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"text": "\n116356\nRANTES/CCL5 and risk for coronary events: results from the MONICA/KORA Augsburg case-cohort, Athero-Express and CARDIoGRAM studies.\n\nHerder, C\n\nPeeters, W\n\nIllig, T\n\nBaumert, J\n\nde Kleijn, DP\n\nMoll, FL\n\nPoschen, U\n\nKlopp, N\n\nMüller-Nurasyid, M\n\nRoden, M\n\nPreuss, M\n\nCARDIoGRAM Consortium\n\nKarakas, M\n\nMeisinger, C\n\nThorand, B\n\nPasterkamp, G\n\nKoenig, W\n\nAssimes, TL\n\nDeloukas, P\n\nErdmann, J\n\nHolm, H\n\nKathiresan, S\n\nKönig, IR\n\nMcPherson, R\n\nReilly, MP\n\nRoberts, R\n\nSamani, NJ\n\nSchunkert, H\n\nStewart, AF\n\nBeiträge in Fachzeitschriften\nISI:000298173500001\n22162987.0\n10.1371/journal.pone.0025734\nPMC3232218\nBackground: The chemokine RANTES (regulated on activation, normal T-cell expressed and secreted)/CCL5 is involved in the pathogenesis of cardiovascular disease in mice, whereas less is known in humans. We hypothesised that its relevance for atherosclerosis should be reflected by associations between CCL5 gene variants, RANTES serum concentrations and protein levels in atherosclerotic plaques and risk for coronary events. Methods and Findings: We conducted a case-cohort study within the population-based MONICA/KORA Augsburg studies. Baseline RANTES serum levels were measured in 363 individuals with incident coronary events and 1, 08 non-cases (mean follow-up: 10.2 +/- 4.8 years). Cox proportional hazard models adjusting for age, sex, body mass index, metabolic factors and lifestyle factors revealed no significant association between RANTES and incident coronary events (HR [95% CI] for increasing RANTES tertiles 1.0, 1.03 [0.75-1.42] and 1.11 [0.81-1.54]). None of six CCL5 single nucleotide polymorphisms and no common haplotype showed significant associations with coronary events. Also in the CARDIoGRAM study (>22, 00 cases, >60, 00 controls), none of these CCL5 SNPs was significantly associated with coronary artery disease. In the prospective Athero-Express biobank study, RANTES plaque levels were measured in 606 atherosclerotic lesions from patients who underwent carotid endarterectomy. RANTES content in atherosclerotic plaques was positively associated with macrophage infiltration and inversely associated with plaque calcification. However, there was no significant association between RANTES content in plaques and risk for coronary events (mean follow-up 2.8 +/- 0.8 years). Conclusions: High RANTES plaque levels were associated with an unstable plaque phenotype. However, the absence of associations between (i) RANTES serum levels, (ii) CCL5 genotypes and (iii) RANTES content in carotid plaques and either coronary artery disease or incident coronary events in our cohorts suggests that RANTES may not be a novel coronary risk biomarker. However, the potential relevance of RANTES levels in platelet-poor plasma needs to be investigated in further studies.\n\nMärz, Winfried\n\nMeinitzer, Andreas\n\nPilz, Stefan\n\nRenner, Wilfried\n\nScharnagl, Hubert\n\n\n"
},
{
"text": "\n130829\nRetreatment with anti-vascular endothelial growth factor therapy based on changes in visual acuity after initial stabilization of neovascular age-related macular degeneration: 3-year follow-up results.\n\nDunavoelgyi, R\n\nSacu, S\n\nEibenberger, K\n\nPalkovits, S\n\nLeydolt, C\n\nPruente, C\n\nSchmidt-Erfurth, U\n\nBeiträge in Fachzeitschriften\nISI:000308672300006\n22414958.0\n10.1097/IAE.0b013e318236e805\nNone\nPurpose: To evaluate the 3-year therapeutic benefit of intravitreal bevacizumab in neovascular related macular degeneration (nAMD) in a standard clinical setting involving 3 initial injections and a pro re nata regimen as recommended in the PRONTO study. Methods: In this interventional clinical study, 181 eyes of 160 consecutive patients with active neovascular related macular degeneration meeting recommended criteria for inclusion and protocol criteria for anti-vascular endothelial growth factor therapy undergoing intravitreal bevacizumab monotherapy were observed. Data of treatment-naive eyes (Group 1, n = 114) were analyzed separately from eyes that had undergone previous photodynamic therapy plus intravitreal triamcinolone (Group 2, n = 67). Re-treatment criteria were based on clinical outcome following the official European label regimen. After 1 year of continuous service at an academic referral center, follow-up was performed in private practices in collaboration with the referral center. Main outcome parameters were best-corrected visual acuity and central retinal thickness. Results: After 3 years, best-corrected visual acuity decreased in the overall population (0.23 +/- 0.16 to 0.16 +/- 0.21. P = 0.002) and in both groups compared with baseline (0.24 +/- 0.21 to 0.17 +/- 0.21, Group 1, P = 0.03; 0.22 +/- 0.19 to 0.16 +/- 0.21, Group 2, P > 0.05), whereas central retinal thickness increased in the overall population (291 +/- 92 to 319 +/- 110 mu m, P = 0.01) and in both groups (291 +/- 96 to 325 +/- 117 mu m, Group 1, P > 0.05; 290 +/- 83 to 308 +/- 96 mu m, Group 2, P > 0.05) because of chronic cystic degeneration changes of the macula. Mean treatment rate was 5.1 +/- 3.9 (Group 1) versus 3.7 +/- 2.7 (Group 2, P = 0.01). Five cases of severe intraocular inflammation after intravitreal bevacizumab were documented. Discussion: While the functional and morphological benefits persisted for the first year after intravitreal bevacizumab treatment, after this time both functional and morphologic results were disappointing during long-term follow-up with visual acuity loss as the main retreatment criterion. After stabilization of the disease, a monthly follow-up of optical coherence tomography and re-treatment based on morphologic, clinical, and vision outcomes may increase the efficacy in patients with neovascular related macular degeneration under anti-vascular endothelial growth factor treatment. RETINA 32:1471-1479, 2012\n\n\n"
},
{
"text": "\n173849\nOrchestration of Tryptophan-Kynurenine Pathway, Acute Decompensation, and Acute-on-Chronic Liver Failure in Cirrhosis.