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"text": "\n171735\nAnalysis of Social Determinants of Health and Disability Scores in Leprosy-Affected Persons in Salem, Tamil Nadu, India.\n\nHeidinger, M\n\nSimonnet, E\n\nKarippadathu, SF\n\nPuchinger, M\n\nPfeifer, J\n\nGrisold, A\n\nBeiträge in Fachzeitschriften\nISI:000456527000160\n30563301.0\n10.3390/ijerph15122769\nNone\nA consistent relationship has been found between leprosy and inequities in social determinants of health. It, however, remains unclear which aspect of these social determinants contributes most to the risk of infection, and even less clear are the risk factors for the development of leprosy-related disabilities. The objective of this study was to elicit the differential impact of social determinants of health in leprosy-affected persons, and determine whether structural inequities in accessibility to societal resources and lower socioeconomic parameters correlated with higher severity of disabilities. This analysis was based on a sampled population affected by leprosy in Salem, Tamil Nadu, India. Persons enrolled in the study were covered by a nongovernmental lifelong care program, had completed a multidrug therapy for leprosy and/or were slit-skin-smear negative, and showed Grade 1 or higher disabilities due to leprosy. Multiple stepwise linear regression analysis was performed. The Eyes-Hands-Feet (EHF) score was the outcome variable, and gender, age, time after release from treatment, monthly income, and living space were explanatory variables. There were 123 participants, comprised of 41 (33.33%) women and 82 (66.67%) men. All study participants belonged to India's Backward classes; 81.30% were illiterate and the average monthly income was 1252 Indian rupee (INR) (US$19.08 or €17.16). The average EHF score was 7.016 (95% CI, 6.595 to 7.437). Stepwise multiple linear regression analysis built a significant model, where F(2, 120) = 13.960, p ≤ 0.001, effect size (Cohen's f2) = 0.81, explaining 18.9% of the variance in EHF scores (R² = 0.189). Significant predictors of a higher EHF score in persons affected by leprosy were found to be higher age (beta = 0.340, 95% CI, 0.039 to 0.111, p < 0.001), as well as less living space (beta = -0.276, 95% CI, -0.041 to -0.011, p = 0.001). Our results suggest that inequalities in social determinants of health correspond to higher disability scores, which indicates that poor living standards are a common phenomenon in those living with leprosy-related disabilities. Further research is needed to dissect the exact development of impairments after release from treatment (RFT) in order to take targeted actions against disability deterioration.\n\nGrisold, Andrea\n\nPfeifer, Johann\n\nPuchinger, Markus\n\n\n"
},
{
"text": "\n174870\nAssessment of Muscle Function and Physical Performance in Daily Clinical Practice : A position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).\n\nBeaudart, C\n\nRolland, Y\n\nCruz-Jentoft, AJ\n\nBauer, JM\n\nSieber, C\n\nCooper, C\n\nAl-Daghri, N\n\nAraujo de Carvalho, I\n\nBautmans, I\n\nBernabei, R\n\nBruyère, O\n\nCesari, M\n\nCherubini, A\n\nDawson-Hughes, B\n\nKanis, JA\n\nKaufman, JM\n\nLandi, F\n\nMaggi, S\n\nMcCloskey, E\n\nPetermans, J\n\nRodriguez Mañas, L\n\nReginster, JY\n\nRoller-Wirnsberger, R\n\nSchaap, LA\n\nUebelhart, D\n\nRizzoli, R\n\nFielding, RA\n\nBeiträge in Fachzeitschriften\nISI:000469477400001\n30972475.0\n10.1007/s00223-019-00545-w\nNone\nIt is well recognized that poor muscle function and poor physical performance are strong predictors of clinically relevant adverse events in older people. Given the large number of approaches to measure muscle function and physical performance, clinicians often struggle to choose a tool that is appropriate and validated for the population of older people they deal with. In this paper, an overview of different methods available and applicable in clinical settings is proposed. This paper is based on literature reviews performed by members of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) working group on frailty and sarcopenia. Face-to-face meetings were organized afterwards where the whole group could amend and discuss the recommendations further. Several characteristics should be considered when choosing a tool: (1) purpose of the assessment (intervention, screening, diagnosis); (2) patient characteristics (population, settings, functional ability, etc.); (3) psychometric properties of the tool (test-retest reliability, inter-rater reliability, responsiveness, floor and ceiling effects, etc.); (4) applicability of the tool in clinical settings (overall cost, time required for the examination, level of training, equipment, patient acceptance, etc.); (5) prognostic reliability for relevant clinical outcomes. Based on these criteria and the available evidence, the expert group advises the use of grip strength to measure muscle strength and the use of 4-m gait speed or the Short Physical Performance Battery test to measure physical performance in daily practice. The tools proposed are relevant for the assessment of muscle weakness and physical performance. Subjects with low values should receive additional diagnostic workups to achieve a full diagnosis of the underlying condition responsible (sarcopenia, frailty or other).\n\nRoller-Wirnsberger, Regina\n\n\n"
},
{
"text": "\n177752\nAlgorithm for the Use of Biochemical Markers of Bone Turnover in the Diagnosis, Assessment and Follow-Up of Treatment for Osteoporosis.\n\nLorentzon, M\n\nBranco, J\n\nBrandi, ML\n\nBruyère, O\n\nChapurlat, R\n\nCooper, C\n\nCortet, B\n\nDiez-Perez, A\n\nFerrari, S\n\nGasparik, A\n\nHerrmann, M\n\nJorgensen, NR\n\nKanis, J\n\nKaufman, JM\n\nLaslop, A\n\nLocquet, M\n\nMatijevic, R\n\nMcCloskey, E\n\nMinisola, S\n\nPikner, R\n\nReginster, JY\n\nRizzoli, R\n\nSzulc, P\n\nVlaskovska, M\n\nCavalier, E\n\nBeiträge in Fachzeitschriften\nISI:000488950000018\n31440982.0\n10.1007/s12325-019-01063-9\nPMC6822833\nIncreased biochemical bone turnover markers (BTMs) measured in serum are associated with bone loss, increased fracture risk and poor treatment adherence, but their role in clinical practice is presently unclear. The aim of this consensus group report is to provide guidance to clinicians on how to use BTMs in patient evaluation in postmenopausal osteoporosis, in fracture risk prediction and in the monitoring of treatment efficacy and adherence to osteoporosis medication.\n A working group with clinical scientists and osteoporosis specialists was invited by the Scientific Advisory Board of European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).