nAlkiza, ME\n\nBouzon, CA\n\nYoung, J\n\nCarriazo, A\n\nLiew, A\n\nHendry, A\n\nEuropean Union Advantage Joint Action Work Package 7 partners in collaboration with the International Foundation for Integrated Care Special Interest Group on Intermediate Care\n\nBeiträge in Fachzeitschriften\nISI:000534198700001\n32430887.0\n10.1007/s40520-020-01579-z\nNone\nAlthough there is growing utilisation of intermediate care to improve the health and well-being of older adults with complex care needs, there is no international agreement on how it is defined, limiting comparability between studies and reducing the ability to scale effective interventions.\n To identify and define the characteristics of intermediate care models.\n A scoping review, a modified two-round electronic Delphi study involving 27 multi-professional experts from 13 countries, and a virtual consensus meeting were conducted.\n Sixty-six records were included in the scoping review, which identified four main themes: transitions, components, benefits and interchangeability. These formed the basis of the first round of the Delphi survey. After Round 2, 16 statements were agreed, refined and collapsed further. Consensus was established for 10 statements addressing the definitions, purpose, target populations, approach to care and organisation of intermediate care models.\n There was agreement that intermediate care represents time-limited services which ensure continuity and quality of care, promote recovery, restore independence and confidence at the interface between home and acute services, with transitional care representing a subset of intermediate care. Models are best delivered by an interdisciplinary team within an integrated health and social care system where a single contact point optimises service access, communication and coordination.\n This study identified key defining features of intermediate care to improve understanding and to support comparisons between models and studies evaluating them. More research is required to develop operational definitions for use in different healthcare systems.\n\nRoller-Wirnsberger, Regina\n\n\n"
},
{
"text": "\n186590\nβ-blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy.\n\nSturm, GJ\n\nHerzog, SA\n\nAberer, W\n\nAlfaya Arias, T\n\nAntolín-Amérigo, D\n\nBonadonna, P\n\nBoni, E\n\nBożek, A\n\nChełmińska, M\n\nErnst, B\n\nFrelih, N\n\nGawlik, R\n\nGelincik, A\n\nHawranek, T\n\nHoetzenecker, W\n\nJiménez Blanco, A\n\nKita, K\n\nKendirlinan, R\n\nKošnik, M\n\nLaipold, K\n\nLang, R\n\nMarchi, F\n\nMauro, M\n\nNittner-Marszalska, M\n\nPoziomkowska-Gęsicka, I\n\nPravettoni, V\n\nPreziosi, D\n\nQuercia, O\n\nReider, N\n\nRosiek-Biegus, M\n\nRuiz-Leon, B\n\nSchrautzer, C\n\nSerrano, P\n\nSin, A\n\nSin, BA\n\nStoevesandt, J\n\nTrautmann, A\n\nVachová, M\n\nArzt-Gradwohl, L\n\nBeiträge in Fachzeitschriften\nISI:000627700100001\n33605465.0\n10.1111/all.14785\nNone\nThere is controversy whether taking β-blockers or ACE inhibitors (ACEI) is a risk factor for more severe systemic insect sting reactions (SSR) and whether it increases the number or severity of adverse events (AE) during venom immunotherapy (VIT).\n In this open, prospective, observational, multicenter trial, we recruited patients with a history of a SSR and indication for VIT. The primary objective of this study was to evaluate whether patients taking β-blockers or ACEI show more systemic AE during VIT compared to patients without such treatment.\n In total, 1, 25 patients were enrolled and VIT was performed in 1, 42 patients. Of all patients included, 388 (27.2%) took antihypertensive (AHT) drugs (10.4% took β-blockers, 11.9% ACEI, 5.0% β-blockers and ACEI). Only 5.6% of patients under AHT treatment experienced systemic AE during VIT as compared with 7.4% of patients without these drugs (OR: 0.74, 95% CI: 0.43-1.22, p=0.25). The severity of the initial sting reaction was not affected by the intake of β-blockers or ACEI (OR: 1.14, 95% CI: 0.89-1.46, p=0.29). In total, 210 (17.7%) patients were re-stung during VIT and 191 (91.0%) tolerated the sting without systemic symptoms. Of the 19 patients with VIT treatment failure, 4 took β-blockers, none an ACEI.\n Thistrial provides robust evidence that taking β-blockers or ACEI does neither increase the frequency of systemic AE during VIT nor aggravate SSR. Moreover, results suggest that these drugs do not impair effectiveness of VIT. (Funded by Medical University of Graz, Austria; Clinicaltrials.gov number, NCT04269629).\n This article is protected by copyright. All rights reserved.\n\nAberer, Werner\n\nArzt-Gradwohl, Lisa\n\nHerzog, Sereina Annik\n\nSchrautzer, Christoph\n\nSturm, Gunter\n\n\n"
},
{