\n\nClària, J\n\nMoreau, R\n\nFenaille, F\n\nAmorós, A\n\nJunot, C\n\nGronbaek, H\n\nCoenraad, MJ\n\nPruvost, A\n\nGhettas, A\n\nChu-Van, E\n\nLópez-Vicario, C\n\nOettl, K\n\nCaraceni, P\n\nAlessandria, C\n\nTrebicka, J\n\nPavesi, M\n\nDeulofeu, C\n\nAlbillos, A\n\nGustot, T\n\nWelzel, TM\n\nFernández, J\n\nStauber, RE\n\nSaliba, F\n\nButin, N\n\nColsch, B\n\nMoreno, C\n\nDurand, F\n\nNevens, F\n\nBañares, R\n\nBenten, D\n\nGinès, P\n\nGerbes, A\n\nJalan, R\n\nAngeli, P\n\nBernardi, M\n\nArroyo, V\n\nCANONIC Study Investigators of the EASL Clif Consortium, Grifols Chair and the European Foundation for the Study of Chronic Liver Failure (EF Clif)\n\nBeiträge in Fachzeitschriften\nISI:000462612400027\n30521097.0\n10.1002/hep.30363\nNone\nSystemic inflammation (SI) is involved in the pathogenesis of acute decompensation (AD) and acute-on-chronic liver failure (ACLF) in cirrhosis. In other diseases, SI activates tryptophan (Trp) degradation through the kynurenine pathway (KP), giving rise to metabolites that contribute to multiorgan/system damage and immunosuppression. In the current study, we aimed to characterize the KP in patients with cirrhosis, in whom this pathway is poorly known. The serum levels of Trp, key KP metabolites (kynurenine and kynurenic and quinolinic acids), and cytokines (SI markers) were measured at enrollment in 40 healthy subjects, 39 patients with compensated cirrhosis, 342 with AD (no ACLF) and 180 with ACLF, and repeated in 258 patients during the 28-day follow-up. Urine KP metabolites were measured in 50 patients with ACLF. Serum KP activity was normal in compensated cirrhosis, increased in AD and further increased in ACLF, in parallel with SI; it was remarkably higher in ACLF with kidney failure than in ACLF without kidney failure in the absence of differences in urine KP activity and fractional excretion of KP metabolites. The short-term course of AD and ACLF (worsening, improvement, stable) correlated closely with follow-up changes in serum KP activity. Among patients with AD at enrollment, those with the highest baseline KP activity developed ACLF during follow-up. Among patients who had ACLF at enrollment, those with immune suppression and the highest KP activity, both at baseline, developed nosocomial infections during follow-up. Finally, higher baseline KP activity independently predicted mortality in patients with AD and ACLF. Conclusion: Features of KP activation appear in patients with AD, culminate in patients with ACLF, and may be involved in the pathogenesis of ACLF, clinical course, and mortality.\n © 2018 by the American Association for the Study of Liver Diseases.\n\nÖttl, Karl\n\nStauber, Rudolf\n\n\n"
},
{
"text": "\n181309\nEffects of a Humanoid Socially Assistive Robot Versus Tablet Training on Psychosocial and Physical Outcomes of Persons With Dementia: Protocol for a Mixed Methods Study.\n\nSchüssler, S\n\nZuschnegg, J\n\nPaletta, L\n\nFellner, M\n\nLodron, G\n\nSteiner, J\n\nPansy-Resch, S\n\nLammer, L\n\nProdromou, D\n\nBrunsch, S\n\nHolter, M\n\nCarnevale, L\n\nRussegger, S\n\nBeiträge in Fachzeitschriften\nISI:000518843100009\n32022697.0\n10.2196/14927\nPMC7055795\nNew technologies, like socially assistive robots (SARs), may have the potential to support caregivers at home. Still, the evidence for people with dementia in home care is unclear because a lot of studies are performed in a laboratory or institutional setting, and mainly use robots in prototype stages.\n This study aims to explore the effects of the refined, commercially-available, humanoid SAR Pepper combined with a tablet PC-based dementia training program (Coach Pepper) versus an exclusively tablet PC-based dementia training program on psychosocial and physical outcomes of people with dementia living at home, including caregivers and dementia trainers. We hypothesize that Coach Pepper has a more positive effect on the primary outcome motivation (stable or decreased apathy) of people with dementia.\n A mixed methods study will be performed, including a randomized controlled, parallel, 2-arm study with a complementary qualitative part. This sample includes 40 PWD living at home and 40 relatives, each complemented with five professional caregivers and dementia trainers. The intervention group will receive Coach Pepper (a SAR connected with a tablet PC-based dementia training program), and the control group will receive exclusively tablet PC-based training without the SAR. The duration of the intervention will be three weeks per household. Data will be collected at baseline and during and after the intervention by standardized questionnaires, sensor data of the robot, and tablet PC, as well as semistructured interviews, focus groups, and observation.\n To date, no results are available for this study protocol. The study intervention started in May 2019 and will end in Spring 2020.\n The intervention of this study can be seen as a nonpharmacological intervention, including cognitive and physical training by a robot. This study will help to further refine SAR for the specific needs of people with dementia living at home.\n DERR1-10.2196/14927.\n ©Sandra Schüssler, Julia Zuschnegg, Lucas Paletta, Maria Fellner, Gerald Lodron, Josef Steiner, Sandra Pansy-Resch, Lara Lammer, Dimitrios Prodromou, Sebastian Brunsch, Magdalena Holter, Lorenzo Carnevale, Silvia Russegger. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 27.01.2020.\n\nHolter, Magdalena\n\nSchüssler, Sandra\n\nZuschnegg, Julia\n\n\n"
},
{
"text": "\n185393\nIs AC TightRope fixation better than Bosworth screw fixation for minimally invasive operative treatment of Rockwood III AC joint injury?\n\nDarabos, N\n\nVlahovic, I\n\nGusic, N\n\nDarabos, A\n\nBakota, B\n\nMiklic, D\n\nBeiträge in Fachzeitschriften\nNone\n26632500.0\n10.1016/j.injury.2015.10.060\nNone\nInjuries to the acromioclavicular (AC) joint are common in sports participants and may lead to instability or degenerative changes that require surgical intervention. Diagnostics include X-ray projections; MRI could also be a useful method. Surgical treatment of acute Rockwood type III AC dislocation varies on a case-by-case basis and includes coracoclavicular (CC) stabilisation with two techniques of minimal invasive fixation: the Bosworth screw and AC TightRope fixation (Arthrex, US). The aim of this study was to analyse whether there is a difference between these two surgical procedures in the quality of repair of CC ligaments by comparing preoperative and postoperative AC joint radiological and clinical findings.\n In this study, we evaluated our 5 years' experience of surgical management of Rockwood type III AC dislocation. Radiological analyses included measurement of CC distance at the AC joint, X-ray and MRI evaluation of CC ligament scar tissue continuity; clinical outcome was assessed using the Constant Murley, Oxford Shoulder and DASH scores preoperatively and during 6 months of postoperative follow-up.\n A total of 68 patients with Rockwood type III AC dislocation were treated surgically with minimally invasive CC fixation using either the AC TightRope implant (34 patients, TR group) or the Bosworth screw (34 patients, BS group) in a prospective, randomised clinical trial. There was no statistically significant difference in radiological X-ray and MRI evaluations of postoperative results between the two groups of patients at the end of follow-up. Patients in the TR group reported significantly less inconvenience with treatment as the patients in the BS group had to undergo a second operation to remove the Bosworth screw. Postoperative recurrence of dislocation was observed in two patients in the TR group (5.88%) and in four patients in the BS group (11.76%) 6 months postoperatively. The difference between the two groups was not statistically significant (p=0.4).\n MRI could be a useful method to evaluate quality of repair of CC ligaments. The minimally invasive surgical techniques used in this study showed similar radiological and clinical efficacy in the treatment of acute Rockwood type III AC dislocation, but AC TightRope fixation provided patients with significantly more treatment satisfaction and less inconvenience than Bosworth screw fixation.\n Copyright © 2015 Elsevier Ltd. All rights reserved.\n\n\n"
