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"text": "\n107646\nDownregulation of Midkine gene expression and its response to retinoic acid treatment in the nitrofen-induced hypoplastic lung.\n\nDoi, T\n\nShintaku, M\n\nDingemann, J\n\nRuttenstock, E\n\nPuri, P\n\nBeiträge in Fachzeitschriften\nISI:000286330000013\n21069354.0\n10.1007/s00383-010-2773-4\nNone\nNitrofen-induced congenital diaphragmatic hernia (CDH) model has been widely used to investigate the pathogenesis of pulmonary hypoplasia (PH) in CDH. Recent studies have suggested that retinoids may be involved in the molecular mechanisms of PH in CDH. Prenatal treatment with retinoic acid (RA) has been reported to improve the growth of hypoplastic lung in the nitrofen CDH model. Midkine (MK), a RA-responsive growth factor, plays key roles in various organogenesis including lung development. In fetal lung, MK mRNA expression has its peak at E13.5-E16.5 and is markedly decreased during mid-to-late gestation, indicating its important role in early lung morphogenesis. We designed this study to investigate the hypothesis that the pulmonary MK gene expression is downregulated in the early lung morphogenesis in the nitrofen-induced PH, and to evaluate the effect of prenatal RA treatment on pulmonary MK gene expression in the nitrofen-induced CDH model. Pregnant rats were exposed to either olive oil or nitrofen on day 9 of gestation (D9). Fetal lungs were harvested on D15, D18, and D21 and divided into control, nitrofen with or without CDH [CDH(+) or CDH(-)]. In addition, RA was given on days D18, D19, and D20 and fetal lungs were harvested on D21, and then divided into control + RA and nitrofen + RA. The pulmonary gene expression levels of MK were evaluated by real-time RT-PCR and statistically analyzed. Immunohistochemistry was also performed to examine protein expression/distribution of MK in fetal lung. The relative mRNA expression levels of MK were significantly downregulated in nitrofen group compared to controls at D15 ((A ) p < 0.01), whereas there were no significant differences at D18 and D21. MK gene expression levels were significantly upregulated in nitrofen + RA (0.71 +/- A 0.17) compared to the control (0.35 +/- A 0.16), CDH(-) (0.24 +/- A 0.15), CDH(+) (0.39 +/- A 0.19) and control + RA (0.47 +/- A 0.13) (*p < 0.05). Immunoreactivity of MK was also markedly decreased in nitrofen lungs compared to controls on D15, and increased in nitrofen + RA lungs compared to the other lungs on D21. Downregulation of MK gene on D15 may contribute to primary PH in the nitrofen CDH model by disrupting early lung morphogenesis. Upregulation of MK gene after RA treatment in the nitrofen-induced hypoplastic lung suggests that RA may have a therapeutic potential to rescue PH in CDH through RA-responsive growth factor signaling.\n\n\n"
},
{
"text": "\n127024\nESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC.\n\nMcMurray, JJ\n\nAdamopoulos, S\n\nAnker, SD\n\nAuricchio, A\n\nBöhm, M\n\nDickstein, K\n\nFalk, V\n\nFilippatos, G\n\nFonseca, C\n\nGomez-Sanchez, MA\n\nJaarsma, T\n\nKøber, L\n\nLip, GY\n\nMaggioni, AP\n\nParkhomenko, A\n\nPieske, BM\n\nPopescu, BA\n\nRønnevik, PK\n\nRutten, FH\n\nSchwitter, J\n\nSeferovic, P\n\nStepinska, J\n\nTrindade, PT\n\nVoors, AA\n\nZannad, F\n\nZeiher, A\n\nTask Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology\n\nBax, JJ\n\nBaumgartner, H\n\nCeconi, C\n\nDean, V\n\nDeaton, C\n\nFagard, R\n\nFunck-Brentano, C\n\nHasdai, D\n\nHoes, A\n\nKirchhof, P\n\nKnuuti, J\n\nKolh, P\n\nMcDonagh, T\n\nMoulin, C\n\nPopescu, BA\n\nReiner, Z\n\nSechtem, U\n\nSirnes, PA\n\nTendera, M\n\nTorbicki, A\n\nVahanian, A\n\nWindecker, S\n\nMcDonagh, T\n\nSechtem, U\n\nBonet, LA\n\nAvraamides, P\n\nBen Lamin, HA\n\nBrignole, M\n\nCoca, A\n\nCowburn, P\n\nDargie, H\n\nElliott, P\n\nFlachskampf, FA\n\nGuida, GF\n\nHardman, S\n\nIung, B\n\nMerkely, B\n\nMueller, C\n\nNanas, JN\n\nNielsen, OW\n\nOrn, S\n\nParissis, JT\n\nPonikowski, P\n\nESC Committee for Practice Guidelines\n\nBeiträge in Fachzeitschriften\nISI:000306924900001\n22828712.0\n10.1093/eurjhf/hfs105\nNone\nESC Committee for Practice Guidelines (CPG): Jeroen J. Bax (CPG Chairperson) (The Netherlands), Helmut Baumgartner (Germany), Claudio Ceconi (Italy), Veronica Dean (France), Christi Deaton (UK), Robert Fagard (Belgium), Christian Funck-Brentano (France), David Hasdai (Israel), Arno Hoes (The Netherlands), Paulus Kirchhof (Germany/UK), Juhani Knuuti (Finland), Philippe Kolh (Belgium), Theresa McDonagh (UK), Cyril Moulin (France), Bogdan A. Popescu (Romania), Z. eljko Reiner (Croatia), Udo Sechtem (Germany), Per Anton Sirnes (Norway), Michal Tendera (Poland), Adam Torbicki (Poland), Alec Vahanian (France), Stephan Windecker (Switzerland). Document Reviewers: Theresa McDonagh (CPG Co-Review Coordinator) (UK), Udo Sechtem (CPG Co-Review Coordinator) (Germany), Luis Almenar Bonet (Spain), Panayiotis Avraamides (Cyprus), Hisham A. Ben Lamin (Libya), Michele Brignole (Italy), Antonio Coca (Spain), Peter Cowburn (UK), Henry Dargie (UK), Perry Elliott (UK), Frank Arnold Flachskampf (Sweden), Guido Francesco Guida (Italy), Suzanna Hardman (UK), Bernard Iung (France), Bela Merkely (Hungary), Christian Mueller (Switzerland), John N. Nanas (Greece), Olav Wendelboe Nielsen (Denmark), Stein Orn (Norway), John T. Parissis (Greece), Piotr Ponikowski (Poland). The disclosure forms of the authors and reviewers are available on the ESC website www.escardio.org/guidelines\n\n\n"
},
{
"text": "\n312\nBasic fibroblast growth factor (BFGF) immunoreactivity as a possible link between head injury and impaired bone fracture healing.\n\nWildburger, R\n\nZarkovic, N\n\nEgger, G\n\nPetek, W\n\nZarkovic, K\n\nHofer, HP\n\nBeiträge in Fachzeitschriften\nISI:A1994QF12100002\n7696886.0\n10.1016/S0169-6009(08)80192-4\nNone\nHealing of fractures of long bones or large joints is often accelerated in patients with severe traumatic brain injury (TBI). However, in these patients an early fracture healing is accompanied by hypertrophic callus formation or heterotopic ossifications which might even result in an ankylosis of the affected joints. It seems that enhanced osteogenesis in patients suffering from TBI could be caused by some humoral factors, since the sera of these patients strongly promote the growth of osteoblast cells in vitro. However, humoral growth promoting factors which could perhaps induce enhanced osteogenesis are not yet identified. Hence, the aim of this study was to analyse if basic fibroblast growth factor (bFGF) could be related to the phenomenon of enhanced osteogenesis, since bFGF stimulates the growth of osteoblasts in vitro and could be found both in the brain and the bone tissue. For that purpose the values of bFGF immunoreactivity were determined in the sera of patients with TBI and bone fractures (n = 8) as well as in the sera of patients with either TBI alone (n = 10) or bone fractures alone (n = 7), during a period of three months after injury. Quantification of the bFGF immunoreactivity was done using the ELISA based on monoclonal antibodies raised against the recombinant human bFGF. The bFGF immunoreactivity values obtained were also compared with the values determined in the sera of normal, healthy persons (n = 9). In the group of patients with bone fractures alone only a transient increase of bFGF immunoreactivity (threefold above the normal values) was observed in the second week after injury. A similar increase of the values of bFGF immunoreactivity was also determined in the sera of patients with TBI only, but it lasted longer (from the 1st until the 7th to 8th week after injury). In the case of patients with TBI and bone fractures a specific pattern of post-traumatic dynamic change of the values of serum bFGF immunoreactivity was observed. Namely, the increase of bFGF immunoreactivity (up to seven-fold above the normal values) was determined even during the first week after injury. Afterwards, periods of high values of bFGF immunoreactivity observed during the 2nd, 4th and the 7-10th weeks after injury were interrupted by sudden decreases even to the normal values (during the 3rd and the 5-6th week after injury).(ABSTRACT TRUNCATED AT 400 WORDS)\n\nHofer, Herwig\n\n\n"
},
{
"text": "\n5248\nClassification of sudden infant death (SID) cases in a multidisciplinary setting. Ten years experience in Styria (Austria).