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"text": "\n182237\nThe identification and management of interstitial lung disease in systemic sclerosis: evidence-based European consensus statements.\n\nHoffmann-Vold, AM\n\nMaher, T\n\nPhilpot, E\n\nAshrafzadeh, A\n\nBarake, R\n\nBarsotti, S\n\nBruni, C\n\nCarducci, P\n\nCarreira, P\n\nCastellví, I\n\ndel Galdo, F\n\nDistler, J\n\nFoeldvari, I\n\nFraticelli, P\n\nGeorge, P\n\nGriffiths, B\n\nGuillén-Del-Castillo, A\n\nHamid, AM\n\nHorváth, R\n\nHughes, M\n\nKreuter, M\n\nMoazedi-Fuerst, F\n\nOlas, J\n\nPaul, S\n\nRotondo, C\n\nRubio-Rivas, M\n\nSeferian, A\n\nTomčík, M\n\nUzunhan, Y\n\nWalker, U\n\nWięsik-Szewczyk, E\n\nDistler, O\n\nBeiträge in Fachzeitschriften\nISI:000547833300010\nNone\n10.1016/S2665-9913(19)30144-4\nNone\nBackground Systemic sclerosis-associated interstitial lung disease (ILD) carries a high mortality risk; expert guidance is required to aid early recognition and treatment. We aimed to develop the first expert consensus and define an algorithm for the identification and management of the condition through application of well established methods. Methods Evidence-based consensus statements for systemic sclerosis-associated ILD management were established for six domains (ie, risk factors, screening, diagnosis and severity assessment, treatment initiation and options, disease progression, and treatment escalation) using a modified Delphi process based on a systematic literature analysis. A panel of 27 Europe-based pulmonologists, rheumatologists, and internists with expertise in systemic sclerosis-associated ILD participated in three rounds of online surveys, a face-to-face discussion, and a WebEx meeting, followed by two supplemental Delphi rounds, to establish consensus and define a management algorithm. Consensus was considered achieved if at least 80% of panellists indicated agreement or disagreement. Findings Between July 1, 2018, and Aug 27, 2019, consensus agreement was reached for 52 primary statements and six supplemental statements across six domains of management, and an algorithm was defined for clinical practice use. The agreed statements most important for clinical use included: all patients with systemic sclerosis should be screened for systemic sclerosis-associated ILD using high-resolution CT; high-resolution CT is the primary tool for diagnosing ILD in systemic sclerosis; pulmonary function tests support screening and diagnosis; systemic sclerosis-associated ILD severity should be measured with more than one indicator; it is appropriate to treat all severe cases; no pharmacological treatment is an option for some patients; follow-up assessments enable identification of disease progression; progression pace, alongside disease severity, drives decisions to escalate treatment. Interpretation Through a robust modified Delphi process developed by a diverse panel of experts, the first evidence-based consensus statements were established on guidance for the identification and medical management of systemic sclerosis-associated ILD. Copyright (C) 2020 Elsevier Ltd. All rights reserved.\n\nMoazedi-Fürst, Florentine\n\n\n"
},
{
"text": "\n186820\nBisphosphonate treatment changes regional distribution of trabecular microstructure in human lumbar vertebrae.\n\nVom Scheidt, A\n\nHemmatian, H\n\nPüschel, K\n\nKrause, M\n\nAmling, M\n\nBusse, B\n\nBeiträge in Fachzeitschriften\nNone\n31280018.0\n10.1016/j.bone.2019.07.003\nNone\nIn osteoporosis patients, antiresorptive treatments such as alendronate reduce the resorption of trabecular bone and thus minimize vertebral fracture risk. However, fracture risk reduction efficacy of antiresorptive drugs varies between skeletal sites and is highest for vertebral bone. In human vertebrae, cancellous bone is distributed heterogeneously between regions. This microstructural heterogeneity is changing with patient age and is likely to play a major role in vertebral failure mechanisms and fracture susceptibility. Whether antiresorptive treatment affects the heterogeneity of vertebral microstructure in osteoporosis has not been unraveled.\n Our aim was to assess whether antiresorptive treatment would have a region-dependent influence on vertebral trabecular bone. Therefore, we used high-resolution peripheral quantitative computed tomography (HR-pQCT), microcomputed tomography (microCT) and uniaxial compression testing to determine the structure and mechanical properties of trabecular bone cores from anterior and posterior regions of 22 lumbar vertebrae from elderly osteoporotic women. We analyzed age-matched ex vivo bone samples from bisphosphonate-treated female osteoporosis patients (age: 82 ± 7y, bisphosphonate treatment period: 4 ± 2 years) along treatment-naïve female controls (82 ± 7y).\n MicroCT analysis showed a significantly lower bone volume fraction (p = 0.006) and lower trabecular number (p = 0.003) for the anterior bone cores compared to posterior bone cores in the treatment-naïve group. The bisphosphonate-treated group had a more homogeneous bone volume distribution and did not show significant regional differences in bone volume, it however also displayed significantly different trabecular numbers (p = 0.016). In bone cores of the bisphosphonate-treated group, trabeculae were thicker in comparison to treatment-naïve controls (p = 0.011). Differences in bone volume further resulted in different maximum forces during compression testing between the samples. In addition, the percental difference between BV/TVμCT in anterior and posterior bone cores was lower in bisphosphonate-treated vertebrae when vertebrae with directly adjacent fractures (n = 3) were excluded.\n In conclusion, regional trabecular bone microstructure in lumbar vertebrae of bisphosphonate-treated women was more homogeneous compared to treatment-naïve controls. Bisphosphonate treatment, which specifically targets resorption surfaces common in anterior vertebral bone, might have resulted in a region-specific preservation of vertebral microstructure and loading capacity. This could have positive implications for the reduction of wedge fracture risk and add to the explanation of the higher efficacy of fracture risk reduction in vertebrae in comparison to other fracture regions.\n Copyright © 2019. Published by Elsevier Inc.\n\nvom Scheidt, Annika\n\n\n"
},
{