},
{
"text": "\n88261\nA threefold dose intensity treatment with ifosfamide, carboplatin, and etoposide for patients with small cell lung cancer: a randomized trial.\n\nLeyvraz, S\n\nPampallona, S\n\nMartinelli, G\n\nPloner, F\n\nPerey, L\n\nAversa, S\n\nPeters, S\n\nBrunsvig, P\n\nMontes, A\n\nLange, A\n\nYilmaz, U\n\nRosti, G\n\nSolid Tumors Working Party of the European Group for Blood and Marrow Transplantation\n\nBeiträge in Fachzeitschriften\nISI:000255151900008\n18398095.0\n10.1093/jnci/djn088\nNone\nBACKGROUND: The dose intensity of chemotherapy can be increased to the highest possible level by early administration of multiple and sequential high-dose cycles supported by transfusion with peripheral blood progenitor cells (PBPCs). A randomized trial was performed to test the impact of such dose intensification on the long-term survival of patients with small cell lung cancer (SCLC). METHODS: Patients who had limited or extensive SCLC with no more than two metastatic sites were randomly assigned to high-dose (High, n = 69) or standard-dose (Std, n = 71) chemotherapy with ifosfamide, carboplatin, and etoposide (ICE). High-ICE cycles were supported by transfusion with PBPCs that were collected after two cycles of treatment with epidoxorubicin at 150 mg/m(2), paclitaxel at 175 mg/m(2), and filgrastim. The primary outcome was 3-year survival. Comparisons between response rates and toxic effects within subgroups (limited or extensive disease, liver metastases or no liver metastases, Eastern Cooperative Oncology Group performance status of 0 or 1, normal or abnormal lactate dehydrogenase levels) were also performed. RESULTS: Median relative dose intensity in the High-ICE arm was 293% (range = 174%-392%) of that in the Std-ICE arm. The 3-year survival rates were 18% (95% confidence interval [CI] = 10% to 29%) and 19% (95% CI = 11% to 30%) in the High-ICE and Std-ICE arms, respectively. No differences were observed between the High-ICE and Std-ICE arms in overall response (n = 54 [78%, 95% CI = 67% to 87%] and n = 48 [68%, 95% CI = 55% to 78%], respectively) or complete response (n = 27 [39%, 95% CI = 28% to 52%] and n = 24 [34%, 95% CI = 23% to 46%], respectively). Subgroup analyses showed no benefit for any outcome from High-ICE treatment. Hematologic toxicity was substantial in the Std-ICE arm (grade > or = 3 neutropenia, n = 49 [70%]; anemia, n = 17 [25%]; thrombopenia, n = 17 [25%]), and three patients (4%) died from toxicity. High-ICE treatment was predictably associated with severe myelosuppression, and five patients (8%) died from toxicity. CONCLUSIONS: The long-term outcome of SCLC was not improved by raising the dose intensity of ICE chemotherapy by threefold.\n\n\n"
},
{
"text": "\n161921\nThe Short Form Score for the Assessment and Quantification of Chronic Rheumatic Affections of the Hands in Daily Clinical Routines-Its Sensitivity to Change and Preliminary Patient Relevant Variation Values: A Pilot Study.\n\nStummer, U\n\nRintelen, B\n\nLeeb, BF\n\nBeiträge in Fachzeitschriften\nISI:000407081600002\n28191456.0\n10.3389/fmed.2017.00006\nPMC5269615\nThe SF-SACRAH was developed to assess the involvement of the hand in rheumatoid arthritis (RA) and hand osteoarthritis (HOA) patients in daily clinical routines. In this pilot study, its sensitivity to change will be assessed longitudinally, and preliminary thresholds for patient relevant changes are derived.\n Ninety-nine outpatients suffering from HOA (n = 55) or RA (n = 44) completed the SF-SACRAH once initially. After approximately 3 months, patients repeated the SF-SACRAH. At both visits, patients rated their satisfaction (PATSAT) with the state of their disease (1 = very good to 5 = unsatisfactory). For assessing its sensitivity to change, SF-SACRAH changes in patients with stable, improving, or worsening conditions according to PATSAT were calculated in HOA and RA patients. The respective medians and highest values were used to estimate patient relevant variation values. SF-SACRAH changes and positive or negative PATSAT changes in HOA as well as RA patients were analyzed by applying the Kruskal-Wallis test. In RA patients, the DAS28 was also calculated. Spearman's rho was calculated to correlate SF-SACRAH changes with the EULAR response criteria.\n In HOA and RA patients, a statistically high correlation between PATSAT changes and SF-SACRAH values was revealed (p < 0.0001 in HOA and p < 0.01 in RA patients, respectively). The median changes in SF-SACRAH in patients with improving, stable, or worsening conditions according to PATSAT were HOA patients: PATSAT improving: ΔSF-SACRAH -1.6, PATSAT stable: ΔSF-SACRAH +0.8, PATSAT worsening: ΔSF-SACRAH +1.0; RA patients: PATSAT improving: ΔSF-SACRAH -0.9, PATSAT stable: ΔSF-SACRAH +0.2, PATSAT worsening: ΔSF-SACRAH +0.8. In RA patients, there is a moderate, but significant, correlation between DAS28 EULAR response criteria and SF-SACRAH changes (ΔDAS28 improving >0.6: ΔSF-SACRAH -0.4, ΔDAS28 <0.6: ΔSF-SACRAH +0.0, ΔDAS28 worsening >0.6: ΔSF-SACRAH +0.5; r = 0.433, p < 0.01).\n The SF-SACRAH constitutes a reliable tool for the assessment of hand impairment in patients with chronic rheumatic diseases. It proved to be sensitive to change in this short-term evaluation in both HOA and RA patients. Additionally, preliminary patient variation values for improvement (-1.60) and deterioration (+1.0) could be derived.\n\n\n"
},
{
"text": "\n176533\nEvaluation of algorithms for Multi-Modality Whole Heart Segmentation: An open-access grand challenge.\n\nZhuang, X\n\nLi, L\n\nPayer, C\n\nŠtern, D\n\nUrschler, M\n\nHeinrich, MP\n\nOster, J\n\nWang, C\n\nSmedby, Ö\n\nBian, C\n\nYang, X\n\nHeng, PA\n\nMortazi, A\n\nBagci, U\n\nYang, G\n\nSun, C\n\nGalisot, G\n\nRamel, JY\n\nBrouard, T\n\nTong, Q\n\nSi, W\n\nLiao, X\n\nZeng, G\n\nShi, Z\n\nZheng, G\n\nWang, C\n\nMacGillivray, T\n\nNewby, D\n\nRhode, K\n\nOurselin, S\n\nMohiaddin, R\n\nKeegan, J\n\nFirmin, D\n\nYang, G\n\nBeiträge in Fachzeitschriften\nISI:000496605700010\n31446280.0\n10.1016/j.media.2019.101537\nPMC6839613\nKnowledge of whole heart anatomy is a prerequisite for many clinical applications. Whole heart segmentation (WHS), which delineates substructures of the heart, can be very valuable for modeling and analysis of the anatomy and functions of the heart. However, automating this segmentation can be challenging due to the large variation of the heart shape, and different image qualities of the clinical data. To achieve this goal, an initial set of training data is generally needed for constructing priors or for training. Furthermore, it is difficult to perform comparisons between different