\n\nKerbl, R\n\nZotter, H\n\nEinspieler, C\n\nRoll, P\n\nRatschek, M\n\nKöstl, G\n\nStrenger, V\n\nHoffmann, E\n\nPerrogon, A\n\nZötsch, W\n\nSchober, P\n\nGränz, A\n\nSauseng, W\n\nBachler, I\n\nKenner, T\n\nIpsiroglu, O\n\nKurz, R\n\nStyrian Sudden Infant Death Study Group\n\nBeiträge in Fachzeitschriften\nISI:000188366100010\n14768536.0\n10.1007/BF03040411\nNone\nObjective: Sudden infant death syndrome (SIDS) remains a challenge for health professionals despite decreasing rates in recent years. The figures for different areas and time periods are hardly comparable, because of differences in postmortem investigations and classification criteria. In 1992, the European Society for the Study and Prevention of Infant Deaths (ESPID) proposed a classification for any sudden and unexpected death in infancy. This proposal has been used in our study since 1993 to better classify sudden infant death (SID) cases.Method: 56 consecutive SID cases observed between 1993 and 2002 in Styria, the south-eastern province of Austria, were analysed by a multidisciplinary team of health professionals. The study group consisted of pediatricians, forensic pathologists, pathologists, psychologists, nurses, members of the parents' association and health authorities. SID cases were analysed with regard to potential risk factors during pregnancy and early life, the circumstances of death (death scene) and post-mortem findings. From the latter, every SID was classified as either 1) classic SIDS, 2) borderline SIDS, 3) non-autopsied SID or 4) explained death.Results: Of the 56 SID cases, 22 were assigned to category 1, 19 to category 2, four to category 3, and in 11 cases death could be explained by major post-mortem findings. For 17/22 cases in category 1 and 11/19 cases in category 2, the death scene investigation showed the typical risk profile of manner of bedding and/or environmental conditions. In three cases, child abuse or infanticide was considered possible but could not be proven despite careful autopsy. In recent years, SIDS incidence in Styria has decreased to approximately 0.18/1, 00 liveborn infants, and the few deaths still occurring mainly present with the typical risk profile.Conclusion: An extensive analysis of SID events is a prerequisite for reliable and comparable SIDS statistics. Our data show that in several SID cases careful postmortem examinations led to an explanation of death. In other cases, minor alterations may have contributed to the lethal event. These findings should therefore be considered in the classification of SIDs. The ESPID classification of 1992 appears to be very useful for this purpose and its use may therefore be recommended.\n\nEinspieler, Christa\n\nKenner, Thomas\n\nKerbl, Reinhold\n\nRatschek, Manfred\n\nRoll, Peter\n\nSchober, Peter\n\nStrenger, Volker\n\n\n"
},
{
"text": "\n126655\nQuantitative determination of oLAb titers in various animal species.\n\nTatzber, F\n\nWonisch, W\n\nSchmidl, E\n\nEsterbauer, H\n\nBeiträge in Fachzeitschriften\nISI:000171771600005\n9259993.0\n10.1002/biof.5520060205\nNone\nIt is generally accepted, that lipid peroxidation plays a pathogenic role in atherosclerosis. Furthermore, recent studies indicate that antibodies directed against oxidative modifications of Low Density Lipoprotein (oLAb) contribute to atherosclerotic processes and may have some function in other disorders. These antibodies have been determined predominantly in humans, because assays for oLAb measurement use species specific anti IgG conjugates. From such assay designs it is not possible to get directly comparable data from various animal species. Main advantages of comparable data between animal species are that results of animal experiments can be interpreted using human calibrators and that results of immunisations and production of monoclonal antibodies are directly comparable not only within, but also between animal species. The aim of this study was to find a modification for ELISAs for oLAb determination, which allows to measure sera of various animal species simultaneously. Microtitration plates were coated with oxidised LDL and blocked with bovine serum albumine. Human and animal sera were then pipetted into the plate in logarithmic serial dilutions and incubated for 2 h at 37 degrees C. After washing, a protein A horse-radish peroxidase conjugate (Biomakor, Israel) was added to each well in a dilution of 1:20, 00. The incubation conditions had to be optimized to achieve reliable results. After another washing step, the assay was developed with TMB. Absorptions were read at 450 nm in a microplate photometer. Following the manufacturers incubation instructions, which recommended a duration of 1 h at room temperature, the system did not work optimally. No binding of protein A to IgG molecules bound to oxidised LDL could be observed, if the system was incubated at 37 degrees C. In our hands, best results were achieved for several animal species, if the conjugate was incubated for two hours at 