\n Serum bone formation marker PINP and resorption marker βCTX-I are the preferred markers for evaluating bone turnover in the clinical setting due to their specificity to bone, performance in clinical studies, wide use and relatively low analytical variability. BTMs cannot be used to diagnose osteoporosis because of low sensitivity and specificity, but can be of value in patient evaluation where high values may indicate the need to investigate some causes of secondary osteoporosis. Assessing serum levels of βCTX-I and PINP can improve fracture prediction slightly, with a gradient of risk of about 1.2 per SD increase in the bone marker in addition to clinical risk factors and bone mineral density. For an individual patient, BTMs are not useful in projecting bone loss or treatment efficacy, but it is recommended that serum PINP and βCTX-I be used to monitor adherence to oral bisphosphonate treatment. Suppression of the BTMs greater than the least significant change or to levels in the lower half of the reference interval in young and healthy premenopausal women is closely related to treatment adherence.\n In conclusion, the currently available evidence indicates that the principal clinical utility of BTMs is for monitoring oral bisphosphonate therapy.\n\nHerrmann, Markus\n\n\n"
},
{
"text": "\n179404\nMind the gap: Incidence of osteoporosis treatment after an osteoporotic fracture - Results of the Austrian branch of the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS).\n\nMalle, O\n\nBorgstroem, F\n\nFahrleitner-Pammer, A\n\nSvedbom, A\n\nDimai, SV\n\nDimai, HP\n\nBeiträge in Fachzeitschriften\nISI:000601337400002\n31593822.0\n10.1016/j.bone.2019.115071\nNone\nDespite availability of effective treatment options proven to prevent osteoporotic fractures, a huge gap in osteoporosis treatment exists. The aim of the present study was to evaluate the treatment rate after a major osteoporotic fracture (MOF) in Austria, one of the 25 wealthiest countries worldwide.\n This analysis is based on the data of the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS), a prospective observational study assessing data from patients who suffered a MOF. We stratified these patients by treatment status at time of fracture and compared treatment use following MOF by sex as well as by fracture sites at the time of the index fracture, and 4, 12, and 18 months thereafter. Descriptive statistics, t-tests for continuous variables and chi-squared tests for nominal variables, were performed to compare treatment groups.\n A total of 915 patients (78% female) were recruited at 8 different trauma centers throughout Austria. At the time of fracture, 731 patients (80%) did not receive osteoporosis treatment. In this group, follow-up analysis after 4, 12 and 18 months revealed a treatment rate of 18%, 16%, 15% in women, and 8%, 12%, 10% in men, respectively. In those who received osteoporosis medication at the time of fracture the treatment rate was 65%, 54% and 60% in women, and comparable results in men.\n Only 1 in 10 men, and <2 in 10 women of those who did not receive osteoporosis treatment at the time of fracture were prescribed an adequate osteoporosis treatment. Thus, the vast majority of patients who sustained an osteoporotic fracture and thus were at imminent risk of receiving subsequent fractures did not receive an adequate treatment. There is a clear need for the implementation of coordinated, multi-disciplinary models of care for secondary fracture prevention.\n Despite availability of effective treatment to prevent osteoporotic fractures, the vast majority of patients in Austria, who sustained an osteoporotic fracture, do not receive an adequate osteoporosis treatment.\n Copyright © 2019. Published by Elsevier Inc.\n\nDimai, Hans\n\nFahrleitner-Pammer, Astrid\n\nMalle, Oliver\n\n\n"
},
{
"text": "\n3164\nAntithrombin III in patients with severe sepsis: a pharmacokinetic study.\n\nIlias, W\n\nList, W\n\nDecruyenaere, J\n\nLignian, H\n\nKnaub, S\n\nSchindel, F\n\nKeinecke, HO\n\nHeinrichs, H\n\nThijs, LG\n\nBeiträge in Fachzeitschriften\nISI:000088208300010\n10945387.0\n10.1007%2Fs001340051236\nNone\nOBJECTIVES: To evaluate the safety, pharmacokinetics, and the practicability of two different antithrombin III (AT III) high-dose regimens in patients with severe sepsis. DESIGN: Prospective, open, randomized, 2 parallel groups, multinational clinical trial. SETTING: Eleven academic medical center intensive care units (ICU) in Austria, Belgium, Denmark, Germany, Norway and Sweden. PATIENTS: Thirty-three patients with severe sepsis who received standard supportive care and antimicrobial therapy, in addition to the administration of AT III. INTERVENTIONS: Patients received an intravenous loading dose of 6, 00 IU AT III followed by either intermittent bolus infusions of 1, 00 IU AT III every 4 h or a continuous infusion of 250 IU AT III/h for 4 days, resulting in a total dose for both dosage regimens of 30, 00 IU AT III. MEASUREMENTS: All patients were evaluated for safety and all but one for pharmacokinetics. RESULTS AND CONCLUSIONS: The administration of AT III was safe and well tolerated. The overall 28-day all-cause mortality was 30% (43% intermittent bolus infusions; 21% continuous infusion). The mean probability of dying according to the SAPS II was 48%. The difference in mortality between both groups was within the range of chance. AT III plasma levels were elevated from low baseline levels to above 120% soon after onset of AT III therapy and remained at these levels for the treatment phase of 4 days. Functional and immunologic levels of AT III corresponded very well. With an overall median volume of distribution of 4.5 l (range: 2.4-6.5 l), AT III only moderately extended beyond plasma. The overall median elimination half-life was 18.6 h (range: 5.1-37.4). Overall, median response was 1.75% per IU/kg (range: 1.14-2.8). The variability of elimination parameters was quite noteworthy (CV = 41-59%), whereas distribution-related parameters showed a moderate variability (CV = 24%). In spite of this variability, both high-dose IV regimens reliably provided AT III levels above 120% for all but one patient. An increased mortality was observed for patients with a distribution volume exceeding 4.5 l (or a response < 1.7% per IU/kg). AT III distribution volumes above 4.5 l might indicate a capillary leak phenomenon. The continuous infusion regimen was slightly preferred by the investigators with regard to practicability.\n\n\n"
},
{