methods, largely due to differences in the datasets and evaluation metrics used. This manuscript presents the methodologies and evaluation results for the WHS algorithms selected from the submissions to the Multi-Modality Whole Heart Segmentation (MM-WHS) challenge, in conjunction with MICCAI 2017. The challenge provided 120 three-dimensional cardiac images covering the whole heart, including 60 CT and 60 MRI volumes, all acquired in clinical environments with manual delineation. Ten algorithms for CT data and eleven algorithms for MRI data, submitted from twelve groups, have been evaluated. The results showed that the performance of CT WHS was generally better than that of MRI WHS. The segmentation of the substructures for different categories of patients could present different levels of challenge due to the difference in imaging and variations of heart shapes. The deep learning (DL)-based methods demonstrated great potential, though several of them reported poor results in the blinded evaluation. Their performance could vary greatly across different network structures and training strategies. The conventional algorithms, mainly based on multi-atlas segmentation, demonstrated good performance, though the accuracy and computational efficiency could be limited. The challenge, including provision of the annotated training data and the blinded evaluation for submitted algorithms on the test data, continues as an ongoing benchmarking resource via its homepage (www.sdspeople.fudan.edu.cn/zhuangxiahai/0/mmwhs/).\n Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.\n\nStern, Darko\n\n\n"
},
{
"text": "\n183297\nBiomarkers for the Discrimination of Acute Kawasaki Disease From Infections in Childhood.\n\nZandstra, J\n\nvan de Geer, A\n\nTanck, MWT\n\nvan Stijn-Bringas Dimitriades, D\n\nAarts, CEM\n\nDietz, SM\n\nvan Bruggen, R\n\nSchweintzger, NA\n\nZenz, W\n\nEmonts, M\n\nZavadska, D\n\nPokorn, M\n\nUsuf, E\n\nMoll, HA\n\nSchlapbach, LJ\n\nCarrol, ED\n\nPaulus, S\n\nTsolia, M\n\nFink, C\n\nYeung, S\n\nShimizu, C\n\nTremoulet, A\n\nGalassini, R\n\nWright, VJ\n\nMartinón-Torres, F\n\nHerberg, J\n\nBurns, J\n\nLevin, M\n\nKuijpers, TW\n\nEUCLIDS Consortium, PERFORM Consortium and UK Kawasaki Disease Genetics Study Network\n\nBeiträge in Fachzeitschriften\nISI:000560073900001\n32775314.0\n10.3389/fped.2020.00355\nPMC7388698\nBackground: Kawasaki disease (KD) is a vasculitis of early childhood mimicking several infectious diseases. Differentiation between KD and infectious diseases is essential as KD's most important complication-the development of coronary artery aneurysms (CAA)-can be largely avoided by timely treatment with intravenous immunoglobulins (IVIG). Currently, KD diagnosis is only based on clinical criteria. The aim of this study was to evaluate whether routine C-reactive protein (CRP) and additional inflammatory parameters myeloid-related protein 8/14 (MRP8/14 or S100A8/9) and human neutrophil-derived elastase (HNE) could distinguish KD from infectious diseases. Methods and Results: The cross-sectional study included KD patients and children with proven infections as well as febrile controls. Patients were recruited between July 2006 and December 2018 in Europe and USA. MRP8/14, CRP, and HNE were assessed for their discriminatory ability by multiple logistic regression analysis with backward selection and receiver operator characteristic (ROC) curves. In the discovery cohort, the combination of MRP8/14+CRP discriminated KD patients (n = 48) from patients with infection (n = 105), with area under the ROC curve (AUC) of 0.88. The HNE values did not improve discrimination. The first validation cohort confirmed the predictive value of MRP8/14+CRP to discriminate acute KD patients (n = 26) from those with infections (n = 150), with an AUC of 0.78. The second validation cohort of acute KD patients (n = 25) and febrile controls (n = 50) showed an AUC of 0.72, which improved to 0.84 when HNE was included. Conclusion: When used in combination, the plasma markers MRP8/14, CRP, and HNE may assist in the discrimination of KD from both proven and suspected infection.\n Copyright © 2020 Zandstra, van de Geer, Tanck, van Stijn-Bringas Dimitriades, Aarts, Dietz, van Bruggen, Schweintzger, Zenz, Emonts, Zavadska, Pokorn, Usuf, Moll, Schlapbach, Carrol, Paulus, Tsolia, Fink, Yeung, Shimizu, Tremoulet, Galassini, Wright, Martinón-Torres, Herberg, Burns, Levin, Kuijpers, EUCLIDS Consortium, PERFORM Consortium and UK Kawasaki Disease Genetics Study Network.\n\nSchweintzger, Nina\n\nZenz, Werner\n\n\n"
},
{
"text": "\n64194\nTrends and geographic inequalities in the prevalence of Down syndrome in Europe, 1980-1999.\n\nDolk, H\n\nLoane, M\n\nGarne, E\n\nDe Walle, H\n\nQueisser-Luft, A\n\nDe Vigan, C\n\nAddor, MC\n\nGener, B\n\nHaeusler, M\n\nJordan, H\n\nTucker, D\n\nStoll, C\n\nFeijoo, M\n\nLillis, D\n\nBianchi, F\n\nBeiträge in Fachzeitschriften\nISI:000233805600010\n16471148.0\nNone\nNone\nBackground: EUROCAT is a network of population-based registries for the epidemiologic surveillance of congenital anomalies covering approximately one quarter of births in the European Union. Down syndrome constitutes approximately 8% of cases of registered congenital anomaly in Europe, with over 7000 affected pregnancies in the 15 current member states of the European Union each year. In this paper, we aim to examine trends in the live birth prevalence of Down syndrome in Europe in the light of trends in maternal age and in prenatal diagnosis. Methods: Descriptive analysis of data from 24 EUROCAT registries, covering 8.3 million births 1980-99. Cases include live births, stillbirths and terminations of pregnancy following prenatal diagnosis. Results: Since 1980, the proportion of births to mothers of 35 years of age and over has risen quite dramatically from 8 to 14% for the European Union as a whole, with steeper rises in some regions. By 1995-1999, the proportion of "older" mothers varied between regions from 10% to 25%, and the total prevalence (including terminations of pregnancy) of Down syndrome varied from 1 to 3 per 1000 births. Some European regions have shown a more than twofold increase in total prevalence of Down syndrome since 1980. The proportion of cases of Down syndrome which were prenatally diagnosed followed by termination of pregnancy in 1995-1999 varied from 0% in the three regions of Ireland and Malta where termination of pregnancy is illegal, to less than 50% in 14 further regions, to 77% in Paris. The extent to which terminations of pregnancy were concentrated among older mothers varied between regions. The live birth prevalence has since 1980 increasingly diverged from the rising total prevalence, in some areas remaining approximately stable, in others decreasing over time. Conclusion: The rise in average maternal age in Europe has brought with it an increase in the number of pregnancies affected by Down syndrome. The widespread practice of prenatal screening and termination of pregnancy has in most of the regions covered by EUROCAT counteracted the effect of maternal age in its effect on live birth prevalence. Under the joint influences of maternal age and prenatal screening the pattern of geographic inequalities in Down syndrome live birth prevalence in Europe has also been changed.\n\n\n"