2-4 degrees C in a refrigerator. Under these conditions, assay sensitivity was the same as in the standard method, which uses anti-species IgG conjugates. The protein A modification of oLAb allows direct reading of animal oLAb titres from human calibrators. With this method, results of animal experiments can be interpreted on the basis of the situation in humans. Preliminary results obtained show that immunisation experiments with oxidised LDL give serum titres in animals, which are in the same order of magnitude as human sera with high oLAb concentrations. The results of this study, in accordance with findings of other authors, give further indications that atherosclerotic processes are influenced by the specific immune system.\n\nTatzber, Franz\n\nWonisch, Willibald\n\n\n"
},
{
"text": "\n129975\nAcute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis.\n\nMoreau, R\n\nJalan, R\n\nGines, P\n\nPavesi, M\n\nAngeli, P\n\nCordoba, J\n\nDurand, F\n\nGustot, T\n\nSaliba, F\n\nDomenicali, M\n\nGerbes, A\n\nWendon, J\n\nAlessandria, C\n\nLaleman, W\n\nZeuzem, S\n\nTrebicka, J\n\nBernardi, M\n\nArroyo, V\n\nCANONIC Study Investigators of the EASL–CLIF Consortium\n\nBeiträge in Fachzeitschriften\nISI:000319498500026\n23474284.0\n10.1053/j.gastro.2013.02.042\nNone\nBACKGROUND & AIMS: Patients with cirrhosis hospitalized for an acute decompensation (AD) and organ failure are at risk for imminent death and considered to have acute-on-chronic liver failure (ACLF). However, there are no established diagnostic criteria for ACLF, so little is known about its development and progression. We aimed to identify diagnostic criteria of ACLF and describe the development of this syndrome in European patients with AD. METHODS: We collected data from 1343 hospitalized patients with cirrhosis and AD from February to September 2011 at 29 liver units in 8 European countries. We used the organ failure and mortality data to define ACLF grades, assess mortality, and identify differences between ACLF and AD. We established diagnostic criteria for ACLF based on analyses of patients with organ failure (defined by the chronic liver failure-sequential organ failure assessment [ CLIF-SOFA] score) and high 28-day mortality rate (> 15%). RESULTS: Of the patients assessed, 303 had ACLF when the study began, 112 developed ACLF, and 928 did not have ACLF. The 28-day mortality rate among patients who had ACLF when the study began was 33.9%, among those who developed ACLF was 29.7%, and among those who did not have ACLF was 1.9%. Patients with ACLF were younger and more frequently alcoholic, had more associated bacterial infections, and had higher numbers of leukocytes and higher plasma levels of C-reactive protein than patients without ACLF (P < .001). Higher CLIF-SOFA scores and leukocyte counts were independent predictors of mortality in patients with ACLF. In patients without a prior history of AD, ACLF was unexpectedly characterized by higher numbers of organ failures, leukocyte count, and mortality compared with ACLF in patients with a prior history of AD. CONCLUSIONS: We analyzed data from patients with cirrhosis and AD to establish diagnostic criteria for ACLF and showed that it is distinct from AD, based not only on the presence of organ failure(s) and high mortality rate but also on age, precipitating events, and systemic inflammation. ACLF mortality is associated with loss of organ function and high leukocyte counts. ACLF is especially severe in patients with no prior history of AD.\n\nSpindelböck, Walter Johann\n\nStauber, Rudolf\n\n\n"
},
{
"text": "\n183250\nA 3 year post-intervention follow-up on mortality in advanced heart failure (EVITA vitamin D supplementation trial).\n\nZittermann, A\n\nErnst, JB\n\nProkop, S\n\nFuchs, U\n\nBerthold, HK\n\nGouni-Berthold, I\n\nGummert, JF\n\nPilz, S\n\nBeiträge in Fachzeitschriften\nISI:000567998200001\n32915512.0\n10.1002/ehf2.12953\nPMC7755020\nVitamin D supplementation is widely used in the clinical setting, but its effects on mortality and cardiovascular outcomes in patients with heart failure are unclear. This paper reports outcome data that were collected during follow-up of 3 years after closure of the EVITA trial (a 3 year randomized, placebo-controlled, intervention study with 4000 IU vitamin D daily in patients with advanced heart failure), to capture potential latency effects of vitamin D supplementation on clinical outcomes.