"text": "\n526\nComparing methods for assessing bronchial responsiveness in children: single step cold air challenge, multiple step cold air challenge, and histamine provocation.\n\nModl, M\n\nEber, E\n\nSteinbrugger, B\n\nWeinhandl, E\n\nZach, MS\n\nBeiträge in Fachzeitschriften\nISI:A1995TG61900021\n8586132.0\n10.1183%2F09031936.95.08101742\nNone\nCold air challenge (CACh) can be applied by either a single step (SSCACh) or a multiple step (MSCACh) protocol. The interrelationship of the responses of the different protocols has not yet been studied. Furthermore, there is contradictory information on the correlation of cold air challenge responses to the outcome of pharmacological provocations. A single and a multiple step cold air challenge and a histamine provocation were performed in random order on three consecutive days on 28 children and adolescents with bronchial asthma, who were currently symptom- and medication-free. Single step cold air challenge consisted of a 4 min isocapnic hyperventilation of dry, -10 degrees C air; the subjects's response was quantified by the induced change in forced expiratory volume in one second (FEV1). Multiple step cold air challenge consisted of a series of 3 min, cold dry air hyperventilation steps from 20 to 80% of maximal voluntary ventilation (MVV); response was expressed as the provocative dose causing a 10% fall in FEV1 (PD10). Histamine provocation consisted of a series of 2 min inhalations of stepwise increasing histamine concentrations from 0.03 to 8.0 mg.mL-1; response was expressed as the provocative concentration of histamine causing a 20% fall in FEV1 (PC20). Change in FEV1 (delta FEV1) (SSCACh) correlated closely with PD10 (MSCACh); scatter around the regression line was minimal. With one exception, both types of CACh identified the same subjects as hyper- and normoresponsive. delta FEV1 (SSCACh) correlated significantly to PC20 (histamine), but scatter around the regression line was substantial. The correlation of PD10 (MSCACh) to PC20 (histamine) failed to reach statistical significance. These results indicate that the stimulus applied and the bronchoconstrictor mechanism activated, and not the challenge protocol, determine the outcome of a cold air challenge. In clinical practice, a brief single step cold air challenge can substitute for a more time-consuming multiple step cold air challenge. As nonpharmacological challenges seem to measure a different type of bronchial responsiveness, neither a single step nor a multiple step cold air challenge can substitute for a pharmacological provocation.\n\nEber, Ernst\n\nModl, Manfred\n\n\n"
},
{
"text": "\n2565\nThe inhibitory modulation of guinea-pig intestinal peristalsis caused by capsaicin involves calcitonin gene-related peptide and nitric oxide.\n\nBartho, L\n\nHolzer, P\n\nBeiträge in Fachzeitschriften\nISI:A1995TM89200014\n8750923.0\nNone\nNone\nThe effect of capsaicin-induced stimulation of afferent neurons on peristalsis and the possible neural mediators involved in this action were examined in the guinea-pig isolated ileum. The intraluminal pressure threshold for eliciting peristaltic waves was used to quantify facilitation (decrease in threshold) or inhibition (increase in threshold) of peristalsis. Capsaicin (0.1-1 microM) caused an initial short-lasting stimulation of peristalsis followed by a prolonged inhibition of peristaltic activity. Capsaicin (1 microM) was ineffective when the gut segments had been pretreated with 3.3 microM capsaicin, which is indicative of an afferent neuron-dependent action of the drug. In contrast, the abolition of peristalsis caused by a high concentration of capsaicin (33 microM) was fully reversible on removal and reproducible on readministration of capsaicin, a feature characteristic of a nonspecific depression of smooth muscle excitability. Baseline peristalsis and the excitatory/inhibitory effect of capsaicin (1 microM) on peristalsis remained unaltered by a combination of the tachykinin NK1 receptor antagonist (+)-(2S, 3S)-3-(2-methoxybenzylamino)-2-phenyl piperidine (CP-99, 94; 0.3 microM) and the tachykinin NK2 receptor antagonist (L(-)-N-methyl-N[4-acetylamino-4-phenyl-piperidine-2-(3, - -dichlorophenyl)butyl]-benzamide (SR-48, 68; 0.1 microM). Further experiments, performed in the presence of a low concentration of atropine (10 nM) showed that the calcitonin gene-related peptide (CGRP) antagonist human alpha-calcitonin gene-related peptide (8-37) [hCGRP(8-37); 10 microM] attenuated the delayed inhibitory effect of capsaicin on peristalsis, but did not influence baseline peristaltic activity and the capsaicin-induced facilitation of peristalsis. Blockade of nitric oxide (NO) synthesis by NG-nitro-L-arginine methylester (L-NAME, 300 microM) facilitated baseline peristaltic activity and reduced the delayed inhibition of peristalsis caused by capsaicin (1 microM) without affecting the initial peristalsis-stimulating action of capsaicin. The effects of L-NAME were prevented by L-arginine (1 mM). The data of the current study indicate that capsaicin-sensitive afferent neurons do not participate in the neural pathways subserving peristalsis in the guinea-pig small intestine, but modulate peristaltic activity upon stimulation with capsaicin. The initial stimulant action of capsaicin on peristalsis is independent of tachykinins acting via NK1 or NK2 receptors, while the delayed capsaicin-induced depression of peristalsis involves CGRP and NO.\n\nHolzer, Peter\n\n\n"
},
{