},
{
"text": "\n110079\nPlacenta-bound and Body Fluid PP13 and its mRNA in Normal Pregnancy Compared to Preeclampsia, HELLP and Preterm Delivery\n\nSammar, M\n\nNisemblat, S\n\nFleischfarb, Z\n\nGolan, A\n\nSadan, O\n\nMeiri, H\n\nHuppertz, B\n\nGonen, R\n\nBeiträge in Fachzeitschriften\nISI:000287624800005\n21257080.0\n10.1016/j.placenta.2010.09.006\nNone\nObjectives: To compare the distribution of placental protein 13 (PP13) in fetal and maternal blood and amnionic fluid and to correlate it with PP13 protein and mRNA in the placenta. Methods: Umbilical arterial serum, amnionic fluid, maternal venous serum and placental tissues were collected from normal outcome pregnancies (N = 63) (GA>37), early onset preeclampsia (PE) (N = 12, GA: 26-33), and HELLP syndrome (N = 5, GA: 27-29). Because PE and HELLP cases delivered preterm, cases of preterm delivery (FTD) (N = 6, GA: 31-36) served as additional control. PP13 was determined by ELISA, Western blot, and immunohistochemistry. PP13 mRNA was measured by PCR (RT-PCR). Continuous parameters were compared by t-test, P < 0.05 was considered significant. Results: In women with normal pregnancy outcome significantly higher PP13 levels were found in maternal serum compared to amnionic fluid and negligible amount was found in fetal serum. A similar pattern was identified in cases of FTD with concentrations similar to term control. In PE and HELLP cases PP13 levels in amnionic fluid level were more than twice compared to maternal serum (P < 0.001). Umbilical cord level was negligible in PE but high in HELLP corresponding to the much higher level of PP13 in this patient group compared to all others. In the placenta PP13 level in term controls was higher compared to FTD. In PE and HELLP (similar early delivery time as PTD) the level was significantly higher (P < 0.01) compared to FTD or term controls. PP13 mRNA levels in term control and PTD were similar while PP13 mRNA levels in PE and HELLP placentas were significantly lower compared to term controls or PTD or the two combined. Syncytiotrophoblast labeling appeared stronger in PE and HELLP compared to term controls and PTD. Conclusions: In all cases but HELLP, PP13 in fetal blood is very low indicating that routing of PP13 to fetal blood is limited and that the fetus is unlikely to generate PP13. PP13 mRNA is lower in the third trimester at the time of disease while protein level accumulates and become higher creating an unparallel change in the level of the mRNA and the corresponding protein. (C) 2010 Elsevier Ltd. All rights reserved.\n\nHuppertz, Berthold\n\n\n"
},
{
"text": "\n128130\nUse of 2-octyl cyanoacrylate together with a self-adhering mesh (Dermabond™ Prineo™) for skin closure following abdominoplasty: an open, prospective, controlled, randomized, clinical study.\n\nParvizi, D\n\nFriedl, H\n\nSchintler, MV\n\nRappl, T\n\nLaback, C\n\nWiedner, M\n\nVasiljeva, A\n\nKamolz, LP\n\nSpendel, S\n\nBeiträge in Fachzeitschriften\nISI:000319282500006\n23613192.0\n10.1007/s00266-013-0123-3\nNone\nAbdominoplasty is one of the most commonly performed procedures in plastic surgery. The appearance of the scar is a major factor that contributes to the aesthetic outcome of the procedure and depends largely on the technique of wound closure. The new Prineo™ wound closure system was introduced to combine the effectiveness of 2-octyl cyanoacrylate (Dermabond™) together with a self-adhering mesh.\n Fifty-two women and eight men aged between 21 and 65 years who were scheduled for abdominoplasty were included in the study. The total operating times after abdominoplasty of the traditional wound closure technique and the Prineo™-type wound closure technique were compared. Furthermore, an analysis comparing the cost of the two methods was performed. Two weeks after surgery the wounds were examined and graded using the Hollander Cosmesis Scale. At the 6- and 12-month follow-ups, the aesthetic outcome of the abdominal scar was evaluated using the Vancouver Scar Scale. Twelve months after surgery, the patients were asked to answer their part of the Patient Scar Assessment Scale.\n The mean total operating time for the new skin closure system was statistically significantly shorter than that of intradermal sutures. The mean price difference per patient was 104.27<euro> (134.79$) in favor of Prineo™. The Hollander Cosmesis Scale indicated a significantly more favorable overall result with Prineo™ at 2 weeks after surgery. The Vancouver Scar Scale demonstrated a better cosmetic outcome in favor of Prineo™ 6 and 12 months after surgery. The Patient Scar Assessment Scale scores 12 months after surgery indicated that the patients noted significantly less pain, thickness, and irregularity with Prineo™.\n Based on our results, we conclude that Prineo™ is a safe and effective substitute for superficial skin closure, with good cosmetic results and no increase in wound complications. The use of Prineo™ decreases operative time and cost and enhances the patient's postoperative comfort.\n This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .\n\nKamolz, Lars-Peter\n\nRappl, Thomas\n\nSchintler, Michael\n\nSpendel, Stephan\n\n\n"
},
{
"text": "\n175063\nStandardization of dermoscopic terminology and basic dermoscopic parameters to evaluate in general dermatology (non-neoplastic dermatoses): an expert consensus on behalf of the International Dermoscopy Society.\n\nErrichetti, E\n\nZalaudek, I\n\nKittler, H\n\nApalla, Z\n\nArgenziano, G\n\nBakos, R\n\nBlum, A\n\nBraun, R\n\nIoannides, D\n\nLacarrubba, F\n\nLazaridou, E\n\nLongo, C\n\nMicali, G\n\nMoscarella, E\n\nPaoli, J\n\nPapageorgiou, C\n\nRusso, T\n\nScope, A\n\nStinco, G\n\nThomas, L\n\nToncic, RJ\n\nTschandl, P\n\nCabo, H\n\nHallpern, A\n\nHofmann-Wellenhof, R\n\nMalvehy, J\n\nMarghoob, A\n\nMenzies, S\n\nPellacani, G\n\nPuig, S\n\nRabinovitz, H\n\nRudnicka, L\n\nVakirlis, E\n\nSoyer, P\n\nStolz, W\n\nTanaka, M\n\nLallas, A\n\nBeiträge in Fachzeitschriften\nISI:000478267900001\n31077336.0\n10.1111/bjd.18125\nNone\nOver the last few years, several articles on dermoscopy of non-neoplastic dermatoses have been published, yet there is poor consistency in the terminology among different studies.\n We aimed to standardize the dermoscopic terminology and identify basic parameters to evaluate in non-neoplastic dermatoses through an expert consensus.\n The modified Delphi method was followed, with two phases: (I) identification of a list of possible items based on a systematic literature review and (II) selection of parameters by a panel of experts through a three-step iterative procedure (blinded email interaction in Round 1 and 3 and face-to-face meeting in Round 2). Initial panellists were recruited via email from all over the world based on their expertise on dermoscopy of non-neoplastic dermatoses.