"text": "\n63954\nIncomplete lupus erythematosus: results of a multicentre study under the supervision of the EULAR Standing Committee on International Clinical Studies Including Therapeutic Trials (ESCISIT).\n\nSwaak, AJ\n\nvan de Brink , H\n\nSmeenk, RJ\n\nManger, K\n\nKalden, JR\n\nTosi, S\n\nMarchesoni, A\n\nDomljan, Z\n\nRozman, B\n\nLogar, D\n\nPokorny, G\n\nKovacs, L\n\nKovacs, A\n\nVlachoyiannopoulos, PG\n\nMoutsopoulos, HM\n\nChwalinska-Sadowska, H\n\nDratwianka, B\n\nKiss, E\n\nCikes, N\n\nAnic, B\n\nSchneider, M\n\nFischer, R\n\nBombardieri, S\n\nMosca, M\n\nGraninger, W\n\nSmolen, JS\n\nStudy group on incomplete SLE and SLE with disease duration longer than 10 years\n\nBeiträge in Fachzeitschriften\nISI:000166782800014\n11157147.0\n10.1093/rheumatology/40.1.89\nNone\nOBJECTIVE: Patients characterized with antinuclear antibodies (ANA) and disease symptoms related to one organ system can be described as having incomplete systemic lupus erythematosus (SLE). The aim of this multicentre study was to describe the outcome of these so-called incomplete SLE patients. Two aspects of the outcome were studied: (i) the disease course, defined by the presence or absence of clinical symptoms; and (ii) the number of patients that eventually developed full SLE. METHODS: Outcome parameters were the ACR criteria, the SLE disease Activity Index (SLEDAI), the European Consensus Lupus Activity Measure (ECLAM) and the requirement for treatment. In 10 European rheumatology centres, patients who had been evaluated in the last 3 months of 1994 and had been diagnosed as having incomplete SLE on clinical grounds for at least 1 yr were included in the study. All 122 patients who were included in the study were evaluated annually during 3 yr of follow-up. RESULTS: Our results are confined to a patient cohort defined by disease duration of at least 1 yr, being under clinical care at the different centres in Europe. These patients showed disease activity that was related mostly to symptoms of the skin and the musculoskeletal system, and leucocytopenia. During the follow-up, low doses of prednisolone were still being prescribed in 43% of the patients. On recruitment to the study, 22 of the 122 incomplete SLE patients already fulfilled the ACR criteria for the diagnosis of SLE. In the 3 yr of follow-up only three patients developed SLE. CONCLUSIONS: A high proportion of patients in our cohort defined on clinical grounds as having incomplete SLE eventually showed disease activity defined by the SLEDAI as well as ECLAM. However, only three cases developed to SLE during the follow-up. This suggests that incomplete SLE forms a subgroup of SLE that has a good prognosis.\n\nGraninger, Winfried\n\n\n"
},
{
"text": "\n64269\nInhalation scintigraphy with iodine-123-labeled interferon gamma-1b: pulmonary deposition and dose escalation study in healthy volunteers.\n\nVirgolini, I\n\nKurtaran, A\n\nLeimer, M\n\nSmith-Jones, P\n\nAgis, H\n\nAngelberger, P\n\nKletter, K\n\nValent, P\n\nLinkesch, W\n\nEichler, HG\n\nBeiträge in Fachzeitschriften\nISI:A1997XV76600041\n9293812.0\nNone\nNone\nRecent studies have suggested that recombinant interferon gamma (IFNg) may be useful in the treatment of various respiratory diseases, such as chronic inflammatory disease. This study was undertaken to investigate the dose response of escalating doses of inhaled 123I-labeled IFNg (123I-IFNg) and its safety, biodistribution and radiation absorbed doses in healthy volunteers. METHODS: IFNg was labeled with 123I to produce a specific activity of 1800 MBq/mg of IFNg. The biological activities of 123I-IFNg, nebulized 123I-IFNg and unlabeled IFNg were evaluated in various functional in vitro tests. Ten healthy volunteers were enrolled in the in vivo dose escalation study (180 MBq of 123I-IFNg diluted with 0.1-2 mg of INFg). Inhalation scintigraphy, using a Pari-Master nebulizer, was performed for up to 37 min, during which dynamic posterior images of the lungs were obtained. Whole-body scanning was performed at various time points up to 24 hr postinjection, for biodistribution and dosimetry purposes. Blood, urine and feces were also collected over this 24-hr period. Lung perfusion scintigraphy with 99mTc-microspheres was performed at the end of the study for attenuation correction. RESULTS: Inhaled nebulized IFNg showed a uniform deposition pattern in the lungs with deposition ratios of 0.74 (central-to-peripheral) and 0.78 (upper-to-lower). The lung deposition of IFNg was time-dependent, with a deposition half-time between 1 and 5 min. Despite a large interindividual variation, the total lung deposition was proportional to the nebulizer charge and was 53 +/- 12% of the inhaled dose and 19 +/- 7% of the initial nebulizer charge (between 0.1 and 2 mg of IFNg). The biological half-life in the lung could be fitted to a biexponential function, with resultant half-lives of 1 and 11 hr. Blood activity was maximal at 3.5 hr after inhalation and was due to free iodine. The radioactivity was excreted through both the urinary and intestinal tracts. Plasma IFNg levels did not significantly increase over time, and no significant HLA-DR induction on peripheral blood cells was detected. The highest radiation absorbed doses of 0.14 and 0.19 mGy/MBq were determined for the trachea and the lower intestines, respectively. The effective dose equivalent was 0.05 mSv/MBq. CONCLUSION: After inhalation with the Pari-Master nebulizer, IFNg deposits normally in the lungs and shows no systemic effects in healthy volunteers.\n\n\n"
},
{
"text": "\n112833\nAssessment of bone quality within the tuberosities of the osteoporotic humeral head: relevance for anchor positioning in rotator cuff repair.\n\nKirchhoff, C\n\nBraunstein, V\n\nMilz, S\n\nSprecher, CM\n\nFischer, F\n\nTami, A\n\nAhrens, P\n\nImhoff, AB\n\nHinterwimmer, S\n\nBeiträge in Fachzeitschriften\nISI:000274803800018\n20118499.0\n10.1177/0363546509354989\nNone\nBackground: Tears of the rotator cuff are highly prevalent in patients older than 60 years, thereby presenting a population also suffering from osteopenia or osteoporosis. Suture fixation in the bone depends on the holding strength of the anchoring technique, whether a bone tunnel or suture anchor is selected. Because of osteopenic or osteoporotic bone changes, suture anchors in the older patient might pull out, resulting in failure of repair. Hypothesis: The aim of our study was to analyze the bone quality within the tuberosities of the osteoporotic humeral head using high-resolution quantitative computed tomography (HR-pQCT). Study Design: Descriptive laboratory study. Methods: Thirty-six human cadaveric shoulders were analyzed using HR-pQCT. The mean bone volume to total volume (BV/TV) as well as trabecular bone mineral densities (trabBMDs) of the greater tuberosity (GT) and the lesser tuberosity (LT) were determined. Within the GT, 6 volumes of interest (VOls) within the LT, and 2 VOls and 1 control volume within the subchondral area beyond the articular surface were set. Results: Comparing BV/TV of the medial and the lateral row, significantly higher values were found medially (P < .001). The highest BV/TV, 0.030% +/- 0.027%, was found in the posteromedial portion of the GT (P < .05). Regarding the analysis of the LT, no difference was found comparing the superior (BV/TV: 0.024% +/- 0.022%) and the inferior (BV/TV: 0.019% +/- 0.016%) portion. Analyzing trabBMD, equal proportions were found. An inverse correlation with a correlation coefficient of -0.68 was found regarding BV/TV of the posterior portion of the GT and age (P < .05). Conclusion: Significant regional differences of trabecular microarchitecture were found in our HR-pQCT study. The volume of highest bone quality resulted for the posteromedial aspect of the GT. Moreover, a significant correlation of bone quality within the GT and age was found, while the bone quality within the LT seems to be independent from it. Clinical Relevance: The shape of the rotator cuff tear largely determines the bony site of tendon reattachment, although the surgeon has distinct options to modify anchor positioning. According to our results, placement of suture anchors in a medialized way at the border to the articular surface might guarantee a better structural bone stock.\n\n\n"