\n The prespecified primary endpoint was overall mortality. Secondary endpoints included hospitalization, mechanical circulatory support implantation, high urgent listing for heart transplantation, and heart transplantation. For group comparisons, we used Cox regression models with a time-dependent categorical covariate. The calculated net difference in circulating 25-hydroxyvitamin D between the vitamin D and placebo groups dropped from 60.9 nmol/L at the end of the active study period to 3.2 nmol/L at the end of the post-intervention period. During the entire 6 year period, 73 patients (36.5%) died in the placebo group and 76 (38.8%) in the vitamin D group. Out of these 149 patients, 36 and 39 died during the first 3 years, and 37 and 37 during the second 3 years, respectively. The hazard ratio (HR) for mortality in the vitamin D versus the placebo group was 1.06 [95% confidence interval (CI): 0.68-1.66] for the first 3 years and 1.07 (95% CI: 0.68-1.70) for the 3 year post-intervention follow-up. Compared with the placebo group, the HRs for hospitalization and for mechanical circulatory support implant were significantly higher in the vitamin D group during vitamin D supplementation (HR = 1.31, 95% CI: 1.01-1.68 and HR = 2.01, 95% CI: 1.08-3.76, respectively) but not after vitamin D discontinuation (HR = 1.10, 95% CI: 0.62-1.94 and HR = 0.99, 95% CI: 0.38-2.56, respectively). There was no significant time-dependent effect on the risk of high urgent listing for heart transplantation and heart transplantation.\n No beneficial latency effects of vitamin D supplementation on overall mortality could be demonstrated. Instead, the disappearance of unfavourable findings in the vitamin D group (higher HRs for hospitalization and for mechanical circulatory support implant) after vitamin D discontinuation supports the assumption of adverse vitamin D effects on the cardiovascular system at doses of 4000 IU daily.\n © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.\n\nPilz, Stefan\n\n\n"
},
{
"text": "\n184935\nEvaluation of Prognostic Factors and Role of Participation in a Randomized Trial or a Prospective Registry in Pediatric and Adolescent Nonmetastatic Medulloblastoma - A Report From the HIT 2000 Trial.\n\nDietzsch, S\n\nPlaczek, F\n\nPietschmann, K\n\nvon Bueren, AO\n\nMatuschek, C\n\nGlück, A\n\nGuckenberger, M\n\nBudach, V\n\nWelzel, J\n\nPöttgen, C\n\nSchmidberger, H\n\nHeinzelmann, F\n\nPaulsen, F\n\nEscudero, MP\n\nSchwarz, R\n\nHornung, D\n\nMartini, C\n\nGrosu, AL\n\nStueben, G\n\nJablonska, K\n\nDunst, J\n\nStranzl-Lawatsch, H\n\nDieckmann, K\n\nTimmermann, B\n\nPietsch, T\n\nWarmuth-Metz, M\n\nBison, B\n\nKwiecien, R\n\nBenesch, M\n\nGerber, NU\n\nGrotzer, MA\n\nPfister, SM\n\nClifford, SC\n\nvon Hoff, K\n\nKlagges, S\n\nRutkowski, S\n\nKortmann, RD\n\nMynarek, M\n\nBeiträge in Fachzeitschriften\nISI:000600604200012\n33305077.0\n10.1016/j.adro.2020.09.018\nPMC7718550\nWe aimed to compare treatment results in and outside of a randomized trial and to confirm factors influencing outcome in a large retrospective cohort of nonmetastatic medulloblastoma treated in Austria, Switzerland and Germany.\n Patients with nonmetastatic medulloblastoma (n = 382) aged 4 to 21 years and primary neurosurgical resection between 2001 and 2011 were assessed. Between 2001 and 2006, 176 of these patients (46.1%) were included in the randomized HIT SIOP PNET 4 trial. From 2001 to 2011 an additional 206 patients were registered to the HIT 2000 study center and underwent the identical central review program. Three different radiation therapy protocols were applied. Genetically defined tumor entity (former molecular subgroup) was available for 157 patients.\n Median follow-up time was 7.3 (range, 0.09-13.86) years. There was no difference between HIT SIOP PNET 4 trial patients and observational patients outside the randomized trial, with 7 years progression-free survival rates (PFS) of 79.5% ± 3.1% versus 78.7% ± 3.1% (P = .62). On univariate analysis, the time interval between surgery and irradiation (≤ 48 days vs ≥ 49 days) showed a strong trend to affect PFS (80.4% ± 2.2% vs 64.6% ± 9.1%; P = .052). Furthermore, histologically and genetically defined tumor entities and the extent of postoperative residual tumor influenced PFS. On multivariate analyses, a genetically defined tumor entity wingless-related integration site-activated vs non-wingless-related integration site/non-SHH, group 3 hazard ratio, 5.49; P = .014) and time interval between surgery and irradiation (hazard ratio, 2.2; P = .018) were confirmed as independent risk factors.\n Using a centralized review program and risk-stratified therapy for all patients registered to the study center, outcome was identical for patients with nonmetastatic medulloblastoma treated on and off the randomized HIT SIOP PNET 4 trial. The prognostic values of prolonged time to RT and genetically defined tumor entity were confirmed.\n © 2020 The Authors.\n\nBenesch, Martin\n\nStranzl-Lawatsch, Heidi\n\n\n"