"text": "\n147606\nEffects of Exercise and Nutrition on the Coagulation System During Bedrest Immobilization.\n\nWaha, JE\n\nGoswami, N\n\nSchlagenhauf, A\n\nLeschnik, B\n\nKoestenberger, M\n\nReibnegger, G\n\nRoller, RE\n\nHinghofer-Szalkay, H\n\nCvirn, G\n\nBeiträge in Fachzeitschriften\nISI:000369533200021\n26402815.0\n10.1097/MD.0000000000001555\nPMC4635755\nImmobilization in hospitalized medical patients or during simulation of spaceflight induced deconditioning has been shown to be associated with loss of muscle mass and bone. Resistance vibrating exercise (RVE) and/or high protein diet are countermeasures, which are capable of mitigating the adverse effects of immobilization. We investigated the effect of these countermeasures on the coagulation system. Two groups of volunteers, each of whom performed such countermeasures, were enrolled in the study. Volunteers, who did nothing while bed rested, served as controls. The berest and the intervention protocols were carried out at Clinique d' Investigation, MEDES, Toulouse, France. Eleven healthy men volunteered for this randomized crossover study. The subjects underwent 21 day of 6° head down bed rest (HDBR) followed by a washout period of 4 months. The first group followed an exercise schedule using resistance-vibrating exercise (RVE group). The second group also used the RVE but complemented it with high-protein supplement diet (NeX group). The third group only did bed rest. The highly sensitive methods calibrated automated thrombography (CAT) and thrombelastometry (TEM) were applied to monitor hemostatic changes. In all 3 groups, the hemostatic system shifted toward hypocoagulability during bed rest. For example, peak and thrombin formation velocity (VELINDEX) reduced in this period. Interestingly, a tendency toward hypercoagulation was observed during re-ambulation. In all 3 groups, ttPeak and StartTail were reduced, and Peak and VELINDEX (except in the RVE group) were significantly higher in relation to baseline values. Influence of bed rest on the coagulation system in the 2 groups performing countermeasures (RVE and NeX group) was the same as in the control bed-rested group. Clotting does not seem to be worsened by prolonged immobilization, or by countermeasures such as RVE/exercise or high-protein supplementation during immobilization. Therefore, only hospitalized medical patients at an elevated risk for thrombosis should be treated with anticoagulants. However, clinicians have to be aware that the re-ambulation period following immobilization might be associated with an elevated risk of thrombotic events.\n\nCvirn, Gerhard\n\nGoswami, Nandu\n\nHinghofer-Szalkay, Helmut\n\nKoestenberger, Martin\n\nReibnegger, Gilbert\n\nRoller-Wirnsberger, Regina\n\nSchlagenhauf, Axel\n\nWaha, James Elvis\n\n\n"
},
{
"text": "\n148787\nEvidence- and consensus-based (S3) Guidelines for the Treatment of Actinic Keratosis - International League of Dermatological Societies in cooperation with the European Dermatology Forum - Short version.\n\nWerner, RN\n\nStockfleth, E\n\nConnolly, SM\n\nCorreia, O\n\nErdmann, R\n\nFoley, P\n\nGupta, AK\n\nJacobs, A\n\nKerl, H\n\nLim, HW\n\nMartin, G\n\nPaquet, M\n\nPariser, DM\n\nRosumeck, S\n\nRöwert-Huber, HJ\n\nSahota, A\n\nSangueza, OP\n\nShumack, S\n\nSporbeck, B\n\nSwanson, NA\n\nTorezan, L\n\nNast, A\n\nInternational League of Dermatological Societies\n\nEuropean Dermatology Forum\n\nBeiträge in Fachzeitschriften\nISI:000363983000002\n26370093.0\n10.1111/jdv.13180\nNone\nActinic keratosis (AK) is a frequent health condition attributable to chronic exposure to ultraviolet radiation. Several treatment options are available and evidence based guidelines are missing.\n The goal of these evidence- and consensus-based guidelines was the development of treatment recommendations appropriate for different subgroups of patients presenting with AK. A secondary aim of these guidelines was the implementation of knowledge relating to the clinical background of AK, including consensus-based recommendations for the histopathological definition, diagnosis and the assessment of patients.\n The guidelines development followed a pre-defined and structured process. For the underlying systematic literature review of interventions for AK, the methodology suggested by the Cochrane Handbook for Systematic Reviews of Interventions, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was adapted. All recommendations were consented during a consensus conference using a formal consensus methodology. Strength of recommendations was expressed based on the GRADE approach. If expert opinion without external evidence was incorporated into the reasoning for making a certain recommendation, the rationale was provided. The Guidelines underwent open public review and approval by the commissioning societies.\n Various interventions for the treatment of AK have been assessed for their efficacy. The consenting procedure led to a treatment algorithm as shown in the guidelines document. Based on expert consensus, the present guidelines present recommendations on the classification of patients, diagnosis and histopathological definition of AK. Details on the methods and results of the systematic literature review and guideline development process have been published separately.\n International guidelines are intended to be adapted to national or regional circumstances (regulatory approval, availability and reimbursement of treatments).\n © 2015 European Academy of Dermatology and Venereology.\n\nKerl, Helmut\n\n\n"
},
{