},
{
"text": "\n148804\nDurability of Treatment Effect Using a Drug-Coated Balloon for Femoropopliteal Lesions: 24-Month Results of IN.PACT SFA.\n\nLaird, JR\n\nSchneider, PA\n\nTepe, G\n\nBrodmann, M\n\nZeller, T\n\nMetzger, C\n\nKrishnan, P\n\nScheinert, D\n\nMicari, A\n\nCohen, DJ\n\nWang, H\n\nHasenbank, MS\n\nJaff, MR\n\nIN.PACT SFA Trial Investigators\n\nBeiträge in Fachzeitschriften\nISI:000365099600009\n26476467.0\n10.1016/j.jacc.2015.09.063\nNone\nEvidence from large, randomized, controlled peripheral artery disease trials reporting long-term outcomes using drug-coated balloons (DCBs) is limited. Previously, the DCB showed favorable 1-year outcomes compared with conventional percutaneous transluminal angioplasty (PTA), yet durability of the treatment effect with DCBs remains unknown.\n This study sought to investigate the longer-term outcomes of a paclitaxel-eluting DCB compared to PTA for femoropopliteal lesions.\n We enrolled 331 patients with symptomatic (Rutherford 2 to 4) femoropopliteal lesions up to 18 cm in length. Patients were randomly assigned in a 2:1 ratio to treatment with DCB or PTA. The 24-month assessments included primary patency, freedom from clinically driven target lesion revascularization (CD-TLR), major adverse events, and quality of life and functional outcomes as assessed by the EuroQOL-5D quality-of-life questionnaire, walking impairment questionnaire, and 6-min walk test.\n At 24 months, patients treated with DCB showed significantly higher primary patency when compared with PTA (78.9% vs. 50.1%; p < 0.001). The rates of CD-TLR were 9.1% and 28.3% (p < 0.001) for the DCB and PTA groups, respectively. The overall mortality rate in the DCB group was 8.1% versus 0.9% in the PTA group (p = 0.008). There were no device- or procedure-related deaths and no major amputations in either group through 24-month follow-up. The rate of vessel thrombosis was low (1.5% DCB vs. 3.8% PTA; p = 0.243), with no new events reported between 1 and 2 years. Both groups showed similar functional improvement at 2 years, although DCB patients achieved this level of function with 58% fewer reinterventions.\n The 24-month outcomes from the trial demonstrate a durable and superior treatment effect of DCB versus PTA with significantly higher primary patency, lower CD-TLR, and similar functional status improvement with fewer repeat interventions. (Randomized Trial of IN.PACT Admiral Drug Eluting Balloon vs Standard PTA for the Treatment of SFA and Proximal Popliteal Arterial Disease [INPACT SFA I]; NCT01175850; and IN.PACT Admiral Drug-Coated Balloon vs. Standard Balloon Angioplasty for the Treatment of Superficial Femoral Artery [SFA] and Proximal Popliteal Artery [PPA] [INPACT SFA II]; NCT01566461).\n Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.\n\nBrodmann, Marianne\n\n\n"
},
{
"text": "\n172469\nImpact of segmentation density on spectral domain optical coherence tomography assessment in Stargardt disease.\n\nVelaga, SB\n\nNittala, MG\n\nJenkins, D\n\nMelendez, J\n\nHo, A\n\nStrauss, RW\n\nScholl, HP\n\nSadda, SR\n\nBeiträge in Fachzeitschriften\nISI:000459788800012\n30613916.0\n10.1007/s00417-018-04229-3\nNone\nAutomated spectral domain optical coherence tomography (SD-OCT) segmentation algorithms currently do not perform well in segmenting individual intraretinal layers in eyes with Stargardt disease (STGD). We compared selective B-scan segmentation strategies for generating mean retinal layer thickness and preserved area data from SD-OCT scans in patients with STGD1.\n Forty-five eyes from 40 Stargardt patients were randomly selected from the ongoing Natural History of the Progression of Atrophy Secondary to Stargardt Disease (ProgStar) study. All eyes underwent SD-OCT using a standard macular volume consisting of 1024 × 49 equally spaced B-scans within a 20 × 20 degree field centered on the fovea. All 49 B-scans were segmented manually to quantify total retina, outer nuclear layer (ONL), photoreceptor inner segments, photoreceptor outer segments (OS), and retinal pigment epithelial layer (RPE). Mean thickness and total area were generated using all 49 B-scans (spaced 122 μm apart), 25 B-scans (every other B-scan, spaced 240 μm apart), 17 B-scans (every third scan, 353 μm apart), and 13 B-scans (every fourth scan, 462 μm apart), as well as by using an "adaptive" method where a subset (minimum 25 B-scans) of B-scans that the grader deemed as significantly different from adjacent B-scans were utilized. Mean absolute and percentage errors were calculated for macular thickness and area of different retinal layers for the different B-scan subset selection strategies relative to using all 49 B-scans, which was considered the reference or ground truth.\n Mean thickness and area measurements were significantly different for any regularly spaced reduction in B-scan density relative to the ground truth. When an adaptive approach was applied using a minimum of half the scans, the differences relative to ground truth were no longer significantly different. The mean percent differences for the area and thicknesses of the various layers ranged from 0.02 to 33.66 (p < 0.05 for all comparisons) and 0.44 to 7.24 (p > 0.05) respectively.\n Manual segmentation of a subset of B-scans using an adaptive strategy can yield thickness and area measurements of retinal sublayers comparable to the reference ground truth derived from using all B-scans in the volume. These results may have implications for increasing the efficiency of SD-OCT grading strategies in clinical trials for STGD and other related macular degenerative disorders.\n\nStrauß, Rupert\n\n\n"
},
{
"text": "\n180347\nThe selection of dermatomes for sham (placebo) acupuncture points is relevant for the outcome of acupuncture studies: a systematic review of sham (placebo)-controlled randomized acupuncture trials.\n\nOts, T\n\nKandirian, A\n\nSzilagyi, I\n\nDiGiacomo, SM\n\nSandner-Kiesling, A\n\nBeiträge in Fachzeitschriften\nISI:000554346700001\n32026725.0\n10.1177/0964528419889636\nNone\nMany randomized controlled trials (RCTs) of acupuncture reveal no significant differences between acupuncture and so-called placebo acupuncture. There is a strong tendency to replace the term "placebo" by the term "sham, because any needling stimulates a certain physiological response. However, neither concept accounts for the great diversity of results in RCTs comparing verum acupuncture and sham (placebo) acupuncture. Some trials have shown little or no difference, while other studies have found statistically significant differences.\n Verum acupuncture and sham (placebo) acupuncture may achieve similar results to the extent that they share active constituents. We identified these common active constituents as dermatomes: the segmental structure of the human body. In our study, we tested the hypothesis that the more verum and sham (placebo) acupuncture share the same dermatomes, the closer the clinical outcomes will be, and vice versa.