},
{
"text": "\n186563\nAssessing the efficacy, safety and utility of closed-loop insulin delivery compared with sensor-augmented pump therapy in very young children with type 1 diabetes (KidsAP02 study): an open-label, multicentre, multinational, randomised cross-over study protocol.\n\nFuchs, J\n\nAllen, JM\n\nBoughton, CK\n\nWilinska, ME\n\nThankamony, A\n\nde Beaufort, C\n\nCampbell, F\n\nYong, J\n\nFroehlich-Reiterer, E\n\nMader, JK\n\nHofer, SE\n\nKapellen, TM\n\nRami-Merhar, B\n\nTauschmann, M\n\nHood, K\n\nKimbell, B\n\nLawton, J\n\nRoze, S\n\nSibayan, J\n\nCohen, N\n\nHovorka, R\n\nKidsAP Consortium\n\nBeiträge in Fachzeitschriften\nISI:000620631300003\n33579766.0\n10.1136/bmjopen-2020-042790\nPMC7883854\nDiabetes management in very young children remains challenging. Glycaemic targets are achieved at the expense of high parental diabetes management burden and frequent hypoglycaemia, impacting quality of life for the whole family. Our objective is to assess whether automated insulin delivery can improve glycaemic control and alleviate the burden of diabetes management in this particular age group.\n The study adopts an open-label, multinational, multicentre, randomised, crossover design and aims to randomise 72 children aged 1-7 years with type 1 diabetes on insulin pump therapy. Following screening, participants will receive training on study insulin pump and study continuous glucose monitoring devices. Participants will be randomised to 16-week use of the hybrid closed-loop system (intervention period) or to 16-week use of sensor-augmented pump therapy (control period) with 1-4 weeks washout period before crossing over to the other arm. The order of the two study periods will be random. The primary endpoint is the between-group difference in time spent in the target glucose range from 3.9 to 10.0 mmol/L based on sensor glucose readings during the 16-week study periods. Analyses will be conducted on an intention-to-treat basis. Key secondary endpoints are between group differences in time spent above and below target glucose range, glycated haemoglobin and average sensor glucose. Participants' and caregivers' experiences will be evaluated using questionnaires and qualitative interviews, and sleep quality will be assessed. A health economic analysis will be performed.\n Ethics approval has been obtained from Cambridge East Research Ethics Committee (UK), Ethics Committees of the University of Innsbruck, the University of Vienna and the University of Graz (Austria), Ethics Committee of the Medical Faculty of the University of Leipzig (Germany) and Comité National d'Ethique de Recherche (Luxembourg). The results will be disseminated by peer-reviewed publications and conference presentations.\n NCT03784027.\n © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.\n\nFröhlich-Reiterer, Elke\n\nMader, Julia\n\n\n"
},
{
"text": "\n145428\nUtilisation of Blood Components in Trauma Surgery: A Single-Centre, Retrospective Analysis before and after the Implementation of an Educative PBM Initiative.\n\nGeissler, RG\n\nKösters, C\n\nFranz, D\n\nBuddendick, H\n\nBorowski, M\n\nJuhra, C\n\nLange, M\n\nBunzemeier, H\n\nRoeder, N\n\nSibrowski, W\n\nRaschke, MJ\n\nSchlenke, P\n\nBeiträge in Fachzeitschriften\nISI:000353433300003\n26019703.0\n10.1159/000377735\nPMC4439836\nThe aim of our single-centre retrospective study presented here is to further analyse the utilisation of allogeneic blood components within a 5-year observation period (2009-2013) in trauma surgery (15, 57 patients) under the measures of an educational patient blood management (PBM) initiative.\n After the implementation of the PBM initiative in January 2012, the Institute of Transfusion Medicine und Transplantation Immunology educates surgeons and nurses at the Department of Trauma Surgery to avoid unnecessary blood transfusions. A standardised reporting system was used to document the utilisation of blood components carefully for the most frequent diagnoses and surgical interventions in trauma surgery. These measures served as basis for the implementation of an interdisciplinary systematic exchange of information to foster decision-making processes in favour of patient blood management.