"text": "\n163518\nLoss of SMAD3 Promotes Vascular Remodeling in Pulmonary Arterial Hypertension via MRTF Disinhibition.\n\nZabini, D\n\nGranton, E\n\nHu, Y\n\nMiranda, MZ\n\nWeichelt, U\n\nBreuils Bonnet, S\n\nBonnet, S\n\nMorrell, NW\n\nConnelly, KA\n\nProvencher, S\n\nGhanim, B\n\nKlepetko, W\n\nOlschewski, A\n\nKapus, A\n\nKuebler, WM\n\nBeiträge in Fachzeitschriften\nISI:000422820200017\n29095649.0\n10.1164/rccm.201702-0386OC\nNone\nVascular remodeling in pulmonary arterial hypertension (PAH) results from smooth muscle cell hypertrophy and proliferation of vascular cells. Loss of BMPR-II (bone morphogenetic protein receptor 2) signaling and increased signaling via TGF-β (transforming growth factor β) and its downstream mediators SMAD (small body size [a C. elegans protein] mothers against decapentaplegic [a Drosophila protein family])-2/3 has been proposed to drive lung vascular remodeling; yet, proteomic analyses indicate a loss of SMAD3 in PAH.\n We proposed that SMAD3 may be dysregulated in PAH and that loss of SMAD3 may present a pathophysiological master switch by disinhibiting its interaction partner, MRTF (myocardin-related transcription factor), which drives muscle protein expression.\n SMAD3 levels were measured in lungs from PAH patients, rats treated either with Sugen/hypoxia or monocrotaline (MCT), and in mice carrying a BMPR2 mutation. In vitro, effects of SMAD3 or BMPR2 silencing or SMAD3 overexpression on cell proliferation or smooth muscle hypertrophy were assessed. In vivo, the therapeutic and prophylactic potential of CCG1423, an inhibitor of MRTF, was investigated in Sugen/hypoxia rats.\n SMAD3 was downregulated in lungs of patients with PAH and in pulmonary arteries of three independent PAH animal models. TGF-β treatment replicated the loss of SMAD3 in human pulmonary artery smooth muscle cells (huPASMCs) and human pulmonary artery endothelial cells. SMAD3 silencing increased proliferation and migration in huPASMCs and human pulmonary artery endothelial cells. Coimmunoprecipitation revealed reduced interaction of MRTF with SMAD3 in TGF-β-treated huPASMCs and pulmonary arteries of PAH animal models. In huPASMCs, loss of SMAD3 or BMPR-II increased smooth muscle actin expression, which was attenuated by MRTF inhibition. Conversely, SMAD3 overexpression prevented TGF-β-induced activation of an MRTF reporter and reduced actin stress fibers in BMPR2-silenced huPASMCs. MRTF inhibition attenuated PAH and lung vascular remodeling in Sugen/hypoxia rats.\n Loss of SMAD3 presents a novel pathomechanism in PAH that promotes vascular cell proliferation and-via MRTF disinhibition-hypertrophy of huPASMCs, thereby reconciling the parallel induction of a synthetic and contractile huPASMC phenotype.\n\nOlschewski, Andrea\n\nZabini, Diana\n\n\n"
},
{
"text": "\n163578\nFractional flow reserve in below the knee arteries with critical limb ischemia and validation against gold-standard morphologic, functional measures and long term clinical outcomes.\n\nRuzsa, Z\n\nRóna, S\n\nTóth, GG\n\nSótonyi, P\n\nBertrand, OF\n\nNemes, B\n\nMerkely, B\n\nHüttl, K\n\nBeiträge in Fachzeitschriften\nISI:000430282300008\n28866449.0\n10.1016/j.carrev.2017.07.007\nNone\nThe aim of this study was to assess the applicability of fractional flow reserve measurement (FFR) in below-the-knee (BTK) arteries and to evaluate its correlation with non-invasive functional parameters before and after angioplasty.\n We enrolled 39 patients with severe BTK arterial lesions. Inclusion criteria were critical limb ischemia (Rutherford 4-6) and angiographically proven arterial stenosis of the distal lower limb (percent diameter stenosis ≥70%). Exclusion criteria were chronic total occlusion, diabetic foot syndrome and non-viable distal lower limb. The transstenotic distal/proximal pressure ratio was measured under resting (Pd/Pa) and hyperemic (FFR) conditions induced by 40mg intra-arterial Papaverin and was compared with quantitative angiography-, laser Doppler- and duplex ultrasound-derived measurements before and after percutaneous angioplasty (PTA).\n Comparing measurements before and after PTA, we found significant improvements in the resting Pd/Pa values (0.79 [0.67-0.90] vs 0.90 [0.85-0.97]; p<0.001) and FFR values (0.60±0.19 vs 0.76±0.15; p<0.001), respectively. At baseline, Pd/Pa ratio and FFR were significantly albeit weakly correlated with % area stenosis (r:-0.31, p=0.05 and r:-0.31, p=0.05, respectively). After PTA, neither Pd/Pa nor FFR remained correlated with % area stenosis. Similarly, prior PTA, Pd/Pa ratio and FFR were significantly correlated with TcO2% and perfusion unit change (r:0.48, p<0.01 and r:0.34, p<0.05, respectively), but after intervention, these significant correlations vanished. Pd/Pa and FFR values did not show correlation with duplex ultrasound-derived measurements. At 1year, major adverse events (MAEs) and major adverse cardiovascular and cerebrovascular (MACCEs) were observed in 7 (17.9%) and in 9 (23.1%) patients, respectively.\n CLI due to severe BTK arterial disease was associated with several impediments of baseline pressure measurements which were significantly improved after successful PTA and stenting. Significant relationships between pressure data and functional and imaging parameters existed prior intervention but vanished after. Further studies are required to determine the clinical value of pre- and post-PTA pressure measurements in BTK arterial disease.\n Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.\n\nToth-Gayor, Gabor\n\n\n"