\n All major databases were searched for RCTs that tested acupuncture versus sham (placebo) acupuncture. The dermatome charts of Hansen and Schliack were used to verify verum and sham (placebo) needling locations. Reported clinical outcomes were assessed in relation to the percentage of overlap between the dermatomes stimulated by acupuncture and sham (placebo) acupuncture.\n Our literature search yielded a total of 1738 references. Thirty-four studies met the inclusion criteria. The effects of sham (placebo) acupuncture varied according to the dermatomes stimulated: high overlap with those stimulated by verum acupuncture resulted in almost identical efficacy, while low overlap resulted in significant differences in efficacy. Clinical outcomes were similar when verum acupuncture and sham (placebo) acupuncture shared the same dermatomes (p < 0.01).\n The findings of this review confirm our hypothesis. Acupuncture studies that employed verum and sham locations on overlapping dermatomes helped to create a mediocre to negative picture of acupuncture's efficacy. The segmental structure of the body with its interconnected reflex system offers an additional neurophysiological explanation for the effectiveness of acupuncture applied to structures segmentally innervated by the spinal and visceral nervous system. Further comparative acupuncture studies should be based on knowledge of segmental anatomy. In testing verum acupuncture versus sham acupuncture, the chosen sham acupuncture needling locations should be situated on non-overlapping dermatomes.\n\nSandner-Kiesling, Andreas\n\nSzilagyi, Istvan - Szilard\n\n\n"
},
{
"text": "\n187332\nInitial Use of Ambrisentan plus Tadalafil in Pulmonary Arterial Hypertension.\n\nGaliè, N\n\nBarberà, JA\n\nFrost, AE\n\nGhofrani, HA\n\nHoeper, MM\n\nMcLaughlin, VV\n\nPeacock, AJ\n\nSimonneau, G\n\nVachiery, JL\n\nGrünig, E\n\nOudiz, RJ\n\nVonk-Noordegraaf, A\n\nWhite, RJ\n\nBlair, C\n\nGillies, H\n\nMiller, KL\n\nHarris, JH\n\nLangley, J\n\nRubin, LJ\n\nAMBITION Investigators\n\nBeiträge in Fachzeitschriften\nNone\n26308684.0\n10.1056/NEJMoa1413687\nNone\nData on the effect of initial combination therapy with ambrisentan and tadalafil on long-term outcomes in patients with pulmonary arterial hypertension are scarce.\n In this event-driven, double-blind study, we randomly assigned, in a 2:1:1 ratio, participants with World Health Organization functional class II or III symptoms of pulmonary arterial hypertension who had not previously received treatment to receive initial combination therapy with 10 mg of ambrisentan plus 40 mg of tadalafil (combination-therapy group), 10 mg of ambrisentan plus placebo (ambrisentan-monotherapy group), or 40 mg of tadalafil plus placebo (tadalafil-monotherapy group), all administered once daily. The primary end point in a time-to-event analysis was the first event of clinical failure, which was defined as the first occurrence of a composite of death, hospitalization for worsening pulmonary arterial hypertension, disease progression, or unsatisfactory long-term clinical response.\n The primary analysis included 500 participants; 253 were assigned to the combination-therapy group, 126 to the ambrisentan-monotherapy group, and 121 to the tadalafil-monotherapy group. A primary end-point event occurred in 18%, 34%, and 28% of the participants in these groups, respectively, and in 31% of the pooled-monotherapy group (the two monotherapy groups combined). The hazard ratio for the primary end point in the combination-therapy group versus the pooled-monotherapy group was 0.50 (95% confidence interval [CI], 0.35 to 0.72; P<0.001). At week 24, the combination-therapy group had greater reductions from baseline in N-terminal pro-brain natriuretic peptide levels than did the pooled-monotherapy group (mean change, -67.2% vs. -50.4%; P<0.001), as well as a higher percentage of patients with a satisfactory clinical response (39% vs. 29%; odds ratio, 1.56 [95% CI, 1.05 to 2.32]; P=0.03) and a greater improvement in the 6-minute walk distance (median change from baseline, 48.98 m vs. 23.80 m; P<0.001). The adverse events that occurred more frequently in the combination-therapy group than in either monotherapy group included peripheral edema, headache, nasal congestion, and anemia.\n Among participants with pulmonary arterial hypertension who had not received previous treatment, initial combination therapy with ambrisentan and tadalafil resulted in a significantly lower risk of clinical-failure events than the risk with ambrisentan or tadalafil monotherapy. (Funded by Gilead Sciences and GlaxoSmithKline; AMBITION ClinicalTrials.gov number, NCT01178073.).\n\nOlschewski, Horst\n\n\n"
},
{
"text": "\n4841\nCytokine production by cord blood mononuclear cells stimulated with cows milk proteins in vitro: interleukin-4 and transforming growth factor beta-secreting cells detected in the CD45RO T cell population in children of atopic mothers.\n\nHauer, AC\n\nRiederer, M\n\nGriessl, A\n\nRosegger, H\n\nMacDonald, TT\n\nBeiträge in Fachzeitschriften\nISI:000182776000013\n12752590.0\n10.1046%2Fj.1365-2222.2003.01646.x\nNone\nBACKGROUND: Food antigens from the maternal circulation may sensitize fetal T cells in utero and be an important determinant in the development of food allergy. METHODS: Here we have examined the spontaneous and recall response to cow's milk proteins of cord blood mononuclear cells (CBMC) of newborn children, using single cell ELISPOT assays. RESULTS: In term newborns, confirming previous studies, the spontaneous cytokine response of CBMC is dominated by IL-4, IL-5, IL-10, and as shown here for the first time, TGF-beta. For TGF-beta only, the response of samples from infants of atopic mothers was significantly lower than samples from infants of non-atopic mothers. In vitro stimulation of CBMC with bovine serum albumin, casein and beta-lactoglobulin resulted in a significant increase of all cytokine-secreting cells, again dominated by T helper type 2 (Th2) cytokines. There was a clear tendency for samples from infants of atopic mothers to have lower Th2 responses than samples from infants of non-atopic mothers, which was particularly significant for both IL-4 and TGF-beta. Spontaneous cytokine secreting cells were virtually absent in cord blood from infants < 34 weeks gestation, as were cows milk protein-induced responses, although they were readily detectable in samples from infants aged > 34 weeks. To explore whether the cytokine secreting cells were in the naive CD4+ CD45RA population or memory CD4+ CD45RO T cells, these subsets were purified by positive and negative selection and tested for spontaneous and cows milk protein-induced cytokine responses. Strikingly, although the responses were small, the CD45RO+ cells from children of atopic mothers showed significant spontaneous and antigen-specific IL-4 and TGF-beta responses, whereas the same population from infants of non-atopic mothers showed virtually no response. In addition CD45RA+ cells from infants of mothers with maternal atopy showed decreased IL-4 and TGF-beta responses, especially the latter. CONCLUSIONS: The cows milk antigen-specific IL-4 and TGF-beta responses preferentially seen in the memory cell subset of infants with a maternal history of atopy strongly suggests Th2 skewing to dietary antigens in utero.\n\nHauer, Almuthe\n\n\n"