\n Twenty-four international experts took part in all the rounds of the consensus and 13 further international participants were also involved in Round 2. Five standardized basic parameters were identified: (I) vessels (including morphology and distribution); (II) scales (including colour and distribution); (III) follicular findings; (IV) "other structures" (including colour and morphology); and (V) "specific clues". For each of them, possible variables were selected, with a total of 31 different sub-items reaching the agreement at the end of the consensus (all the 29 proposed initially + 2 added in the course of the consensus procedure).\n This expert consensus provides a set of standardized basic dermoscopic parameters to follow when evaluating inflammatory, infiltrative and infectious dermatoses. This tool, if adopted by clinicians/researchers of the field, is likely to enhance the reproducibility and comparability of existing and future research findings and uniformly expand the universal knowledge on dermoscopy in general dermatology. This article is protected by copyright. All rights reserved.\n This article is protected by copyright. All rights reserved.\n\nHofmann-Wellenhof, Rainer\n\nZalaudek, Iris\n\n\n"
},
{
"text": "\n183303\nThe Recovery of Muscle Spindle Sensitivity Following Stretching Is Promoted by Isometric but Not by Dynamic Muscle Contractions.\n\nBudini, F\n\nRafolt, D\n\nChristova, M\n\nGallasch, E\n\nTilp, M\n\nBeiträge in Fachzeitschriften\nISI:000563484400001\n32848855.0\n10.3389/fphys.2020.00905\nPMC7418680\nIt is often suggested that stretching-related changes in performance can be partially attributed to stretching-induced neural alterations. Recent evidence though shows that neither spinal nor cortico-spinal excitability are susceptible of a long-lasting effect and only the amplitude of stretch or tap reflex (TR) is reduced up to several minutes. Since afferents from muscle spindles contribute to voluntary muscle contractions, muscle stretching could be detrimental to muscle performance. However, the inhibition of muscle spindle sensitivity should be reversed as soon as the stretched muscle contracts again, due to α-γ co-activation. The present work evaluated which type of muscle contraction (static or dynamic) promotes the best recovery from the inhibition in spindle sensitivity following static stretching. Fifteen students were tested for TR at baseline and after 30 s maximal individual static stretching of the ankle plantar flexors followed by one of three randomized interventions (isometric plantar flexor MVC, three counter movement jumps, and no contraction/control). Ten TRs before and 20 after the procedures were induced with intervals of 30 s up to 10 min after static stretching. The size of the evoked TRs (peak to peak amplitude of the EMG signal) following stretching without a subsequent contraction (control) was on average reduced by 20% throughout the 10 min following the intervention and did not show a recovery trend. Significant decrease in relation to baseline were observed at 9 of the 20 time points measured. After MVC of plantar flexors, TR recovered immediately showing no differences with baseline at none of the investigated time points. Following three counter movement jumps it was observed a significant 34.4% group average inhibition (p < 0.0001) at the first time point. This effect persisted for most of the participants for the next measurement (60 s after intervention) with an average reduction of 23.4% (p = 0.008). At the third measurement, 90 s after the procedure, the reflexes were on average still 21.4% smaller than baseline, although significant level was not reached (p = 0.053). From 120 s following the intervention, the reflex was fully recovered. This study suggests that not every type of muscle contraction promotes a prompt recovery of a stretch-induced inhibition of muscle spindle sensitivity.\n Copyright © 2020 Budini, Rafolt, Christova, Gallasch and Tilp.\n\nChristova, Monica\n\nGallasch, Eugen\n\n\n"
},
{
"text": "\n187188\nThe high variability of the chiasma plantare and the long flexor tendons: Anatomical aspects of tendon transfer in foot surgery.\n\nPretterklieber, B\n\nBeiträge in Fachzeitschriften\nNone\n28163203.0\n10.1016/j.aanat.2017.01.011\nNone\nAs tendon transfer of the flexor hallucis longus (FHL) and the flexor digitorum longus (FDL) is an established procedure, exact knowledge of the formation of the chiasma plantare is of great interest. Although the quadratus plantae (QP) appears to play a major role, it has been rarely addressed in previous studies. The aim of the present study was to reinvestigate the formation of the chiasma plantare and the composition of the long flexor tendons in order to clarify the inexact and partly contradictory descriptions published from 1865 onward. The chiasma plantare and the long flexor tendons in both feet of 50 formalin-fixed specimens of body donors (25 men and women) were analyzed by gross anatomical dissection. It was composed of one (3%), two (69%) or three layers (28%) which were variably established by the tendinous and muscular fibers of the FHL, the FDL and the QP. In 61% the FHL gave one or more slips to the FDL, and in 39% there was a bidirectional interconnection between the two tendons. The slip from the FHL to the FDL largely reinforces the second (45%), or the second and third tendon (46%). Thus, the FHL is involved in the first tendon in all cases, in the second one in 97% of cases, and in the third tendon in about one half of cases (53%). In all instances, the FDL contributes to the third to fourth, in 98% the second, and in at least 39% to the first tendon. The QP reinforces the second to fourth tendon in nearly all cases, the fifth in about one half of cases, and even the first tendon in 14% of cases. In addition, the individual composition of the five long flexor tendons arising from the chiasma plantare was analyzed in detail. Special emphasis was placed on the evaluation of side and sex differences as well as individual symmetry. Furthermore, biomechanical, developmental and phylogenetic aspects were outlined. In terms of the outcome of this study, the FHL appears to be the better donor for tendon transfer to restore lost function, but harvesting the FDL seems to be more suitable to prevent long-term functional damage. The decision depends on the individual patient's needs and should be made with due care.\n Copyright © 2017 Elsevier GmbH. All rights reserved.\n\nPretterklieber, Bettina\n\n\n"
},
{