\n Since January 2012, the proportion of patients who received a transfusion as well as the number of transfused red blood cell (RBC) (7.3%/6.4%; p = 0.02), fresh frozen plasma (FFP) (1.7%/1.3%; p < 0.05) and platelet (PLT) (1.0%/0.5%; p < 0.001) units were reduced as a result of our PBM initiative. However, among the transfused patients, the number of administered RBC, FFP and PLT units did not decrease significantly. Overall, patients who did not receive transfusions were younger than transfused patients (p = 0.001). The subgroup with the highest probability of blood transfusion administered included patients with intensive care and long-term ventilation (before/after implementation of PBM: RBC 81.5%/75.9%; FFP 33.3%/20.4%; PLT 24.1%/13.0%). Only a total of 60 patients of 531 patients suffering multiple traumas were massively transfused (before/after implementation of PBM: RBC 55.6%/49.8%; FFP 28.4%/20.4%; PLT 17.6%/8.9%).\n According to our educational PBM initiative, at least the proportion of trauma patients who received allogeneic blood transfusions could be reduced significantly. However, in case of blood transfusions, the total consumption of RBC, FFP and PLT units remained stable in both time periods. This phenomenon might indicate that the actual need of blood transfusions rather depends on the severity of trauma-related blood loss, the coagulopathy rates or the complexity of the surgical intervention which mainly determines the intra-operative blood loss. Taken together, educational training sessions and systematic reporting systems are suitable measures to avoid unnecessary allogeneic blood transfusions and to continuously improve their restrictive application.\n\nSchlenke, Peter\n\n\n"
},
{
"text": "\n157355\nClinical characterization and mutation spectrum of German patients with familial hypercholesterolemia.\n\nGrenkowitz, T\n\nKassner, U\n\nWühle-Demuth, M\n\nSalewsky, B\n\nRosada, A\n\nZemojtel, T\n\nHopfenmüller, W\n\nIsermann, B\n\nBorucki, K\n\nHeigl, F\n\nLaufs, U\n\nWagner, S\n\nKleber, ME\n\nBinner, P\n\nMärz, W\n\nSteinhagen-Thiessen, E\n\nDemuth, I\n\nBeiträge in Fachzeitschriften\nISI:000389401200014\n27596133.0\n10.1016/j.atherosclerosis.2016.08.037\nNone\nAutosomal-dominant familial hypercholesterolemia (FH) is characterized by elevated plasma levels of low-density lipoprotein cholesterol (LDL-C) and a dramatically increased risk to develop cardiovascular disease (CVD). Mutations in three major genes have been associated with FH: the LDL receptor gene (LDLR), the apolipoprotein B gene (APOB), and the proprotein convertase subtilisin/kexin 9 gene (PCSK9). Here we investigated the frequency and the spectrum of FH causing mutations in Germany.\n We screened 206 hypercholesterolemic patients, of whom 192 were apparently unrelated, for mutations in the coding region of the genes LDLR, PCSK9 and the APOB [c.10580G > A (p.Arg3527Gln)]. We also categorized the patients according to the Dutch Lipid Clinic Network Criteria (DLCNC) in order to allow a comparison between the mutations identified and the clinical phenotypes observed. Including data from previous studies on German FH patients enabled us to analyse data from 479 individuals.\n Ninety-eight FH causing variants were found in 92 patients (nine in related patients and 6 patients with two variants and likely two affected alleles), of which 90 were located in the LDLR gene and eight mutations were identified in the APOB gene (c.10580G > A). No mutation was found in the PCSK9 gene. While 48 of the LDLR mutations were previously described as disease causing, we found 9 new LDLR variants which were rated as "pathogenic" or "likely pathogenic" based on the predicted effect on the corresponding protein. The proportions of different types of LDLR mutations and their localization within the gene was similar in the group of patients screened for mutations here and in the combined analysis of 479 patients (current study/cases from the literature) and also to other studies on the LDLR mutation spectrum, with about half of the variants being of the missense type and clustering of mutations in exons 4, 5 and 9. The mutation detection rate in the 35 definite and 45 probable FH patients (according to DLCNC) was 77.1% and 68.9%, respectively. The data show a similar discriminatory power between the DLCNC score (AUC = 0.789 (95% CI 0.721-0, 57)) and baseline LDL-C levels (AUC = 0.799 (95% CI = 0.732-0.866)).\n This study further substantiates the mutation spectrum for FH in German patients and confirms the clinical and genetic heterogeneity of the disease.\n Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.\n\nMärz, Winfried\n\n\n"