},
{
"text": "\n65977\nDeletion polymorphism of the angiotensin I-converting enzyme gene is associated with increased plasma angiotensin-converting enzyme activity but not with increased risk for myocardial infarction and coronary artery disease.\n\nWinkelmann, BR\n\nNauck, M\n\nKlein, B\n\nRuss, AP\n\nBöhm, BO\n\nSiekmeier, R\n\nIhnken, K\n\nVerho, M\n\nGross, W\n\nMärz, W\n\nBeiträge in Fachzeitschriften\nISI:A1996UT39900003\n8644984.0\n10.7326/0003-4819-125-1-199607010-00004\nNone\nBACKGROUND: Previous research has shown that the insertion/deletion (I/D) polymorphism of the angiotensin I-converting enzyme (ACE) gene is a major determinant of plasma ACE activity. It has been suggested that persons with the DD genotype (those who express, on average, the highest levels of circulating ACE) have an increased risk for myocardial infarction and coronary artery disease, particularly if they are otherwise at low risk. Subsequent studies, however, have not confirmed that ACE I/D gene polymorphism is a risk factor for coronary artery disease and myocardial infarction. OBJECTIVE: To investigate the association between the I/D polymorphism of the ACE gene and the risk for coronary artery disease and myocardial infarction in patients in whom coronary artery disease status was documented by angiography. DESIGN: Cross-sectional study. SETTING: University medical center. PATIENTS: 209 male case-patients with coronary artery disease and 92 male controls without coronary artery disease, as documented by coronary angiography. MEASUREMENTS: Assessment of the cardiac risk profile by questionnaire; classification of patients by the degree of coronary artery stenosis; levels of lipoproteins, apolipoproteins, and fibrinogen; and ACE I/D gene polymorphism assessed by polymerase chain reaction amplification. RESULTS: Plasma ACE activity was significantly associated with ACE I/D gene polymorphism. The ACE genotype was not associated with the presence of coronary artery disease or myocardial infarction. If a recessive effect of the D allele was assumed (DD compared with DI and II), the relative risk was 1.00 (95% CI, 0.76 to 1.30) for coronary artery disease and 1.03 (CI, 0.77 to 1.38) for myocardial infarction. Results of analyses were also negative when a dominant effect of the D allele was assumed and when low-risk subgroups were examined. The established risk factors age and apolipoprotein B level emerged as the most important risk predictors in multivariate analyses, followed by diastolic blood pressure and fasting glucose levels. CONCLUSIONS: In an angiographically defined study sample, ACE I/D gene polymorphism was not associated with an increased risk for coronary artery disease or myocardial infarction, despite its effects on plasma ACE activity.\n\nMärz, Winfried\n\n\n"
},
{
"text": "\n130212\nQuality of caesarean delivery services and documentation in first-line referral facilities in Afghanistan: a chart review.\n\nKim, YM\n\nTappis, H\n\nZainullah, P\n\nAnsari, N\n\nEvans, C\n\nBartlett, L\n\nZaka, N\n\nZeck, W\n\nBeiträge in Fachzeitschriften\nISI:000304425900001\n22420615.0\n10.1186/1471-2393-12-14\nPMC3359271\nIncreasing appropriate use and documentation of caesarean section (CS) has the potential to decrease maternal and perinatal mortality in settings with low CS rates. We analyzed data collected as part of a comprehensive needs assessment of emergency obstetric and newborn care (EmONC) facilities in Afghanistan to gain a greater understanding of the clinical indications, timeliness, and outcomes of CS deliveries.\n Records were reviewed at 78 government health facilities expected to function as EmONC providers that were located in secure areas of the country. Information was collected on the three most recent CS deliveries in the preceding 12 months at facilities with at least one CS delivery in the preceding three months. After excluding 16 facilities with no recent CS deliveries, the sample includes 173 CS deliveries at 62 facilities.\n No CS deliveries were performed in the previous three months at 21% of facilities surveyed; all of these were lower-level facilities. Most CS deliveries (88%) were classified as emergencies, and only 12% were referrals from another facility. General anesthesia was used in 62% of cases, and spinal or epidural anesthesia in 34%. Only 28% of cases were managed with a partograph. Surgery began less than one hour after the decision for a CS delivery in just 30% of emergency cases. Among the 173 cases, 27 maternal deaths, 28 stillbirths, and 3 early neonatal deaths were documented. In cases of maternal and fetal death, the most common indications for CS delivery were placenta praevia or abruption and malpresentation. In 62% of maternal deaths, the fetus was stillborn or died shortly after birth. In 48% of stillbirths, the fetus had a normal heart rate at the last check. Information on partograph use was missing in 38% of cases, information on parity missing in 23% of cases and indications for cesareans missing in 9%.\n Timely referral within and to EmONC facilities would decrease the proportion of CS deliveries that develop to emergency status. While the substantial mortality associated with CS in Afghanistan may be partly due to women coming late for obstetric care, efforts to increase the availability and utilization of CS must also focus on improving the quality of care to reduce mortality. Key goals should be encouraging use of partographs and improving decision-making and documentation around CS deliveries.\n\n\n"
},
{
"text": "\n131643\nInsulin degludec is not associated with a delayed or diminished response to hypoglycaemia compared with insulin glargine in type 1 diabetes: a double-blind randomised crossover study.\n\nKoehler, G\n\nHeller, S\n\nKorsatko, S\n\nRoepstorff, C\n\nRasmussen, S\n\nHaahr, H\n\nPieber, TR\n\nBeiträge in Fachzeitschriften\nISI:000328332900005\n24057153.0\n10.1007/s00125-013-3056-0\nPMC3855490\nInsulin degludec (Des(B30)LysB29(γ-Glu Nε-hexadecandioyl) human insulin; IDeg) is a new basal insulin with an ultra-long flat action profile. The acute physiological responses to hypoglycaemia with IDeg and insulin glargine (A21Gly, 31Arg, 32Arg human insulin; IGlar) were compared.\n Twenty-eight adult type 1 diabetic patients with normal hypoglycaemia awareness (age = 41 ± 12 years, HbA1c = 7.8 ± 0.6% [62.8 ± 7 mmol/mol]) were randomised to once-daily IDeg or IGlar for 5 days in a two-period crossover design. Participants and research staff were blinded to group assignment. Patients were assigned the lowest available randomisation number from a set of blinded randomisation codes provided by the trial sponsor. Hypoglycaemia was induced by administering three times the usual daily insulin dose at midnight on day 5. Plasma glucose (PG) was stabilised by glucose clamp (5.5 mmol/l) for 7-9 h post dosing. Next morning, PG was allowed to decrease stepwise from 5.5 to 3.5 mmol/l (maintained for 30 min) to 2.5 mmol/l (for 15 min). PG was then increased to 3.9 mmol/l (for 120 min), before being returned to baseline. Hypoglycaemic symptom score (HSS), hypoglycaemic awareness, cognitive function, counter-regulatory hormones and vital signs were assessed during each glucose plateau. The primary analysis was to compare IDeg vs IGlar with respect to HSS at nadir PG concentration (2.5 mmol/l).