"text": "\n4260\nSubstance P in the uterine cervix, dorsal root ganglia and spinal cord during pregnancy and the effect of estrogen on SP synthesis.\n\nMowa, CN\n\nUsip, S\n\nStorey-Workley, M\n\nAmann, R\n\nPapka, R\n\nBeiträge in Fachzeitschriften\nISI:000184783900018\n12895664.0\n10.1016/S0196-9781(03)00120-7\nNone\nPrior to parturition the non-pliable uterine cervix undergoes a ripening process ("softens" and dilates) to allow a timely passage of the fetus at term. The exact mechanism(s) triggering and involved in cervical ripening are unknown, though evidence for a role for sensory neurons and their contained neuropeptides is emerging. Moreover, an apparent increase in neuropeptide immunoreactive nerves occurs in the cervix during pregnancy, maternal serum estrogen levels rise at term and uterine cervix-related L6-S1 dorsal root ganglia (DRG) sensory neurons express estrogen receptor (ER) and neuropeptides. Thus, we sought to test the hypothesis that the neuropeptide substance P (SP) changes biosynthesis and release over pregnancy, that estrogen, acting via the ER pathway, increases synthesis of SP in DRG, and that SP is utilized in cervical ripening at late pregnancy. Using immunohistochemistry, in situ hybridization, reverse transcriptase-polymerase chain reaction (RT-PCR) and radioimmunoassay (RIA), we investigated coexpression of ER-alpha/beta and SP; differential expression of ER-alpha and -beta mRNA in DRG neurons; SP synthesis in DRG; and changes in SP concentration in the cervix, DRG and spinal cord over pregnancy. In addition, the effect of exogenous estrogen on SP synthesis in L6-S1 DRG of ovariectomized rats was examined. SP-immunoreactive neurons expressed ER-alpha and ER-beta. SP synthesis (expressed as beta-PPT mRNA label) was prominent in small DRG neurons. SP concentration increased in the L6-S1 DRG and spinal cord segments, with a peak at Day 20 of gestation, but decreased in the cervix during the first two trimesters, with a rise over the last trimester to Day 10 levels. SP and ER-alpha mRNA synthesis increased in DRG over pregnancy but ER-beta mRNA levels were largely unchanged. When ovariectomized rats were treated with exogenous estrogen, SP mRNA synthesis in the DRG increased in a dose-related manner, an effect blocked by ER blocker ICI 182 780. From these results, we postulate that synthesis of SP in L6-S1 DRG and utilization in the cervix increase over pregnancy and this synthesis is under influence of the estrogen-ER system, most likely ER-alpha. We postulate that SP may play a role in cervical ripening and, consequently in the birth process.\n\n\n"
},
{
"text": "\n146074\nSex- and age-based variation in transfusion practices among patients undergoing major surgery.\n\nValero-Elizondo, J\n\nSpolverato, G\n\nKim, Y\n\nWagner, D\n\nEjaz, A\n\nFrank, SM\n\nPawlik, TM\n\nBeiträge in Fachzeitschriften\nISI:000363005800024\n26067458.0\n10.1016/j.surg.2015.04.030\nNone\nData on hemoglobin (Hb) threshold levels for "appropriate" packed red blood cell (PRBC) transfusions have not taken into account patient-specific variables such as sex and age. We sought to define differences in perioperative transfusion practices based on patient sex and age among patients undergoing complex gastrointestinal (GI) and cardiothoracic-vascular (CT-V) surgical procedures.\n All patients undergoing any major GI or CT-V procedures between January 2010 and April 2014 at the Johns Hopkins Hospital were identified. Data on sex, age, as well as other clinicopathologic and procedures were collected and analyzed relative to transfusion practices (restrictive: transfusion at blood Hb < 7 vs liberal transfusion at Hb ≥ 7 g/dL).\n Among the 10, 72 patients included in the study cohort, 4, 89 (44.0%) were transfused with ≥ 1 PRBC. Median preoperative Hb was lower among women (12.3 vs 13.4 g/dL in men) and the aged (<65 years, 13.1 vs ≥ 65 years, 12.7 g/dL) patients (both P < .05). On adjusted analysis, male sex (odds ratio [OR], 1.13; 95% CI, 1.02-1.26; P = .03) and age ≥ 65 (OR, 1.77; 95% CI, 1.35-2.33; P < .001) were associated independently with an increased odds of receipt of ≥ 1 PRBC. Although sex did not seem to impact transfusion strategy, patient age did impact the relative trigger used by providers for a transfusion. Specifically, patients 65-74 years (OR, 2.87; 95% CI, 1.93-4.26) and those ≥ 74 years (OR, 3.42; 95% CI, 2.28-5.14) were at a much greater odds of being transfused liberally compared with patients <65 years old (both P < .05). The proportion of patients who had a potentially avoidable transfusion (ie, both trigger ≥ 7 and target ≥ 9 g/dL) was greater among aged patients (50%) compared with nonaged patients (41%; P < .001). Of note, a restrictive transfusion strategy did not increase the risk of overall morbidity among women (OR, 0.76; 95% CI, 0.59-0.99; P = .04) or aged (OR, 1.13; 95% CI, 0.87-1.47; P = .37) patients.\n Sex and age were associated with receipt of transfusion and, in the case of older patients, transfusion strategy. Given the lack of evidence to support a higher Hb level in older patients, emphasis should be placed on aligning transfusion practices with current evidence to employ a more restrictive transfusion strategy to decrease overuse of blood resources.\n Copyright © 2015 Elsevier Inc. All rights reserved.\n\nWagner, Doris\n\n\n"
},
{
"text": "\n177470\nClinical evaluation of in silico planning and real-time simulation of hepatic radiofrequency ablation (ClinicIMPPACT Trial).\n\nMoche, M\n\nBusse, H\n\nFutterer, JJ\n\nHinestrosa, CA\n\nSeider, D\n\nBrandmaier, P\n\nKolesnik, M\n\nJenniskens, S\n\nBlanco Sequeiros, R\n\nKomar, G\n\nPollari, M\n\nEibisberger, M\n\nPortugaller, HR\n\nVoglreiter, P\n\nFlanagan, R\n\nMariappan, P\n\nReinhardt, M\n\nBeiträge in Fachzeitschriften\nISI:000511977900028\n31471752.0\n10.1007/s00330-019-06411-5\nNone\nTo evaluate the accuracy and clinical integrability of a comprehensive simulation tool to plan and predict radiofrequency ablation (RFA) zones in liver tumors.\n Forty-five patients with 51 malignant hepatic lesions of different origins were included in a prospective multicenter trial. Prior to CT-guided RFA, all patients underwent multiphase CT which included acquisitions for the assessment of liver perfusion. These data were used to generate a 3D model of the liver. The intra-procedural position of the RFA probe was determined by CT and semi-automatically registered to the 3D model. Size and shape of the simulated ablation zones were compared with those of the thermal ablation zones segmented in contrast-enhanced CT images 1 month after RFA; procedure time was compared with a historical control group.\n Simulated and segmented ablation zone volumes showed a significant correlation (ρ = 0.59, p < 0.0001) and no significant bias (Wilcoxon's Z = 0.68, p = 0.25). Representative measures of ablation zone comparison were as follows: average surface deviation (absolute average error, AAE) with 3.4 ± 1.7 mm, Dice similarity coefficient 0.62 ± 0.14, sensitivity 0.70 ± 0.21, and positive predictive value 0.66 ± 0. There was a moderate positive correlation between AAE and duration of the ablation (∆t; r = 0.37, p = 0.008). After adjustments for inter-individual differences in ∆t, liver perfusion, and prior transarterial chemoembolization procedures, ∆t was an independent predictor of AAE (ß = 0.03 mm/min, p = 0.01). Compared with a historical control group, the simulation added 3.5 ± 1.9 min to the procedure.\n The validated simulation tool showed acceptable speed and accuracy in predicting the size and shape of hepatic RFA ablation zones. Further randomized controlled trials are needed to evaluate to what extent this tool might improve patient outcomes.\n • More reliable, patient-specific intra-procedural estimation of the induced RFA ablation zones in the liver may lead to better planning of the safety margins around tumors. • Dedicated real-time simulation software to predict RFA-induced ablation zones in patients with liver malignancies has shown acceptable agreement with the follow-up results in a first prospective multicenter trial suggesting a randomized controlled clinical trial to evaluate potential outcome benefit for patients.\n\nPortugaller, Rupert\n\n\n"