},
{
"text": "\n168443\nMalignancy and mortality in paediatric-onset inflammatory bowel disease: a 3-year prospective, multinational study from the paediatric IBD Porto group of ESPGHAN.\n\nJoosse, ME\n\nAardoom, MA\n\nKemos, P\n\nTurner, D\n\nWilson, DC\n\nKoletzko, S\n\nMartin-de-Carpi, J\n\nFagerberg, UL\n\nSpray, C\n\nTzivinikos, C\n\nSladek, M\n\nShaoul, R\n\nRoma-Giannikou, E\n\nBronsky, J\n\nSerban, DE\n\nRuemmele, FM\n\nGarnier-Lengline, H\n\nVeres, G\n\nHojsak, I\n\nKolho, KL\n\nDavies, IH\n\nAloi, M\n\nLionetti, P\n\nHussey, S\n\nVeereman, G\n\nBraegger, CP\n\nTrindade, E\n\nWewer, AV\n\nHauer, AC\n\nde Vries, ACH\n\nSigall Boneh, R\n\nSarbagili Shabat, C\n\nLevine, A\n\nde Ridder, L\n\nPaediatric IBD Porto group of ESPGHAN\n\nBeiträge in Fachzeitschriften\nISI:000441233600003\n29984520.0\n10.1111/apt.14893\nNone\nRisk benefit strategies in managing inflammatory bowel diseases (IBD) are dependent upon understanding the risks of uncontrolled inflammation vs those of treatments. Malignancy and mortality in IBD have been associated with disease-related inflammation and immune suppression, but data are limited due to their rare occurrence.\n To identify and describe the most common causes of mortality, types of cancer and previous or current therapy among children and young adults with paediatric-onset IBD.\n Information on paediatric-onset IBD patients diagnosed with malignancy or mortality was prospectively collected via a survey in 25 countries over a 42-month period. Patients were included if death or malignancy occurred after IBD diagnosis but before the age of 26 years.\n In total, 60 patients were identified including 43 malignancies and 26 fatal cases (9 due to cancer). Main causes of fatality were malignancies (n = 9), IBD or IBD-therapy related nonmalignant causes (n = 10; including 5 infections), and suicides (n = 3). Three cases, all fatal, of hepatosplenic T-cell lymphoma were identified, all were biologic-naïve but thiopurine-exposed. No other haematological malignancies were fatal. The 6 other fatal cancer cases included 3 colorectal adenocarcinomas and 3 cholangiocarcinomas (CCAs). Primary sclerosing cholangitis (PSC) was present in 5 (56%) fatal cancers (1 colorectal carcinoma, 3 CCAs and 1 hepatosplenic T-cell lymphoma).\n We report the largest number of paediatric-onset IBD patients with cancer and/or fatal outcomes to date. Malignancies followed by infections were the major causes of mortality. We identified PSC as a significant risk factor for cancer-associated mortality. Disease-related adenocarcinomas were a commoner cause of death than lymphomas.\n © 2018 John Wiley & Sons Ltd.\n\nHauer, Almuthe\n\n\n"
},
{
"text": "\n181110\nMedial minimally invasive helical plate osteosynthesis of the distal femur - a new technique.\n\nHohenberger, GM\n\nSchwarz, AM\n\nGrechenig, P\n\nClement, B\n\nStaresinic, M\n\nBakota, B\n\nBeiträge in Fachzeitschriften\nNone\n32067767.0\n10.1016/j.injury.2020.02.051\nNone\nThe goal of this study was to evaluate distal femoral minimally invasive plate osteosynthesis (MIPO) from a distal medial approach by use of a pre-bent helical implant.\n A total of 18 lower extremities was evaluated. A 29.6 cm steel plate was constructed and pre-bent on bone specimens with a torsion of 55.7° A 5 cm incision was performed from the tip of the medial epicondyle alongside its centre in a proximal direction. The medial border of the vastus medialis was retracted anteriorly. The level of the proximal skin incision was determined using the length of the pre-bent plates. The proximal incision was performed at a length of 4 cm at the described height at a line between the lateral epicondyle and the tip of the greater trochanter. A raspatory was advanced beneath the vastus medialis in a proximal direction to create an extraperiosteal tunnel for plate insertion. The plate was fixed to the bone at its proximal and distal portion via screws. Following dissection, the distance between the nearest perforator to the proximal plate end was evaluated. The vertical distances between the medial border of the plate and the femoral artery and femoral nerve were measured at the level of the proximal plate end and at the level of the proximal margin of the vastoadductor membrane.\n The most proximal perforating artery was located at a mean distance of 20.15 mm starting from the proximal plate margin. The mean interval between the medial border of the plate at the level of its proximal tip and the femoral artery was 51.9 mm. The average distance between the femoral nerve and the medial border of the proximal part of the plate was 42.3 mm. Regarding the interval between the medial border of the plate and the femoral artery, this was at a mean of 40.5 mm at the level of the proximal margin of the vastoadductor membrane. During dissection, none of the specimens showed any lesions of the adjacent anatomical characteristics.\n Our results indicate MIPO of the distal femur from a medial approach as a safe technique.\n Copyright © 2020 Elsevier Ltd. All rights reserved.\n\nHohenberger, Gloria\n\nSchwarz, Angelika\n\n\n"