\n The full analysis set for treatment comparisons comprised data from all 28 exposed patients. Rates of PG decline and PG at nadir were similar for IDeg and IGlar. No treatment differences in HSS (estimated difference: 0.17 [95% CI -1.71, 2.05]; p > 0.05), cognitive function or awareness were observed at any time. Growth hormone and cortisol responses during hypoglycaemia were greater with IDeg than IGlar (AUC treatment ratio [IDeg/IGlar]: 2.44 [1.30, 4.60], p < 0.01; and 1.23 [1.01, 1.50]; p < 0.05), and adrenaline (epinephrine) responses trended higher (1.40 [0.96, 2.04], p = 0.07). The rates of recovery from hypoglycaemia were similar.\n IDeg and IGlar elicit comparable symptomatic and cognitive responses to induced hypoglycaemia. IDeg may elicit a moderately greater endocrine response, but times to PG recovery were similar for the two insulins.\n ClinicalTrials.gov NCT01002768.\n Novo Nordisk.\n\nKöhler, Gerd\n\nKorsatko, Stefan\n\nPieber, Thomas\n\n\n"
},
{
"text": "\n147656\nCerebral volumetric abnormalities in Neurofibromatosis type 1: associations with parent ratings of social and attention problems, executive dysfunction, and autistic mannerisms.\n\nHuijbregts, SC\n\nLoitfelder, M\n\nRombouts, SA\n\nSwaab, H\n\nVerbist, BM\n\nArkink, EB\n\nVan Buchem, MA\n\nVeer, IM\n\nBeiträge in Fachzeitschriften\nISI:000362818800001\n26473019.0\n10.1186/s11689-015-9128-3\nPMC4607002\nNeurofibromatosis type 1 (NF1) is a single-gene neurodevelopmental disorder, in which social and cognitive problems are highly prevalent. Several commonly observed central nervous system (CNS) abnormalities in NF1 might underlie these social and cognitive problems. Cerebral volumetric abnormalities are among the most consistently observed CNS abnormalities in NF1. This study investigated whether differences were present between NF1 patients and healthy controls (HC) in volumetric measures of cortical and subcortical brain regions and whether differential associations existed for NF1 patients and HC between the volumetric measures and parent ratings of social skills, attention problems, social problems, autistic mannerisms, and executive dysfunction.\n Fifteen NF1 patients (mean age 12.9 years, SD 2.6) and 18 healthy controls (HC, mean age 13.8 years, SD 3.6) underwent 3 T MRI scanning. Segmentation of cortical gray and white matter, as well as volumetry of subcortical nuclei, was carried out. Voxel-based morphometry was performed to assess cortical gray matter density. Correlations were calculated, for NF1-patients and HC separately, between MRI parameters and scores on selected dimensions of the following behavior rating scales: the Social Skills Rating System, the Child Behavior Checklist, the Social Responsiveness Scale, the Behavior Rating Inventory of Executive Functioning, and the Dysexecutive Questionnaire.\n After correction for age, sex, and intracranial volume, larger volumes of all subcortical regions were found in NF1 patients compared to controls. Patients further showed decreased gray matter density in midline regions of the frontal and parietal lobes and larger total white matter volume. Significantly more social and attention problems, more autistic mannerisms, and poorer executive functioning were reported for NF1 patients compared to HC. In NF1 patients, larger left putamen volume and larger total white matter volume were associated with more social problems and poorer executive functioning, larger right amygdala volume with poorer executive functioning and autistic mannerisms, and smaller precentral gyrus gray matter density was associated with more social problems. In controls, only significant negative correlations were observed: larger volumes (and greater gray matter density) were associated with better outcomes.\n Widespread volumetric differences between patients and controls were found in cortical and subcortical brain regions. In NF1 patients but not HC, larger volumes were associated with poorer behavior ratings.\n\nKoini, Marisa\n\n\n"
},
{
"text": "\n153386\n25-hydroxy-Vitamin D status: limitations in comparison and clinical interpretation of serum-levels across different assay methods.\n\nEnko, D\n\nFridrich, L\n\nRezanka, E\n\nStolba, R\n\nErnst, J\n\nWendler, I\n\nFabian, D\n\nHauptlorenz, S\n\nHalwachs-Baumann, G\n\nBeiträge in Fachzeitschriften\nISI:000342857900015\n25291951.0\n10.7754/Clin.Lab.2014.131114\nNone\nBackground: Over the last decade, clinical interest to evaluate human 25-hydroxy-vitamin D (25[OH]D) serum levels has increased exponentially. In the present study, four chemiluminescence immunoassays (CLIA), one radioimmunoassy (RIA), and one high performance liquid chromatography (HPLC) method were compared and also with the liquid chromatography-tandem mass spectrometry (LC-MS/MS) method in view of 25(OH)D serum level determination. Methods: For the method comparison, blood samples from 133 consecutive patients were prospectively collected. All participants gave written informed consent for their blood samples to be used in this study. They came to the Department of Nuclear Medicine of the Central Hospital Steyr (Austria) for osteodensidometric measurement as part of their preventive medical check-up. Pearson's correlation coefficients, Bland-Altman plots, and paired t-tests were calculated. Assay-specific reference ranges were considered using blood samples from persons with normal parathormone, calcium, and total-protein values (n = 97). Results: The highest correlation was between the HPLC and the LC-MS/MS method (r = 0.96). The lowest correlation was between the cobas Vitamin D3 assay (Roche) and any of the evaluated assays (r = 0.46 - 0.63). Bland-Altman plots revealed a big negative mean bias in three assays (cobas Vitamin D3 assay [Roche]: -22.8; DiaSorin LIAISON [25[OH]D total CLIA [Diasorin]: -18.4; Diasorin 25[OH]D125 I RIA [Diasorin]: -23.8 [nmol/L]) and a much smaller positive mean bias in the other assays (ClinRep complete 25[OH]D2/D3 HPLC kit [Recipe]: 2.7; ADVIA Centaur Vitamin D total assay [Siemens]: 8.2; IDS total vitamin D assay [Immunodiagnostic Systems]: 12.1 [nmol/L]) compared to the LC-MS/MS method. Meanwhile, the manufacturer has withdrawn the cobas Vitamin D3 assay from the market. Conclusions: Poor antibody specificity with cross-reactivity to other vitamin D metabolites, incomplete extraction of the 25(OH)D analyte from the vitamin D-binding protein (DBP), and confounding matrix substances such as lipids could be potential reasons for the unacceptable performance of the cobas Vitamin D3 assay (Roche) and also the significant differences in the 25(OH)D determination between various assays. Standardization and harmonization of 25(OH)D measurements are therefore urgently needed. The widespread introduction of well standardized assays in clinical laboratories is the challenge in the next years. (Clin. Lab. 2014;60:1541-1550. DOI: 10.7754/Clin.Lab.2014.131114)\n\nEnko, Dietmar\n\n\n"