"text": "\n9209\nThe significance of the parametrium in the operative treatment of cervical cancer.\n\nBurghardt, E\n\nHaas, J\n\nGirardi, F\n\nBeiträge in Fachzeitschriften\nISI:A1988T330600014\n3229057.0\n10.1016/S0950-3552(98)80015-1\nNone\nThe first sharp improvement in the operative treatment of cervical cancer was the shifting of the plane of resection away from the tumour into the parametria. This permitted resection of the primary cancer with a margin of healthy tissue. Systematic studies of excised parametrial tissue, carried out around the turn of the century, showed four types of parametrial involvement: continuous, discontinuous, carcinomatosis of the parametrial lymphatics, and parametrial lymph node involvement. It is well known that histologically demonstrated parametrial involvement often contradicts the clinical stage. So-called staging laparotomies are meant to address this problem but they, too, are inadequate since most parametrial cancer deposits are microscopic and cannot be palpated. In our own studies of totally extirpated parametria, contiguous cancer spread into the parametria never exceeded 10 mm, not even in the largest still-operable tumours. Thus the theory of contiguous, direct cancer spread to the pelvic wall is wrong. Parametrial involvement usually occurred as cancer deposits in the rarely mentioned parametrial lymph nodes. Parametrial involvement correlates better with the size of the primary tumour, expressed as the tumour-cervix quotient, than with the clinical stage. The smallest tumours, without showing continuous parametrial involvement, had a 3.4% incidence of positive nodes. Thirty-five per cent of the patients with the largest tumours had positive parametrial nodes. Parametrial lymph nodes were found in 280 (78%) of 359 surgical specimens processed as giant sections. Sixty-three patients (22.5%) had positive parametrial nodes. The nodes at the pelvic wall were involved in 80% of the patients with positive parametrial nodes. The five-year survival rate was 84% if the parametria were free of disease, but it dropped to 53% with any type of parametrial involvement. Survival rates did not differ much if only the parametrial nodes or only the pelvic nodes were positive (56% and 66%, respectively). However, if both groups were positive survival dropped to 43.1%. Positive parametrial nodes can be located anywhere in the parametrium; therefore, surgery must remove the entire structure. It remains to be seen whether an exception can be made for small Stage Ib tumours, or if lymphadenectomy can be omitted in these patients. If so, radical vaginal surgery may be the treatment of choice.\n\nHaas, Josef\n\n\n"
},
{
"text": "\n21965\nInhaled iloprost for severe pulmonary hypertension.\n\nOlschewski, H\n\nSimonneau, G\n\nGaliè, N\n\nHigenbottam, T\n\nNaeije, R\n\nRubin, LJ\n\nNikkho, S\n\nSpeich, R\n\nHoeper, MM\n\nBehr, J\n\nWinkler, J\n\nSitbon, O\n\nPopov, W\n\nGhofrani, HA\n\nManes, A\n\nKiely, DG\n\nEwert, R\n\nMeyer, A\n\nCorris, PA\n\nDelcroix, M\n\nGomez-Sanchez, M\n\nSiedentop, H\n\nSeeger, W\n\nAerosolized Iloprost Randomized Study Group\n\nBeiträge in Fachzeitschriften\nISI:000177665900004\n12151469.0\n10.1056/NEJMoa020204\nNone\nBACKGROUND: Uncontrolled studies suggested that aerosolized iloprost, a stable analogue of prostacyclin, causes selective pulmonary vasodilatation and improves hemodynamics and exercise capacity in patients with pulmonary hypertension. METHODS: We compared repeated daily inhalations of 2.5 or 5.0 microg of iloprost (six or nine times per day; median inhaled dose, 30 microg per day) with inhalation of placebo. A total of 203 patients with selected forms of severe pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (New York Heart Association [NYHA] functional class III or IV) were included. The primary end point was met if, after week 12, the NYHA class and distance walked in six minutes were improved by at least one class and at least 10 percent, respectively, in the absence of clinical deterioration according to predefined criteria and death. RESULTS: The combined clinical end point was met by 16.8 percent of the patients receiving iloprost, as compared with 4.9 percent of the patients receiving placebo (P=0.007). There were increases in the distance walked in six minutes of 36.4 m in the iloprost group as a whole (P=0.004) and of 58.8 m in the subgroup of patients with primary pulmonary hypertension. Overall, 4.0 percent of patients in the iloprost group (including one who died) and 13.7 percent of those in the placebo group (including four who died) did not complete the study (P=0.024); the most common reason for withdrawal was clinical deterioration. As compared with base-line values, hemodynamic values were significantly improved at 12 weeks when measured after iloprost inhalation (P<0.001), were largely unchanged when measured before iloprost inhalation, and were significantly worse in the placebo group. Further significant beneficial effects of iloprost treatment included an improvement in the NYHA class (P=0.03), dyspnea (P=0.015), and quality of life (P=0.026). Syncope occurred with similar frequency in the two groups but was more frequently rated as serious in the iloprost group, although this adverse effect was not associated with clinical deterioration. CONCLUSIONS: Inhaled iloprost is an effective therapy for patients with severe pulmonary hypertension.\n\nOlschewski, Horst\n\n\n"
},
{
"text": "\n115330\nPulmonary arterial hypertension therapy may be safe and effective in patients with systemic sclerosis and borderline pulmonary artery pressure.\n\nKovacs, G\n\nMaier, R\n\nAberer, E\n\nBrodmann, M\n\nGraninger, W\n\nKqiku, X\n\nScheidl, S\n\nTröster, N\n\nHesse, C\n\nRubin, L\n\nOlschewski, H\n\nBeiträge in Fachzeitschriften\nISI:000302475500036\n22127844.0\n10.1002/art.33460\nNone\nBorderline pulmonary arterial hypertension (PAH), characterized by a marked exercise-induced increase in pulmonary artery pressure (PAP) with normal resting values, may precede overt PAH in systemic sclerosis (SSc). We undertook the present study to investigate whether PAH treatment is safe in these patients and might attenuate hemodynamic progression.\n SSc patients with borderline PAH underwent right heart catheterization at baseline, after a 12-month observation period, and subsequently after 6 months of bosentan therapy. Changes in mean PAP at 50W during the observation period versus during therapy were compared.