},
{
"text": "\n183611\nThe 'double transition': a novel electrocardiogram sign to discriminate posteroseptal accessory pathways ablated from the right endocardium from those requiring a left-sided or epicardial coronary venous approach.\n\nPascale, P\n\nHunziker, S\n\nDenis, A\n\nGómez Flores, JR\n\nRoten, L\n\nShah, AJ\n\nScherr, D\n\nKomatsu, Y\n\nRamoul, K\n\nDaly, M\n\nLeBloa, M\n\nPruvot, E\n\nDerval, N\n\nSacher, F\n\nHocini, M\n\nJaïs, P\n\nHaïssaguerre, M\n\nBeiträge in Fachzeitschriften\nISI:000593357300017\n32984869.0\n10.1093/europace/euaa200\nNone\nThe precise localization of manifest posteroseptal accessory pathways (APs) often poses diagnostic challenges considering that a small area may encompass AP that may be ablated from the right or left endocardium, or epicardially within the coronary sinus (CS). We sought to explore whether the QRS transition pattern in the precordial lead may help to discriminate the necessary ablation approach.\n Consecutive patients who underwent a successful ablation of a single manifest AP over a 5-year period were included. Standard 12-lead electrocardiograms were reviewed. A total of 273 patients were identified. Mean age was 31 ± 15 years and 62% were male. Of the 110 identified posteroseptal AP, 64 were ablated from the right endocardium, 33 from the left endocardium, and 13 inside the CS. While a normal precordial QRS transition was most often observed, a subset of 33 patients presented an atypical 'double transition' pattern which specifically identified right endocardial AP. The combination of a q wave in V1 with a proportion of the positive QRS component in V1 < V2 > V3, predicted a right endocardial AP with a 100% specificity. In case of a positive QRS sum in V2, this 'double transition' pattern predicted a posteroseptal right endocardial AP with 99.5% specificity and 44% sensitivity. The positive predictive value was 97%. The only false positive was a midseptal AP. In the case of a negative or isoelectric QRS sum in V2, APs were located more laterally on the tricuspid annulus.\n The combination of a q wave in V1 with a double QRS transition pattern in the precordial leads is highly specific of a right endocardial AP and rules out the need for CS or left-sided mapping.\n Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.\n\nScherr, Daniel\n\n\n"
},
{
"text": "\n184925\nComparison of nab-paclitaxel plus gemcitabine in elderly versus younger patients with metastatic pancreatic cancer: Analysis of a multicentre, prospective, non-interventional study.\n\nPrager, GW\n\nOehler, L\n\nGerger, A\n\nMlineritsch, B\n\nAndel, J\n\nPetzer, A\n\nWilthoner, K\n\nSliwa, T\n\nPichler, P\n\nWinder, T\n\nHeibl, S\n\nGruenberger, B\n\nLaengle, F\n\nHubmann, E\n\nKorger, M\n\nPecherstorfer, M\n\nDjanani, A\n\nNeumann, HJ\n\nPhilipp-Abbrederis, K\n\nWöll, E\n\nTrondl, R\n\nArnold-Schrauf, C\n\nEisterer, W\n\nBeiträge in Fachzeitschriften\nISI:000604902700015\n33296830.0\n10.1016/j.ejca.2020.11.003\nNone\nPancreatic cancer (PC) ranks among the deadliest malignancies worldwide. In the MPACT study, first-line nab-paclitaxel plus gemcitabine (nab-P/G) demonstrated activity (median overall survival [OS], 8.7 months) and tolerability in patients with metastatic PC (mPC). However, the clinical evidence of nab-P/G in the elderly (>70 years), who account for the majority of patients with mPC, is limited. This is the first prospective, multicentre, non-interventional study evaluating the tolerability and effectiveness of nab-P/G in younger (≤70 years) versus elderly (>70 years) patients with mPC in the daily clinical routine.\n Eligible patients with mPC were treated with nab-P/G and observed until disease progression or unacceptable toxicity. The primary objectives were safety and tolerability of nab-P/G, and the secondary objectives were efficacy and real-life dosing.\n A total of 317 patients with mPC (median age, 70 years) were recruited, of which 299, aged ≤70 (n = 162) and >70 (n = 137) years, were eligible for analysis. Baseline characteristics and the safety profile were comparable between the groups. However, fatigue (22.8% versus 13.0%) and decreased appetite (8.8% versus 1.2%) were more frequent in elderly patients. Younger versus elderly patients equally benefited in terms of objective response rate (36% versus 48%), median progression-free survival (5.6 versus 5.5 months; hazard ratio [HR] = 1.03; p = 0.81) and OS (10.6 versus 10.2 months; HR = 0.89; p = 0.4). In addition, the median treatment duration (5 versus 4 cycles), relative dose intensity (70% versus 74%) or reasons for treatment discontinuation were similar. Most patients (56.2% versus 47.4%) benefited from a second-line therapy.\n This prospective real-world analysis confirms the feasibility and tolerability of nab-P/G treatment and reveals OS data similar for younger patients and elderly patients aged >70 years. CLINICALTRIALS.\n NCT02555813.\n NIS005071.\n Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.\n\nGerger, Armin\n\n\n"
},
{