},
{
"text": "\n168349\nIs imperative partial nephrectomy feasible for kidney cancer with venous thrombus involvement? Outcomes of 42 cases and matched pair analysis with a large radical nephrectomy cohort.\n\nMarra, G\n\nGontero, P\n\nBrattoli, M\n\nFilippini, C\n\nCapitanio, U\n\nMontorsi, F\n\nDaneshmand, S\n\nHuang, WC\n\nLinares Espinós, E\n\nMartínez-Salamanca, JI\n\nMcKiernan, JM\n\nZigeuner, R\n\nLibertino, JA\n\nBeiträge in Fachzeitschriften\nISI:000436648100007\n29801993.0\n10.1016/j.urolonc.2018.04.007\nNone\nRadical nephrectomy (RN) with/without (±) thrombus excision (ThE) is the undisputed standard treatment for kidney cancer (KC) with renal or caval thrombus (Th). However, partial nephrectomy (PN) ± ThE may be considered in rare cases due to imperative (I) indications.\n To evaluate the efficacy of IPN ± ThE and to compare it with RN ± ThE for KC with Th.\n Records of 2, 49 patients undergoing surgery for KC with Th at 24 institutions between 1971 and 2014 were retrospectively reviewed.\n Primary outcomes were overall survival (OS) and cancer specific survival (CSS), renal function variation after surgery and complications. Secondary outcomes were predictors of OS and CSS for IPN cases. To reduce bias IPN group was matched with RN using a propensity score with greedy algorithm on the basis of age, gender, tumor size, TNM, and histology.\n Forty-two patients underwent IPN ± Th. All thrombi were ≥level I; 5 patients experienced Clavien ≥ 3 complications with 2 complications-related deaths. At 27.3 (interquartile range: 7.1-47.7) months OS and CSS were 54.8% and 78.6%, respectively whereas at 9.7 (interquartile range: 1.4-43.7) months eGFR change was -17.3 ± 27.0ml/min. On univariate analysis tumour size, preoperative eGFR, transfusions, hospital stay, high serum creatinine, operating time, complications, lymphadenectomy, and metastases related to an increased risk of death. After matching (n = 38 per arm) no significant differences were present except for tumor necrosis (IPN = 39.5%; 15.8%; P = 0.01), thrombus level (P = 0.02), so as for operating time (P = 0.27), perioperative transfusions (P = 0.74) and complications (P = 0.35). A 5-year OS and CSS for IPN were 57.9% and 73.7%, respectively with no significant differences with RN (OS = 63.2, P = 0.611; CSS = 68.4, P>0.99). After 14.9 months creatinine and eGFR changes were (+0.4 ± 0.6mg/dl and -23.2 ± 37.3ml/min; P = 0.2879).\n In selected cases due to imperative indications PN ± ThE is a complex procedure and may be an alternative to RN ± ThE for KC with Th yielding noninferior oncological outcomes, functional outcomes, and complications. Further studies are needed to determine the role of PN ± ThE for KC with Th.\n Copyright © 2018 Elsevier Inc. All rights reserved.\n\nZigeuner, Richard\n\n\n"
},
{
"text": "\n182221\nReal-life assessment of chronic rhinosinusitis patients using mobile technology: the mySinusitisCoach project by EUFOREA.\n\nSeys, SF\n\nDe Bont, S\n\nFokkens, WJ\n\nBachert, C\n\nAlobid, I\n\nBernal-Sprekelsen, M\n\nBjermer, L\n\nCallebaut, I\n\nCardell, LO\n\nCarrie, S\n\nCastelnuovo, P\n\nCathcart, R\n\nConstantinidis, J\n\nCools, L\n\nCornet, M\n\nClement, G\n\nCox, T\n\nDelsupehe, L\n\nCorreia-de-Sousa, J\n\nDeneyer, L\n\nDe Vos, G\n\nDiamant, Z\n\nDoulaptsi, M\n\nGane, S\n\nGevaert, P\n\nHopkins, C\n\nHox, V\n\nHummel, T\n\nHosemann, W\n\nJacobs, R\n\nJorissen, M\n\nKjeldsen, A\n\nLandis, BN\n\nLemmens, W\n\nLeunig, A\n\nLund, V\n\nMariën, G\n\nMullol, J\n\nOnerci, M\n\nPalkonen, S\n\nProano, I\n\nProkopakis, E\n\nRyan, D\n\nRiechelmann, H\n\nSahlstrand-Johnson, P\n\nSalmi-Toppila, S\n\nSegboer, C\n\nSpeleman, K\n\nSteinsvik, A\n\nSurda, P\n\nTomazic, PV\n\nVanderveken, O\n\nVan Gerven, L\n\nVan Zele, T\n\nVerfaillie, J\n\nVerhaeghe, B\n\nVierstraete, K\n\nVlaminck, S\n\nWagenmann, M\n\nPugin, B\n\nHellings, PW\n\nBeiträge in Fachzeitschriften\nISI:000566571500001\n32424899.0\n10.1111/all.14408\nPMC7687134\nChronic rhinosinusitis (CRS) is a chronic inflammatory disease associated with a substantial personal and socio-economic burden. Monitoring of patient-reported outcomes by mobile technology offers the possibility to better understand real-life burden of CRS.\n This study reports on the cross-sectional evaluation of data of 626 users of mySinusitisCoach (mSC), a mobile application for CRS patients. Patient characteristics of mSC users were analysed as well as the level of disease control based on VAS global rhinosinusitis symptom score and adapted EPOS criteria.\n The mSC cohort represents a heterogeneous group of CRS patients with a diverse pattern of major symptoms. Approximately half of patients reported nasal polyps. 47.3% of all CRS patients were uncontrolled based on evaluation of VAS global rhinosinusitis symptom score compared to 40.9% based on adapted EPOS criteria. The impact of CRS on sleep quality and daily life activities was significantly higher in uncontrolled versus well-controlled patients. Half of patients had a history of FESS (functional endoscopic sinus surgery) and reported lower symptom severity compared to patients without a history of FESS, except for patients with a history of more than 3 procedures. Patients with a history of FESS reported higher VAS levels for impaired smell.\n Real-life data confirm the high disease burden in uncontrolled CRS patients, clearly impacting quality of life. Sinus surgery improves patient-reported outcomes, but not in patients with a history of more than 3 procedures. Mobile technology opens a new era of real-life monitoring, supporting the evolution of care towards precision medicine.\n This article is protected by copyright. All rights reserved.\n\nTomazic, Peter Valentin\n\n\n"
},
{
"text": "\n22039\nPhacotrabeculectomy with a small-optic PMMA implant: two-year functional and morphological results.\n\nMenapace, R\n\nWedrich, A\n\nMühlbauer-Ries, E\n\nStrenn, K\n\nVass, C\n\nBeiträge in Fachzeitschriften\nISI:000075472600006\n9693289.0\n10.1159/000027316\nNone\nPURPOSE: Previous studies have documented good pressure control with combined cataract and filtering surgery. However, relatively high incidences of iridocapsular synechiae (ICS) and cell precipitates on the optic (CPO) were found. Corneal valve incisions preclude intraoperative chamber flattening and iris injury or prolapse. Rigid one-piece PMMA lenses with a small optic maintain a pronounced optic-iris clearance. In a prospective series, the effect of this approach was studied with special regard to the morphological results. METHODS: A temporary corneal lip was created in the clear cornea beneath the scleral flap to serve as a temporary valve during cataract extraction. The lip was then widened and a rigid one-piece 5-mm PMMA lens implanted. Lip and trabeculum were finally excised en bloc at a width of 3 mm. Two years' functional and morphological results were evaluated. RESULTS: Fifty-four eyes were available for evaluation. After the mean follow-up of 21 months, mean IOP had dropped from 21.6+/-3 mm Hg preoperatively