\n Ten patients completed the study. Mean PAP at rest, at 50W, and during maximal exercise increased significantly during the observation period (mean ± SD increases of 2.5 ± 3.0 mm Hg [P = 0.03], 4.0 ± 2.9 mm Hg [P = 0.002], and 6.8 ± 4.1 mm Hg [P = 0.0005], respectively) and tended to decrease during the treatment period (decreases of 2.5 ± 3.9 mm Hg [P = 0.07], 1.5 ± 4.5 mm Hg [P = 0.32], and 1.8 ± 7.0 mm Hg [P = 0.43], respectively). The changes during the observation period versus the therapy period were significantly different (P = 0.03 at rest, P = 0.01 at 50W [primary end point], and P = 0.02 during maximal exercise). The changes in resting pulmonary vascular resistance were also significantly different during the observation period (increase of 8 ± 25 dynes · seconds · cm(-5) ) versus during the therapy period (decrease of 45 ± 22 dynes · seconds · cm(-5) ) (P < 0.0005). Changes in resting pulmonary arterial wedge pressure were not significantly different between the observation period and the treatment period, despite the significant increase during the observation period (2.6 ± 2.5 mm Hg [P = 0.01]). No relevant adverse effects were reported.\n In SSc patients with borderline abnormal pulmonary hemodynamics, resting and exercise PAP may increase significantly within 1 year of observation. Bosentan might be safe and effective to attenuate these changes. Randomized controlled trials are warranted to confirm the exploratory findings of this hypothesis-generating pilot study.\n Copyright © 2012 by the American College of Rheumatology.\n\nBrodmann, Marianne\n\nGraninger, Winfried\n\nHesse, Christian\n\nKovacs, Gabor\n\nMaier, Robert\n\nOlschewski, Horst\n\nScheidl, Stefan\n\nTröster, Natascha\n\n\n"
},
{
"text": "\n135436\nLarge, segmental, circular vascular malformation of the small intestine (in a female toddler with hematochezia): unusual presentation in a child.\n\nKalmar, PI\n\nPetnehazy, T\n\nWießpeiner, U\n\nBeer, M\n\nHauer, AC\n\nTill, H\n\nRiccabona, M\n\nBeiträge in Fachzeitschriften\nISI:000335408500001\n24571577.0\n10.1186/1471-2431-14-55\nPMC3938034\nFailure to thrive and hematochezia in children may be alarm signs warranting endoscopy. In contrast, vascular malformations of the small intestine are uncommon in this age group. We report on a female toddler in whom various imaging techniques revealed an unusually large segmental vascular malformation of the ileum as the cause of the child's main clinical symptoms.\n A 19 months old girl presented with severe anemia (Hb 3 mmol/l), failure to thrive and chronic diarrhea. Diagnostics for intestinal blood loss and pathogens were negative. The child had duodenoscopy, also for histological diagnosis of celiac disease, with negative results. A dietary protocol was suggestive for inadequate iron intake and she was supplemented. After symptomless four-months the child presented again, now with mild abdominal pain and, for the first time, hematochezia. An orienting abdominal ultrasound (US) study showed a suspicious tumorous bowel condition. A subsequent detailed abdominal US supplemented by a saline enema during investigation (i.e., "hydrocolon", to improve outlining of the formation's localization) revealed a large circumferential cystiform vascular mass of the ileum causing segmental ileal obstruction.Complementing preoperative abdominal hydro-MRI, planned based on the findings of the US study, confirmed the suspected vascular malformation of the ileum and exquisitely outlined the extent, location and anatomy.The patient was successfully operated laparoscopically, the affected ileum segment with the mass was completely removed as proven by histology, and the child recovered well.\n The huge segmental vascular malformation of the distal ileum described here is an extreme rarity in young children. Although the reported child's presenting symptoms malabsorption and malnutrition could have been responsible for its severe anemia, this was obviously caused by blood losses from the ileal vascular malformation. It was due to incipient abdominal pain rather than hematochezia that abdominal US was performed and proved crucial for correctly diagnosing this rare malformation. Even in this extensive case detailed imaging work-up including adapted MRI added all information necessary for minimal invasive laparoscopic en bloc resection.\n\nHauer, Almuthe\n\nKalmar, Peter\n\nRiccabona, Michael\n\nTill, Holger\n\nWießpeiner, Ulrike Josefine\n\n\n"
},
{
"text": "\n135873\nPerformance of galactomannan, beta-d-glucan, Aspergillus lateral-flow device, conventional culture, and PCR tests with bronchoalveolar lavage fluid for diagnosis of invasive pulmonary aspergillosis.\n\nHoenigl, M\n\nPrattes, J\n\nSpiess, B\n\nWagner, J\n\nPrueller, F\n\nRaggam, RB\n\nPosch, V\n\nDuettmann, W\n\nHoenigl, K\n\nWölfler, A\n\nKoidl, C\n\nBuzina, W\n\nReinwald, M\n\nThornton, CR\n\nKrause, R\n\nBuchheidt, D\n\nBeiträge in Fachzeitschriften\nISI:000337919500032\n24671798.0\n10.1128/JCM.00467-14\nPMC4042784\nGalactomannan detection in bronchoalveolar lavage (BAL) fluid samples (GM test) is currently considered the gold standard test for diagnosing invasive pulmonary aspergillosis (IPA). The limitations, however, are the various turnaround times and availability of testing. We compared the performance of GM testing with that of conventional culture, an Aspergillus lateral-flow-device (LFD) test, a beta-d-glucan (BDG) test, and an Aspergillus PCR assay by using BAL fluid samples from immunocompromised patients. A total of 78 BAL fluid samples from 78 patients at risk for IPA (74 samples from Graz and 4 from Mannheim) collected between December 2012 and May 2013 at two university hospitals in Austria and Germany were included. Three patients had proven IPA, 14 probable IPA, and 17 possible IPA, and 44 patients had no IPA. The diagnostic accuracies of the different methods for probable/proven IPA were evaluated. The diagnostic odds ratios were the highest for the GM, PCR, and LFD tests. The sensitivities for the four methods (except culture) were between 70 and 88%. The combination of the GM (cutoff optical density index [ODI], >1.0) and LFD tests increased the sensitivity to 94%, while the combination of the GM test (>1.0) and PCR resulted in 100% sensitivity (specificity for probable/proven IPA, 95 to 98%). The performance of conventional culture was limited by low sensitivity, while that of the BDG test was limited by low specificity. We evaluated established and novel diagnostic methods for IPA and found that the Aspergillus PCR, LFD, and GM tests were the most useful methods for diagnosing the disease by using BAL fluid samples. In particular, the combination of the GM test and PCR or, if PCR is not available, the LFD test, allows for sensitive and specific diagnosis of IPA. \n Copyright © 2014, American Society for Microbiology. All Rights Reserved.\n\nBuzina, Walter\n\nHönigl, Martin\n\nKoidl, Christoph\n\nKrause, Robert\n\nPrattes, Jürgen\n\nPrüller, Florian\n\nRabensteiner, Jasmin\n\nRaggam, Reinhard Bernd\n\nWoelfler, Albert\n\n\n"
},
{