"text": "\n186908\nClinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy.\n\nTemplin, C\n\nGhadri, JR\n\nDiekmann, J\n\nNapp, LC\n\nBataiosu, DR\n\nJaguszewski, M\n\nCammann, VL\n\nSarcon, A\n\nGeyer, V\n\nNeumann, CA\n\nSeifert, B\n\nHellermann, J\n\nSchwyzer, M\n\nEisenhardt, K\n\nJenewein, J\n\nFranke, J\n\nKatus, HA\n\nBurgdorf, C\n\nSchunkert, H\n\nMoeller, C\n\nThiele, H\n\nBauersachs, J\n\nTschöpe, C\n\nSchultheiss, HP\n\nLaney, CA\n\nRajan, L\n\nMichels, G\n\nPfister, R\n\nUkena, C\n\nBöhm, M\n\nErbel, R\n\nCuneo, A\n\nKuck, KH\n\nJacobshagen, C\n\nHasenfuss, G\n\nKarakas, M\n\nKoenig, W\n\nRottbauer, W\n\nSaid, SM\n\nBraun-Dullaeus, RC\n\nCuculi, F\n\nBanning, A\n\nFischer, TA\n\nVasankari, T\n\nAiraksinen, KE\n\nFijalkowski, M\n\nRynkiewicz, A\n\nPawlak, M\n\nOpolski, G\n\nDworakowski, R\n\nMacCarthy, P\n\nKaiser, C\n\nOsswald, S\n\nGaliuto, L\n\nCrea, F\n\nDichtl, W\n\nFranz, WM\n\nEmpen, K\n\nFelix, SB\n\nDelmas, C\n\nLairez, O\n\nErne, P\n\nBax, JJ\n\nFord, I\n\nRuschitzka, F\n\nPrasad, A\n\nLüscher, TF\n\nBeiträge in Fachzeitschriften\nISI:000360439500008\n26332547.0\n10.1056/NEJMoa1406761\nNone\nThe natural history, management, and outcome of takotsubo (stress) cardiomyopathy are incompletely understood.\n The International Takotsubo Registry, a consortium of 26 centers in Europe and the United States, was established to investigate clinical features, prognostic predictors, and outcome of takotsubo cardiomyopathy. Patients were compared with age- and sex-matched patients who had an acute coronary syndrome.\n Of 1750 patients with takotsubo cardiomyopathy, 89.8% were women (mean age, 66.8 years). Emotional triggers were not as common as physical triggers (27.7% vs. 36.0%), and 28.5% of patients had no evident trigger. Among patients with takotsubo cardiomyopathy, as compared with an acute coronary syndrome, rates of neurologic or psychiatric disorders were higher (55.8% vs. 25.7%) and the mean left ventricular ejection fraction was markedly lower (40.7±11.2% vs. 51.5±12.3%) (P<0.001 for both comparisons). Rates of severe in-hospital complications including shock and death were similar in the two groups (P=0.93). Physical triggers, acute neurologic or psychiatric diseases, high troponin levels, and a low ejection fraction on admission were independent predictors for in-hospital complications. During long-term follow-up, the rate of major adverse cardiac and cerebrovascular events was 9.9% per patient-year, and the rate of death was 5.6% per patient-year.\n Patients with takotsubo cardiomyopathy had a higher prevalence of neurologic or psychiatric disorders than did those with an acute coronary syndrome. This condition represents an acute heart failure syndrome with substantial morbidity and mortality. (Funded by the Mach-Gaensslen Foundation and others; ClinicalTrials.gov number, NCT01947621.).\n\nJenewein, Josef\n\n\n"
},
{
"text": "\n187022\nXAOM: A method for automatic alignment and orientation of radiographs for computer-aided medical diagnosis.\n\nHržić, F\n\nTschauner, S\n\nSorantin, E\n\nŠtajduhar, I\n\nBeiträge in Fachzeitschriften\nISI:000649716300001\n33714842.0\n10.1016/j.compbiomed.2021.104300\nNone\nComputer-aided diagnosis relies on machine learning algorithms that require filtered and preprocessed data as the input. Aligning the image in the desired direction is an additional manual step in post-processing, commonly overlooked due to workload issues. Several state-of-the-art approaches for fracture detection and disease-struck region segmentation benefit from correctly oriented images, thus requiring such preprocessing of X-ray images. Furthermore, it is desirable to have archived studies in a standardized format. Radiograph hanging protocols also differ from case to case, which means that images are not always aligned and oriented correctly. As a solution, the paper proposes XAOM, an X-ray Alignment and Orientation Method for images from 21 different body regions.\n Typically, other methods are crafted for this purpose to suit a specific body region and form of usage. In contrast, the method proposed in this paper is comprehensive and easily tuned to align and orient X-ray images of any body region. XAOM consists of two stages. For the first stage of the method, aligning X-ray images, we experimented with the following approaches: Hough transform, Fast line detection algorithm, and Principal Component Analysis method. For the second stage, we have experimented with the adaptations of several well known convolutional neural network topologies for correctly predicting image orientation: LeNet5, AlexNet, VGG16, VGG19, and ResNet50.\n In the first stage, the PCA-based approach performed best. The average difference between the angle detected by the algorithm and the angle marked by the experts on the test set containing 200 pediatric X-ray images was 1.65∘, while the median value was 0.11∘. In the second stage, the VGG16-based network topology achieved the best accuracy of 0.993 on a test set containing 4, 21 images.\n XAOM is highly accurate at aligning and orienting pediatric X-ray images of 21 common body regions according to a set standard. The proposed method is also robust and can be easily adjusted to the different alignment and rotation criteria.\n The Python source code of the best performing implementation of XAOM is publicly available at https://github.com/fhrzic/XAOM.\n Copyright © 2021 Elsevier Ltd. All rights reserved.\n\nSorantin, Erich\n\nTschauner, Sebastian\n\n\n"