to 13.9+/-2.4 mm Hg, with a mean pressure reduction of 7.7+/-3.4 mm Hg. IOP was 18 mm Hg or less in all cases. The mean medication index dropped from 2.7 to 1.0. Eyes with a preoperative IOP of 21 mm Hg or more showed a significantly greater IOP reduction than eyes with an IOP of 20 mm Hg or less (-9.2+/-3.0 vs. -6.1+/-2.9 mm Hg, p = 0.0003). Intraoperatively, the temporary valve effectively prevented chamber flattening and iris injury or prolapse. Postoperatively, 9 eyes or 6% showed hyphemas, 1 undergoing lavage. Two eyes developed a capsular hematoma, 1 requiring YAG capsulotomy. Ten eyes or 19% developed mild and 2 eyes severe but transient fibrin exudation following hypotony or iridoplasty. One eye showed grade I anterior chamber flattening, 1 developed a ciliolenticular block requiring surgery. Postoperative pressure spikes of 30-35 mm Hg were noted in 4 eyes. Three eyes showed prolonged hypotony associated with transient choroidal effusion. A pronounced optic-iris clearance was found in 87% of the eyes. Iris-optic touch developed in 1 eye with prolonged postoperative anterior chamber flattening and in 3 of the 4 eyes that had undergone intraoperative iridoplasty. Three of the latter developed extensive ICS followed by CPO. The mean optic-iris distance was 1.2 mm and the anterior chamber depth 4.2 mm. CONCLUSION: Apart from effectively lowering IOP, the surgical approach used significantly reduced the incidence of ICS and CPO.\n\nWedrich, Andreas\n\n\n"
},
{
"text": "\n96985\nGenome-wide association studies of MRI-defined brain infarcts: meta-analysis from the CHARGE Consortium.\n\nDebette, S\n\nBis, JC\n\nFornage, M\n\nSchmidt, H\n\nIkram, MA\n\nSigurdsson, S\n\nHeiss, G\n\nStruchalin, M\n\nSmith, AV\n\nvan der Lugt, A\n\nDecarli, C\n\nLumley, T\n\nKnopman, DS\n\nEnzinger, C\n\nEiriksdottir, G\n\nKoudstaal, PJ\n\nDestefano, AL\n\nPsaty, BM\n\nDufouil, C\n\nCatellier, DJ\n\nFazekas, F\n\nAspelund, T\n\nAulchenko, YS\n\nBeiser, A\n\nRotter, JI\n\nTzourio, C\n\nShibata, DK\n\nTscherner, M\n\nHarris, TB\n\nRivadeneira, F\n\nAtwood, LD\n\nRice, K\n\nGottesman, RF\n\nvan Buchem, MA\n\nUitterlinden, AG\n\nKelly-Hayes, M\n\nCushman, M\n\nZhu, Y\n\nBoerwinkle, E\n\nGudnason, V\n\nHofman, A\n\nRomero, JR\n\nLopez, O\n\nvan Duijn, CM\n\nAu, R\n\nHeckbert, SR\n\nWolf, PA\n\nMosley, TH\n\nSeshadri, S\n\nBreteler, MM\n\nSchmidt, R\n\nLauner, LJ\n\nLongstreth, WT\n\nBeiträge in Fachzeitschriften\nISI:000273951600005\n20044523.0\n10.1161/STROKEAHA.109.569194\nPMC2923092\nBACKGROUND AND PURPOSE: Previous studies examining genetic associations with MRI-defined brain infarct have yielded inconsistent findings. We investigated genetic variation underlying covert MRI infarct in persons without histories of transient ischemic attack or stroke. We performed meta-analysis of genome-wide association studies of white participants in 6 studies comprising the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium. METHODS: Using 2.2 million genotyped and imputed single nucleotide polymorphisms, each study performed cross-sectional genome-wide association analysis of MRI infarct using age- and sex-adjusted logistic regression models. Study-specific findings were combined in an inverse-variance-weighted meta-analysis, including 9401 participants with mean age 69.7 (19.4% of whom had >or=1 MRI infarct). RESULTS: The most significant association was found with rs2208454 (minor allele frequency, 20%), located in intron 3 of MACRO domain containing 2 gene and in the downstream region of fibronectin leucine-rich transmembrane protein 3 gene. Each copy of the minor allele was associated with lower risk of MRI infarcts (odds ratio, 0.76; 95% confidence interval, 0.68-0.84; P=4.64x10(-7)). Highly suggestive associations (P<1.0x10(-5)) were also found for 22 other single nucleotide polymorphisms in linkage disequilibrium (r(2)>0.64) with rs2208454. The association with rs2208454 did not replicate in independent samples of 1822 white and 644 black participants, although 4 single nucleotide polymorphisms within 200 kb from rs2208454 were associated with MRI infarcts in the black population sample. CONCLUSIONS: This first community-based, genome-wide association study on covert MRI infarcts uncovered novel associations. Although replication of the association with top single nucleotide polymorphisms failed, possibly because of insufficient power, results in the black population sample are encouraging, and further efforts at replication are needed.\n\nEnzinger, Christian\n\nFazekas, Franz\n\nSchmidt, Helena\n\nSchmidt, Reinhold\n\n\n"
},
{
"text": "\n155844\nHow many CT detector rows are necessary to perform adequate three dimensional visualization?\n\nFischer, L\n\nTetzlaff, R\n\nSchöbinger, M\n\nRadeleff, B\n\nBruckner, T\n\nMeinzer, HP\n\nBüchler, MW\n\nSchemmer, P\n\nBeiträge in Fachzeitschriften\nISI:000279350800046\n19559549.0\n10.1016/j.ejrad.2009.05.033\nNone\nThe technical development of computer tomography (CT) imaging has experienced great progress. As consequence, CT data to be used for 3D visualization is not only based on 4 row CTs and 16 row CTs but also on 64 row CTs, respectively. The main goal of this study was to examine whether the increased amount of CT detector rows is correlated with improved quality of the 3D images.\n All CTs were acquired during routinely performed preoperative evaluation. Overall, there were 12 data sets based on 4 detector row CT, 12 data sets based on 16 detector row CT, and 10 data sets based on 64 detector row CT. Imaging data sets were transferred to the DKFZ Heidelberg using the CHILI teleradiology system. For the analysis all CT scans were examined in a blinded fashion, i.e. both the name of the patient as well as the name of the CT brand were erased. For analysis, the time for segmentation of liver, both portal and hepatic veins as well as the branching depth of portal veins and hepatic veins was recorded automatically. In addition, all results were validated in a blinded fashion based on given quality index.\n Segmentation of the liver was performed in significantly shorter time (p<0.01, Kruskal-Wallis test) in the 16 row CT (median 479 s) compared to 4 row CT (median 611 s), and 64 row CT (median 670 s), respectively. The branching depth of the portal vein did not differ significantly among the 3 different data sets (p=0.37, Kruskal-Wallis test). However, the branching depth of the hepatic veins was significantly better (p=0.028, Kruskal-Wallis test) in the 4 row CT and 16 row CT compared to 64 row CT. The grading of the quality index was not statistically different for portal veins and hepatic veins (p=0.80, Kruskal-Wallis test). Even though the total quality index was better for the vessel tree based on 64 row CT data sets (mean scale 2.6) compared to 4 CT row data (mean scale 3.25) and 16 row CT data (mean scale 3.0), these differences did not reach statistical difference (p=0.53, Kruskal-Wallis test).\n Even though 3D visualization is useful in operation planning, the quality of the 3D images appears to be not dependent of the number of CT detector rows.\n Copyright (c) 2009. Published by Elsevier Ireland Ltd.\n\nSchemmer, Peter\n\n\n"
}
]
}