"text": "\n137018\nThe present and future disease burden of hepatitis C virus (HCV) infection with today's treatment paradigm.\n\nRazavi, H\n\nWaked, I\n\nSarrazin, C\n\nMyers, RP\n\nIdilman, R\n\nCalinas, F\n\nVogel, W\n\nMendes Correa, MC\n\nHézode, C\n\nLázaro, P\n\nAkarca, U\n\nAleman, S\n\nBalık, I\n\nBerg, T\n\nBihl, F\n\nBilodeau, M\n\nBlasco, AJ\n\nBrandão Mello, CE\n\nBruggmann, P\n\nButi, M\n\nCalleja, JL\n\nCheinquer, H\n\nChristensen, PB\n\nClausen, M\n\nCoelho, HS\n\nCramp, ME\n\nDore, GJ\n\nDoss, W\n\nDuberg, AS\n\nEl-Sayed, MH\n\nErgör, G\n\nEsmat, G\n\nFalconer, K\n\nFélix, J\n\nFerraz, ML\n\nFerreira, PR\n\nFrankova, S\n\nGarcía-Samaniego, J\n\nGerstoft, J\n\nGiria, JA\n\nGonçales, FL\n\nGower, E\n\nGschwantler, M\n\nGuimarães Pessôa, M\n\nHindman, SJ\n\nHofer, H\n\nHusa, P\n\nKåberg, M\n\nKaita, KD\n\nKautz, A\n\nKaymakoglu, S\n\nKrajden, M\n\nKrarup, H\n\nLaleman, W\n\nLavanchy, D\n\nMarinho, RT\n\nMarotta, P\n\nMauss, S\n\nMoreno, C\n\nMurphy, K\n\nNegro, F\n\nNemecek, V\n\nÖrmeci, N\n\nØvrehus, AL\n\nParkes, J\n\nPasini, K\n\nPeltekian, KM\n\nRamji, A\n\nReis, N\n\nRoberts, SK\n\nRosenberg, WM\n\nRoudot-Thoraval, F\n\nRyder, SD\n\nSarmento-Castro, R\n\nSemela, D\n\nSherman, M\n\nShiha, GE\n\nSievert, W\n\nSperl, J\n\nStärkel, P\n\nStauber, RE\n\nThompson, AJ\n\nUrbanek, P\n\nVan Damme, P\n\nvan Thiel, I\n\nVan Vlierberghe, H\n\nVandijck, D\n\nWedemeyer, H\n\nWeis, N\n\nWiegand, J\n\nYosry, A\n\nZekry, A\n\nCornberg, M\n\nMüllhaupt, B\n\nEstes, C\n\nBeiträge in Fachzeitschriften\nISI:000333893200003\n24713005.0\n10.1111/jvh.12248\nNone\nThe disease burden of hepatitis C virus (HCV) is expected to increase as the infected population ages. A modelling approach was used to estimate the total number of viremic infections, diagnosed, treated and new infections in 2013. In addition, the model was used to estimate the change in the total number of HCV infections, the disease progression and mortality in 2013-2030. Finally, expert panel consensus was used to capture current treatment practices in each country. Using today's treatment paradigm, the total number of HCV infections is projected to decline or remain flat in all countries studied. However, in the same time period, the number of individuals with late-stage liver disease is projected to increase. This study concluded that the current treatment rate and efficacy are not sufficient to manage the disease burden of HCV. Thus, alternative strategies are required to keep the number of HCV individuals with advanced liver disease and liver-related deaths from increasing. \n © 2014 John Wiley & Sons Ltd.\n\nStauber, Rudolf\n\n\n"
},
{
"text": "\n153896\nEffects of Corroded and Non-Corroded Biodegradable Mg and Mg Alloys on Viability, Morphology and Differentiation of MC3T3-E1 Cells Elicited by Direct Cell/Material Interaction.\n\nMostofi, S\n\nBonyadi Rad, E\n\nWiltsche, H\n\nFasching, U\n\nSzakacs, G\n\nRamskogler, C\n\nSrinivasaiah, S\n\nUeçal, M\n\nWillumeit, R\n\nWeinberg, AM\n\nSchaefer, U\n\nBeiträge in Fachzeitschriften\nISI:000381515600060\n27459513.0\n10.1371/journal.pone.0159879\nPMC4961286\nThis study investigated the effect of biodegradable Mg and Mg alloys on selected properties of MC3T3-E1 cells elicited by direct cell/material interaction. The chemical composition and morphology of the surface of Mg and Mg based alloys (Mg2Ag and Mg10Gd) were analysed by scanning electron microscopy (SEM) and EDX, following corrosion in cell culture medium for 1, 2, 3 and 8 days. The most pronounced difference in surface morphology, namely crystal formation, was observed when Pure Mg and Mg2Ag were immersed in cell medium for 8 days, and was associated with an increase in atomic % of oxygen and a decrease of surface calcium and phosphorous. Crystal formation on the surface of Mg10Gd was, in contrast, negligible at all time points. Time-dependent changes in oxygen, calcium and phosphorous surface content were furthermore not observed for Mg10Gd. MC3T3-E1 cell viability was reduced by culture on the surfaces of corroded Mg, Mg2Ag and Mg10Gd in a corrosion time-independent manner. Cells did not survive when cultured on 3 day pre-corroded Pure Mg and Mg2Ag, indicating crystal formation to be particular detrimental in this regard. Cell viability was not affected when cells were cultured on non-corroded Mg and Mg alloys for up to 12 days. These results suggest that corrosion associated changes in surface morphology and chemical composition significantly hamper cell viability and, thus, that non-corroded surfaces are more conducive to cell survival. An analysis of the differentiation potential of MC3T3-E1 cells cultured on non-corroded samples based on measurement of Collagen I and Runx2 expression, revealed a down-regulation of these markers within the first 6 days following cell seeding on all samples, despite persistent survival and proliferation. Cells cultured on Mg10Gd, however, exhibited a pronounced upregulation of collagen I and Runx2 between days 8 and 12, indicating an enhancement of osteointegration by this alloy that could be valuable for in vivo orthopedic applications.\n\nSchäfer, Ute\n\nÜcal, Muammer\n\nWeinberg, Annelie-Martina\n\nZefferer, Ulrike\n\n\n"
},
{
"text": "\n160722\nEvaluation of age-dependent treatment strategies for children and young adults with pineoblastoma: analysis of pooled European Society for Paediatric Oncology (SIOP-E) and US Head Start data.\n\nMynarek, M\n\nPizer, B\n\nDufour, C\n\nvan Vuurden, D\n\nGarami, M\n\nMassimino, M\n\nFangusaro, J\n\nDavidson, T\n\nGil-da-Costa, MJ\n\nSterba, J\n\nBenesch, M\n\nGerber, N\n\nJuhnke, BO\n\nKwiecien, R\n\nPietsch, T\n\nKool, M\n\nClifford, S\n\nEllison, DW\n\nGiangaspero, F\n\nWesseling, P\n\nGilles, F\n\nGottardo, N\n\nFinlay, JL\n\nRutkowski, S\n\nvon Hoff, K\n\nBeiträge in Fachzeitschriften\nISI:000400894900015\n28011926.0\n10.1093/neuonc/now234\nPMC5464312\nPineoblastoma is a rare pineal region brain tumor. Treatment strategies have reflected those for other malignant embryonal brain tumors.\n Original prospective treatment and outcome data from international trial groups were pooled. Cox regression models were developed considering treatment elements as time-dependent covariates.