},
{
"text": "\n2403\nSpecific cutaneous infiltrates of B-cell chronic lymphocytic leukemia arising at the site of herpes zoster and herpes simplex scars.\n\nCerroni, L\n\nZenahlik, P\n\nKerl, H\n\nBeiträge in Fachzeitschriften\nISI:A1995RD89700004\n8630873.0\n10.1002/1097-0142(19950701)76:1<26::AID-CNCR2820760105>3.0.CO;2-J\nNone\nBACKGROUND. Cutaneous lymphoid infiltrates at sites of herpes zoster scars in patients with B-cell chronic lymphocytic leukemia (B-CLL) often are diagnosed as benign lymphoid hyperplasia ("pseudolymphomas"). The histologic and immunophenotypic features of these lesions are not well characterized. Appearance of skin lesions in B-CLL patients is considered a poor prognostic sign. METHOD. Eight punch biopsies from five patients (three males, two females; mean age, 66.7 years) affected by B-CLL and presenting with lesions at sites of previous herpes simplex (upper lip, one patient) or herpes zoster (trunk, four patients; forehead, one patient) infections were included in the study. Histologic examination was performed on routine sections stained with hematoxylin and eosin and Giemsa. Immunohistologic stainings were performed with a standard three-step immunoperoxidase technique on formalin fixed, paraffin embedded tissue sections. RESULTS. Specific cutaneous infiltrates of B-CLL were diagnosed histopathologically and immunophenotypically in eight biopsies from all five patients. Clinically, patients presented with erythematous papules or plaques confined to the area of previous herpes virus eruptions. Histopathologic features in most cases were characterized by a variably dense perivascular and periadnexal infiltrate of small hyperchromatic lymphocytes throughout the entire dermis, reaching the subcutaneous fat. In one case, a dense, diffuse infiltrate involving the entire dermis was observed. A granulomatous reaction with presence of epithelioid and multinucleated giant cells was a prominent feature in four biopsies from three patients. Light areas containing large lymphoid cells with features of prolymphocytes and paraimmunoblasts (so-called "proliferation centers") could be observed only in the case characterized by a diffuse infiltrate. Immunohistology revealed an aberrant CD20+/CD43+ phenotype of neoplastic B cells, which is not found in normal B lymphocytes (CD20+/CD43-). Reactive T lymphocytes were present in all lesions and had a normal CD20-/CD43+/CD45Ro+ phenotype. At the time of this writing, four patients were alive without signs of skin disease after a mean follow-up of 58.5 months, and one patient died of B-CLL 24 months after the cutaneous eruption. CONCLUSIONS. Specific cutaneous infiltrates of B-CLL are not uncommon at sites of herpes virus scars. The diagnosis can be confirmed by histopathologic and immunophenotypic criteria. The prognosis is better than previously reported.\n\nCerroni, Lorenzo\n\nKerl, Helmut\n\n\n"
},
{
"text": "\n2719\nValue of echo-enhanced Doppler sonography in evaluation of transjugular intrahepatic portosystemic shunts.\n\nUggowitzer, MM\n\nKugler, C\n\nMachan, L\n\nHausegger, KA\n\nGroell, R\n\nQuehenberger, F\n\nLindbichler, F\n\nSchreyer, H\n\nBeiträge in Fachzeitschriften\nISI:000072608400039\n9530056.0\n10.2214/ajr.170.4.9530056\nNone\nOBJECTIVE: The value of echo-enhanced color and power Doppler sonography in the evaluation of transjugular intrahepatic portosystemic shunts (TIPS) was assessed and compared with that of unenhanced Doppler sonography and portal angiography. SUBJECTS AND METHODS: In a prospective randomized trial, 31 shunts in 30 patients underwent unenhanced conventional color and power Doppler sonography and portal venography including pressure measurements. The patients were allocated to either echo-enhanced conventional color Doppler sonography or echo-enhanced power Doppler sonography. For echo enhancement, a galactose-based suspension was administered IV. Shunt stenoses, if present, were quantified by percentage of stenosis and correlated with angiography, which was the gold standard. The diagnostic confidence of unenhanced and echo-enhanced Doppler sonography was assessed using a visual analog scale. RESULTS: In the diagnosis of shunt occlusion, echo-enhanced Doppler sonography yielded a sensitivity and a specificity of 100% and 100%, respectively, compared with 100% and 89%, respectively, for unenhanced Doppler sonography. Our evaluation of hemodynamically significant stenoses (portosystemic gradient > or = 15 mm Hg) found echo-enhanced Doppler sonography to be superior to unenhanced Doppler sonography (sensitivity and specificity of 82% and 83%, respectively, compared with 64% and 80%, respectively). In the detection of a shunt stenosis based on morphologic criteria only, echo-enhanced Doppler sonography yielded a sensitivity and a specificity of 78% and 100%, respectively, compared with 47% and 50%, respectively, for unenhanced Doppler sonography. Power Doppler imaging did not improve diagnostic accuracy but did increase diagnostic confidence for unenhanced Doppler sonography compared with conventional color Doppler sonography. The diagnostic confidence for sonographic evaluation of TIPS was significantly (p < .001) increased and the variability of hemodynamic measurements was markedly decreased with echo-enhanced sonography. CONCLUSION: Echo-enhanced Doppler sonography provides images of TIPS like those of angiography and allows morphologic assessment of the shunts, complementary to the essential pulsed Doppler waveform analysis that would be performed in a more guided manner. Also, echo-enhanced Doppler sonography significantly increases the sensitivity and specificity in the diagnosis of shunt dysfunction. The high diagnostic confidence and the diminished variability of spectral Doppler measurements may improve acceptance of sonographic evaluation of TIPS. Echo-enhanced Doppler sonography is safe and effective and may reduce the instances in which TIPS sonographic surveillance is nondiagnostic, in which case angiographic assessment is required.\n\nHausegger, Klaus\n\nQuehenberger, Franz\n\n\n"
}
]
}