},
{
"text": "\n397\nCardiac output and urea kinetics in dialysis patients: evidence supporting the regional blood flow model.\n\nGeorge, TO\n\nPriester-Coary, A\n\nDunea, G\n\nSchneditz, D\n\nTarif, N\n\nDaugirdas, JT\n\nBeiträge in Fachzeitschriften\nISI:A1996VJ31400025\n8887288.0\n10.1038/ki.1996.438\nNone\nThe regional blood flow model predicts that urea sequestration occurs in organs rather than cells, and that post-dialysis urea rebound is a function of both cardiac index (CI) and regional blood flow distribution to muscle. We measured cardiac output (CO) in 100 randomly selected dialysis patients using bioelectric impedance three times during a single dialysis. Mean CO was 5.8 +/- 2.1 liter/min and CI averaged 3.1 +/- 1.1 liter/min/M2. CI was negatively correlated with age (r = -0.48, P < 0.01). CI was strongly affected by vasodilator ingestion (yes, N = 36, CI = 3.5 +/- 1.2; no, N = 64, CI = 2.88 +/- 0.92, P < 0.006). CI was not associated with systolic, diastolic, or mean blood pressures, nor with Hct, although very few severely anemic patients were in the cohort. Repeat intra-dialytic CO measurements two to three months later in 15 patients with low CI (2.59 +/- 0.59 liter/min/M2) and in 13 patients with high CI (5.00 +/- 0.9, P < 0.001) during a urea kinetic modeling session including 30 minutes post-dialysis rebound, sampling showed highly reproducible values for CO, with a mean absolute value % difference between CO values measured several months apart of 9.0 +/- 17%, r = 0.92. Urea rebound expressed as the difference (delta Kt/V30) between equilibrated and single-pool Kt/V was lower in the high CI group (-0.099 +/- 0.07) than in the low CI group (-0.16 +/- 0.06, P = 0.026), and delta KT/V30 as well as delta Kt/V30 divided by K/V correlated with CI (r = 0.48 and 0.48, respectively, P < 0.01). The RBF model was used to compute a group mean predicted delta Kt/V30 for the low CI and high CI groups based on measured group mean values for CI and K/V. The predicted delta Kt/V30 values for the high CI group (-0.097) and the low CI group (-0.183) agreed closely with measured values. RBF modeled values of CO (7.46 +/- 2.96 liter/min) were not significantly different from impedance-derived CO (6.93 +/- 2.70 liter/min), and the two CO measures correlated significantly (r = 0.63, P = 0.0003). The results provide support for the regional blood flow model of urea kinetics.\n\nSchneditz, Daniel\n\n\n"
},
{
"text": "\n1311\nIncreased neopterin in patients with chronic and acute coronary syndromes.\n\nSchumacher, M\n\nHalwachs, G\n\nTatzber, F\n\nFruhwald, FM\n\nZweiker, R\n\nWatzinger, N\n\nEber, B\n\nWilders-Truschnig, M\n\nEsterbauer, H\n\nKlein, W\n\nBeiträge in Fachzeitschriften\nISI:A1997XT43600016\n9283529.0\n10.1016/S0735-1097(97)00172-1\nNone\nThe aim of our study was to determine neopterin levels in patients with chronic and acute coronary syndromes.\n In chronic and acute coronary syndromes the release of different cytokines activates cellular defense. Infiltration of neutrophils and monocytes/macrophages is detected in the vessel wall as well as in the myocardium. Neopterin, which is a by-product of the guanosine triphosphate-biopterin pathway, is a marker for those activated macrophages.\n We studied 123 subjects: 1) 21 consecutive patients (17 men, 4 women; mean age +/- SD 66 +/- 15 years, range 31 to 87) with acute myocardial infarction (AMI); 2) 62 consecutive patients (50 men, 12 women; mean age 61 +/- 8 years, range 43 to 81) with signs and symptoms of clinically stable coronary artery disease (CAD); and 3) 40 healthy blood donors (28 men, 12 women; mean age 35 +/- 13 years). Neopterin levels were determined with a commercially available enzyme-linked immunosorbent assay method.\n In patients with AMI before thrombolytic therapy, neopterin levels were significantly higher than levels in patients with CAD and control subjects (13.7 vs. 8.6 and vs. 6.8 nmol/liter, p < 0.0001). Values also differed significantly between patients with CAD and control subjects (p < 0.0001). Neopterin levels in patients with AMI were measured seven times during a 72-h period. Within-group comparison showed significant differences over this period (p < 0.00001). The lowest value (11.4 nmol/liter) was observed after 4 h and differed significantly from the initial value and values after 24 and 72 h (p < 0.05). After 72 h, neopterin increased to 14.9 nmol/liter, a value significantly different from all values other than the initial one. There was no correlation between neopterin and creatine kinase (CK); CK, MB isoenzyme; or lactate dehydrogenase as markers for the extent of the myocardial infarction during the observation period.\n Our data support the hypothesis of an activation of monocytes and macrophages in patients with an acute or chronic coronary syndrome. Neopterin as a marker for macrophage activation is significantly increased in patients with chronic CAD and more pronounced in patients with AMI shortly after the onset of symptoms.\n\nFruhwald, Friedrich\n\nSchumacher, Martin\n\nTatzber, Franz\n\nWatzinger, Norbert\n\nZweiker, Robert\n\n\n"
}
]
}