\n Data on 135 patients with pineoblastoma aged 0.01-20.7 (median 4.9) years were analyzed. Median observation time was 7.3 years. Favorable prognostic factors were age ≥4 years (hazard ratio [HR] for progression-free survival [PFS] 0.270, P < .001) and administration of radiotherapy (HR for PFS 0.282, P < .001). Metastatic disease (HR for PFS 2.015, P = .006), but not postoperative residual tumor, was associated with unfavorable prognosis. In 57 patients <4 years old, 5-year PFS/overall survival (OS) were 11 ± 4%/12 ± 4%. Two patients survived after chemotherapy only, while 3 of 16 treated with craniospinal irradiation (CSI) with boost, and 3 of 5 treated with high-dose chemotherapy (HDCT) and local radiotherapy survived. In 78 patients aged ≥4 years, PFS/OS were 72 ± 7%/73 ± 7% for patients without metastases, and 50 ± 10%/55 ± 10% with metastases. Seventy-three patients received radiotherapy (48 conventionally fractionated CSI, median dose 35.0 [18.0-45.0] Gy, 19 hyperfractionated CSI, 6 local radiotherapy), with (n = 68) or without (n = 6) chemotherapy. The treatment sequence had no impact; application of HDCT had weak impact on survival in older patients.\n Survival is poor in young children treated without radiotherapy. In these patients, combination of HDCT and local radiotherapy may warrant further evaluation in the absence of more specific or targeted treatments. CSI combined with chemotherapy is effective for older non-metastatic patients.\n © The Author(s) 2016. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com\n\nBenesch, Martin\n\n\n"
},
{
"text": "\n167052\nPostoperative restoration of upper extremity motion and neuromuscular control during the overhand pitch: evaluation of tenodesis and repair for superior labral anterior-posterior tears.\n\nChalmers, PN\n\nTrombley, R\n\nCip, J\n\nMonson, B\n\nForsythe, B\n\nNicholson, GP\n\nBush-Joseph, CA\n\nCole, BJ\n\nWimmer, MA\n\nRomeo, AA\n\nVerma, NN\n\nBeiträge in Fachzeitschriften\nISI:000345600600005\n25326013.0\n10.1177/0363546514551924\nNone\nSuperior labral anterior-posterior (SLAP) tears are a common cause of shoulder pain and dysfunction in overhand throwers. Treatment outcomes remain unpredictable, with a large percentage of athletes unable to return to sport. There is considerable debate about the optimal treatment between debridement, repair, and tenodesis.\n Labral repair more closely restores neuromuscular control and motion during the overhand pitch than tenodesis of the long head of the biceps.\n Controlled laboratory study.\n Eighteen pitchers, including 7 uninjured controls, 6 players pitching after SLAP repair, and 5 players pitching after subpectoral biceps tenodesis (BT), underwent simultaneous surface electromyographic measurement at 1500 Hz and motion analysis at 120 Hz with a 14-camera markerless motion analysis system and high-speed video (120 Hz) to confirm accurate motion tracking. Patients had undergone surgery at least 1 year previously and had returned to pitching with a painless shoulder.\n No significant differences were observed in the long head of the biceps muscle, short head of the biceps muscle, deltoid, infraspinatus, or latissimus activity between controls, patients after SLAP repair, and patients after BT. The variability from pitch to pitch for each study participant was similar between groups. Based on visual inspection of the activity time plots, BT appeared to more closely restore the normal pattern of muscular activation within the long head of the biceps muscle than did SLAP repair. There were no significant differences between controls and postoperative patients in the majority of pitching kinematics; however, pitchers after SLAP repair showed significantly altered patterns of thoracic rotation (P = .034) compared with controls and were significantly less likely to fall into previously published normal values for lead knee flexion at front foot contact (P = .019).\n While both BT and SLAP repair can restore physiologic neuromuscular control, pitchers who undergo SLAP repair may exhibit altered patterns of thoracic rotation when compared with controls and pitchers who undergo BT.\n While both tenodesis and SLAP repair can restore physiologic neuromuscular control, SLAP repair may alter pitching biomechanics.\n © 2014 The Author(s).\n\n\n"
},
{
"text": "\n3595\nConcentrations of copper, zinc, manganese, rubidium, and magnesium in thoracic empyemata and corresponding sera.\n\nDomej, W\n\nKrachler, M\n\nGoessler, W\n\nMaier, A\n\nIrgolic, KJ\n\nLang, JK\n\nBeiträge in Fachzeitschriften\nISI:000167741800006\n11314988.0\n10.1385/BTER:78:1-3:53\nNone\nIn this study, a number of selected trace elements and clinically relevant parameters were compared between thoracic empyemata and the corresponding sera for a better understanding of the trace element distribution between these two compartments. Serumempyema pairs were obtained from 13 patients and quantified for selected and essential trace elements, namely copper (Cu), zinc (Zn), manganese (Mn), rubidium (Rb), and magnesium (Mg), by inductively coupled plasma-mass spectrometry (ICP-MS). In addition, the concentrations of the following clinical laboratory parameters were analyzed by standard methods: total protein, leukocyte count, lactate dehydrogenase, glucose, pH, and the C-reactive protein. Individual concentrations of the elements determined in the empyemata were frequently higher than in pleural effusions of any other benign or malignant condition except for Cu. Serum Cu exceeded the normal range (600-1400 microg/kg) in 6 out of 13 patients (median 1410 microg/kg). In the empyemata, Zn concentrations (median 2000 microg/kg) were characteristically higher than in the sera (median 450 microg/kg) and exceeded the upper limit for serum (1200 microg/kg) in 8 of the 13 patients. Manganese concentrations in the empyemata (median 2.7 microg/kg) were also higher compared to corresponding sera, although they stayed within the limits considered normal for serum of healthy adults (upper limit 2.9 microg/kg). Rubidium was also moderately higher in most empyemata (median 290 microg/kg) and exceeded the upper limit for serum (560 microg/kg) in two patients. The median concentration of the essential element magnesium was higher in the empyemata (23 mg/kg) than in the sera (21 mg/kg). However, all serum Mg concentrations except three remained within the normal range (17-22 mg/kg). Removal of large amounts of empyematous fluid may deprive the body of trace elements and can cause suboptimal or deficient trace element status and homeostasis. Recuperation will be accelerated by compensatory supplementation of trace elements. Therefore, selective medication with adequate trace element compounds in patients with thoracic empyema can be generally recommended for zinc. The other elements need not necessarily be monitored or substituted, because of their stable concentrations in the serum. Rb may have a biological impact, but deficiency symptoms in man are not clearly defined.\n\nDomej, Wolfgang\n\n\n"
},
{
"text": "\n22152\nComparison of unilateral and bilateral intrastriatal 6-hydroxydopamine-induced axon terminal lesions: evidence for interhemispheric functional coupling of the two nigrostriatal pathways.\n\nRoedter, A\n\nWinkler, C\n\nSamii, M\n\nWalter, GF\n\nBrandis, A\n\nNikkhah, G\n\nBeiträge in Fachzeitschriften\nISI:000167306700006\n11241387.0\n10.1002/cne.1098\nNone\nPartial lesions of the nigrostriatal dopamine system can be induced reliably by the intrastriatal injection of 6-hydroxydopamine (6-OHDA) and are considered to be analogous to the early stages of human Parkinson's disease. Previous studies have established a clear correlation between different doses and placements of the 6-OHDA toxin and the degree of neurodegenerative changes and behavioral impairments. In the present study, the influence of the interdependence between the two nigrostriatal systems in both hemispheres on the effects on sensorimotor behavioral performances after terminal 6-OHDA lesions was investigated. The behavioral effects were correlated to the extent of nigral dopamine neuron cell and striatal tyrosine-hydroxylase (TH)-positive fiber loss. Sprague-Dawley rats receiving unilateral intrastriatal 6-OHDA injections (4 x 5 microg) exhibited a 30-70% reduction in striatal TH-positive fiber density along an anterior-posterior gradient, an 80% loss of nigral dopamine neurons and a mild degree of behavioral impairments as revealed by amphetamine-induced rotational asymmetry, and a reduced performance in the stepping and postural balance tests. When the same amount of toxin was injected twice into both hemispheres (2 x 4 x 5 microg), additional behavioral deficits were observed, consisting of a significant, but temporary, weight loss, a stable reduction in general locomotor activity and explorational behavior, and a long-term deficit in skilled forelimb use. This is interesting in light of the morphological findings, in which uni- and bilaterally lesioned animals did not differ significantly in the extent of TH-immunoreactive fiber and dopamine neuron loss within the nigrostriatal system in each lesioned hemisphere. These results indicate that the interdependent regulation of the two nigrostriatal systems may provide some compensatory support for the function and behavioral performance of the lesioned side via the normal unlesioned side, which is lost in animals with bilateral lesions of the nigrostriatal system. Therefore, this model of uni- and bilateral partial lesions of the nigrostriatal system, as characterized in the present study, may foster further exploration of compensatory functional mechanisms active in the early stages of Parkinson's disease and promote development of novel neuroprotective and restorative strategies.\n\n\n"
},
{
"text": "\n119093\nCombination chemotherapy in advanced adrenocortical carcinoma.\n\nFassnacht, M\n\nTerzolo, M\n\nAllolio, B\n\nBaudin, E\n\nHaak, H\n\nBerruti, A\n\nWelin, S\n\nSchade-Brittinger, C\n\nLacroix, A\n\nJarzab, B\n\nSorbye, H\n\nTorpy, DJ\n\nStepan, V\n\nSchteingart, DE\n\nArlt, W\n\nKroiss, M\n\nLeboulleux, S\n\nSperone, P\n\nSundin, A\n\nHermsen, I\n\nHahner, S\n\nWillenberg, HS\n\nTabarin, A\n\nQuinkler, M\n\nde la Fouchardire, C\n\nSchlumberger, M\n\nMantero, F\n\nWeismann, D\n\nBeuschlein, F\n\nGelderblom, H\n\nWilmink, H\n\nSender, M\n\nEdgerly, M\n\nKenn, W\n\nFojo, T\n\nMüller, HH\n\nSkogseid, B\n\nFIRM-ACT Study Group\n\nBeiträge in Fachzeitschriften\nISI:000304863400008\n22551107.0\n10.1056/NEJMoa1200966\nNone\nBACKGROUND Adrenocortical carcinoma is a rare cancer that has a poor response to cytotoxic treatment. METHODS We randomly assigned 304 patients with advanced adrenocortical carcinoma to receive mitotane plus either a combination of etoposide (100 mg per square meter of body-surface area on days 2 to 4), doxorubicin (40 mg per square meter on day 1), and cisplatin (40 mg per square meter on days 3 and 4) (EDP) every 4 weeks or streptozocin (streptozotocin) (1 g on days 1 to 5 in cycle 1; 2 g on day 1 in subsequent cycles) every 3 weeks. Patients with disease progression received the alternative regimen as second-line therapy. The primary end point was overall survival. RESULTS For first-line therapy, patients in the EDP-mitotane group had a significantly higher response rate than those in the streptozocin-mitotane group (23.2% vs. 9.2%, P<0.001) and longer median progression-free survival (5.0 months vs. 2.1 months; hazard ratio, 0.55; 95% confidence interval [CI], 0.43 to 0.69; P<0.001); there was no significant between-group difference in overall survival (14.8 months and 12.0 months, respectively; hazard ratio, 0.79; 95% CI, 0.61 to 1.02; P=0.07). Among the 185 patients who received the alternative regimen as second-line therapy, the median duration of progression-free survival was 5.6 months in the EDP-mitotane group and 2.2 months in the streptozocin-mitotane group. Patients who did not receive the alternative second-line therapy had better overall survival with first-line EDP plus mitotane (17.1 month) than with streptozocin plus mitotane (4.7 months). Rates of serious adverse events did not differ significantly between treatments. CONCLUSIONS Rates of response and progression-free survival were significantly better with EDP plus mitotane than with streptozocin plus mitotane as first-line therapy, with similar rates of toxic events, although there was no significant difference in overall survival. (Funded by the Swedish Research Council and others; FIRM-ACT ClinicalTrials.gov number, NCT00094497.)\n\nStepan, Vinzenz\n\n\n"
},
{
"text": "\n170583\nDiastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study.\n\nBelyavskiy, E\n\nMorris, DA\n\nUrl-Michitsch, M\n\nVerheyen, N\n\nMeinitzer, A\n\nRadhakrishnan, AK\n\nKropf, M\n\nFrydas, A\n\nOvchinnikov, AG\n\nSchmidt, A\n\nTadic, M\n\nGenger, M\n\nLindhorst, R\n\nBobenko, A\n\nTschöpe, C\n\nEdelmann, F\n\nPieske-Kraigher, E\n\nPieske, B\n\nBeiträge in Fachzeitschriften\nISI:000459632300018\n30451399.0\n10.1002/ehf2.12375\nPMC6352885\nThe purpose of this pilot study was to assess the potential usefulness of diastolic stress test (DST) echocardiography in patients with suspected heart failure with preserved ejection fraction (HFpEF).\n Patients with suspected HFpEF (left ventricular ejection fraction ≥ 50%, exertional dyspnoea, septal E/e' at rest 9-14, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) at rest < 220 pg/mL; n = 13) and a control group constituted from asymptomatic patients with arterial hypertension (n = 19) and healthy subjects (n = 18) were included. All patients were analysed by two-dimensional and Doppler echocardiography at rest and during exercise (DST) and underwent cardiopulmonary exercise testing and NT-proBNP analysis during exercise. HFpEF during exercise was defined as exertional dyspnoea and peak VO2 ≤ 20.0 mL/min/kg. In patients with suspected HFpEF at rest, 84.6% of these patients developed HFpEF during exercise, whereas in the group of asymptomatic patients with hypertension and healthy subjects, the rate of developed HFpEF during exercise was 0%. Regarding the diagnostic performance of DST to detect HFpEF during exercise, an E/e' ratio >15 during exercise was the most accurate parameter to detect HFpEF (accuracy 86%), albeit a low sensitivity (45.5%). Nonetheless, combining E/e' with tricuspid regurgitation (TR) velocity > 2.8 m/s during exercise provided a significant increase in the sensitivity to detect patients with HFpEF during exercise (sensitivity 72.7%, specificity 79.5%, and accuracy 78%). Consistent with these findings, an increase of E/e' was significantly linked to worse peak VO2 , and the combination of an increase of both E/e' and TR velocity was associated with elevated NT-proBNP values during exercise.\n The findings of this pilot study suggest that DST using E/e' ratio and TR velocity could be of potential usefulness to diagnose HFpEF during exercise in patients with suspected HFpEF at rest.\n © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.\n\nMeinitzer, Andreas\n\nSchmidt, Albrecht\n\nVerheyen, Nicolas Dominik\n\n\n"
},
{
"text": "\n174112\nSerum Levels of MicroRNA-371a-3p (M371 Test) as a New Biomarker of Testicular Germ Cell Tumors: Results of a Prospective Multicentric Study.\n\nDieckmann, KP\n\nRadtke, A\n\nGeczi, L\n\nMatthies, C\n\nAnheuser, P\n\nEckardt, U\n\nSommer, J\n\nZengerling, F\n\nTrenti, E\n\nPichler, R\n\nBelz, H\n\nZastrow, S\n\nWinter, A\n\nMelchior, S\n\nHammel, J\n\nKranz, J\n\nBolten, M\n\nKrege, S\n\nHaben, B\n\nLoidl, W\n\nRuf, CG\n\nHeinzelbecker, J\n\nHeidenreich, A\n\nCremers, JF\n\nOing, C\n\nHermanns, T\n\nFankhauser, CD\n\nGillessen, S\n\nReichegger, H\n\nCathomas, R\n\nPichler, M\n\nHentrich, M\n\nEredics, K\n\nLorch, A\n\nWülfing, C\n\nPeine, S\n\nWosniok, W\n\nBokemeyer, C\n\nBelge, G\n\nBeiträge in Fachzeitschriften\nISI:000471946600007\n30875280.0\n10.1200/JCO.18.01480\nPMC6544462\nPrevious studies suggested that serum levels of microRNA (miR)-371a-3p (so-called M371 test) have a much higher sensitivity and specificity than the classic markers of testicular germ cell tumors (GCTs) and are applicable toward both seminoma and nonseminoma. We sought to confirm the usefulness of this test as a novel biomarker for GCT.\n In a prospective, multicentric study, serum samples of 616 patients with testicular GCTs and 258 male controls were examined for serum levels of miRNA-371a-3p (miR levels) by quantitative polymerase chain reaction. The GCT population encompassed 359 patients with seminoma and 257 with nonseminoma; 371 had clinical stage I disease, 201 had systemic disease, and 46 had relapses. Paired measurements before and after orchiectomy were performed in 424 patients; 118 with systemic disease had serial measurements during treatment. miR levels were compared with those of β-human chorionic gonadotropin, α-fetoprotein, and lactate dehydrogenase.\n For the primary diagnosis of GCT, the M371 test showed a sensitivity of 90.1%, a specificity of 94.0%, an area under the curve of 0.966 upon receiver operating characteristic analysis, and a positive predictive value of 97.2%. α-Fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase had sensitivities of less than 50% in seminoma and slightly higher sensitivities in nonseminomas. miR levels were significantly associated with clinical stage, primary tumor size, and response to treatment. Relapses had elevated miR levels that subsequently dropped to normal upon remission. Teratoma did not express miR-371a-3p.\n The M371 test outperforms the classic markers of GCT with both a sensitivity and a specificity greater than 90%. All histologic subgroups, except teratoma, express this marker. The test could be considered for clinical implementation after further validation.\n\nPichler, Martin\n\n\n"
},
{
"text": "\n183335\nPredictive Value of Cardiac CT Angiography, Cardiac MRI, and Transthoracic Echocardiography for Cardioembolic Stroke Recurrence.\n\nApfaltrer, G\n\nLavra, F\n\nDe Cecco, CN\n\nVarga-Szemes, A\n\nvan Assen, M\n\nMastrodicasa, D\n\nScarabello, M\n\nEid, MH\n\nGriffith, LP\n\nNance, JW\n\nLitwin, SE\n\nSaba, L\n\nSchoepf, UJ\n\nBeiträge in Fachzeitschriften\nNone\n32936016.0\n10.2214/AJR.20.23903\nNone\nBackground: Transthoracic echocardiography (TTE) is the standard of care for initial evaluation of patients with suspected cardioembolic stroke. While TTE is useful for assessing certain sources of cardiac emboli, its diagnostic capability is limited in the detection of other sources, including left atrial thrombus and aortic plaques. Objectives: To investigate sensitivity, specificity and predictive value of cardiac CT angigography (cCTA), cardiac MRI (CMR), and TTE for recurrence in patients with suspected cardioembolic stroke. Methods: We retrospectively included 151 patients with suspected cardioembolic stroke who underwent TTE and either CMR (n=75) or cCTA (n=76) between January 2013 and May 2017. We evaluated for presence of left atrial thrombus, left ventricular thrombus, vulnerable aortic plaque, cardiac tumors, and valvular vegetation as causes of cardioembolic stroke. The end-point was stroke recurrence. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for recurrent stroke were calculated; the diagnostic accuracy of CMR, cCTA, and TTE was compared between and within groups using area under the curves (AUCs). Results: Twelve and 14 recurrent strokes occurred in the cCTA and CMR groups, respectively. Sensitivity, specificity, PPV and NPV were: 33.3%, 93.7%, 50.0%, and 88.2% for cCTA; 14.3%, 80.3%, 14.3%, and 80.3% for CMR; 14.3%, 83.6%, 16.7%, 80.9% for TTE in the CMR group, and 8.3%, 93.7%, 20.0% and 84.5% for TTE in the cCTA group. Accuracy was not different (p>0.05) between cCTA (0.63, 95% CI [0.49, 0.77]), CMR (0.53, [0.42, 0.63]), TTE in CMR group (0.51, [0.40, 0.61], and TTE in cCTA group (0.51, [0.42, 0.59]). In cCTA group, atrial and ventricular thrombus were detected by cCTA in 3 patients and TTE in 1 patient; in CMR group, thrombus was detected by CMR in 1 patient and TTE in 2 patients. Conclusion: cCTA, CMR, and TTE showed comparably high specificity and NPV for cardioembolic stroke recurrence. cCTA and CMR may be valid alternatives to TTE. cCTA may be preferred given potentially better detection of atrial and ventricular thrombus. Clinical impact: cCTA and CMR have similar clinical performance as TTE for predicting cardioembolic stroke recurrence. This observation may be especially important when TTE provides equivocal findings.\n\nApfaltrer, Georg\n\n\n"
}
]
}