},
{
"text": "\n187498\nGo Ask Your Patients! PSS-QoL Reported Perception of Dryness Correlates With Lacrimal and Salivary Flow in Primary Sjögren's Syndrome.\n\nLackner, A\n\nBosch, P\n\nZenz, S\n\nHorwath-Winter, J\n\nRabensteiner, DF\n\nHermann, J\n\nGraninger, W\n\nStradner, MH\n\nBeiträge in Fachzeitschriften\nISI:000645022700001\n33937295.0\n10.3389/fmed.2021.660580\nPMC8081854\nIntroduction/Objectives: The patient perspective is an essential outcome parameter in the quest for effective therapy in primary Sjögren's Syndrome (PSS). The EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) is recommended by EULAR to quantify patient's symptom burden and has been used in several clinical trials. Surprisingly, the patient's perception of dryness quantified with ESSPRI does not correlate with objective measures of salivary or lacrimal flow. Thus, we evaluated a newly developed assessment tool-the Primary Sjögren's Syndrome Quality of Life Questionnaire (PSS-QoL)-for quantifying symptoms of dryness in comparison with the ESSPRI and objective measurements of salivary and lacrimal flow. Methods: Data of patients from the PSS registry of the Medical University of Graz fulfilling the 2016 ACR/EULAR classification criteria for PSS were analyzed. The patient perspective was analyzed by PSS-QoL, ESSPRI, Xerostomia Inventory (XI) and Ocular Surface Disease Index (OSDI). Sicca signs were measured with Schirmer's test, unstimulated salivary flow test (USF) and stimulated salivary flow test (SSF). ESSDAI (EULAR Sjögren's Syndrome Disease Activity Index) and EGA (Evaluator Global Assessment, numeric rating scale from 0 to 10) were obtained. In addition, free light chains (FLC) κ and λ, rheumatoid factor (RF) IgM and IgA were determined. Results: Data from 123 PSS patients were analyzed; 91.9% (n = 113) were female, with a mean disease duration of 6.2 (±5.3) years and mean age of 60.1 (±12.4) years. PSS-QoL-dryness revealed significant negative correlations with Schirmer's test (r = -0.31, p < 0.05) and SSF-test (r = -0.390, p < 0.01). In contrast, we found no significant correlation between ESSPRI-dryness and any objective dryness test. Lower perceived dryness was associated with higher immunological activity determined by increased levels of IgG, FLC and RF-IgA. Whereas patients with only subjective signs of dryness had lower immunological activity. Discussion: Patients' perception of dryness assessed by PSS-QoL correlates with objective measurements of salivary gland function while ESSPRI-dryness did not. Based on the PSS-QoL and objective measures of dryness two distinct groups of PSS patients could be distinguished, which may have implications in daily practice and future clinical studies.\n Copyright © 2021 Lackner, Bosch, Zenz, Horwath-Winter, Rabensteiner, Hermann, Graninger and Stradner.\n\nBosch, Philipp\n\nGraninger, Winfried\n\nHermann, Josef\n\nHorwath-Winter, Jutta\n\nLackner, Angelika\n\nStradner, Martin Helmut\n\nZenz, Sabine\n\n\n"
},
{
"text": "\n179783\nLong-term outcomes in patients with decompensated alcohol-related liver disease, steatohepatitis and Maddrey's discriminant function <32.\n\nDegré, D\n\nStauber, RE\n\nEnglebert, G\n\nSarocchi, F\n\nVerset, L\n\nRainer, F\n\nSpindelboeck, W\n\nNjimi, H\n\nTrépo, E\n\nGustot, T\n\nLackner, C\n\nDeltenre, P\n\nMoreno, C\n\nBeiträge in Fachzeitschriften\nISI:000520050900008\n31954208.0\n10.1016/j.jhep.2019.12.023\nNone\nPatients with alcoholic hepatitis and a modified Maddrey's discriminant function (mDF) <32 have a low risk of short-term mortality. However, few data exist concerning long-term outcomes. The aims of this study were to evaluate 5-year survival rates and to identify predictive factors for long-term prognosis in this patient population.\n We studied patients from 2 centers who were admitted for hepatic decompensation (ascites, hepatic encephalopathy, or jaundice) and who had histological findings of steatohepatitis and an mDF <32. Clinical and biological parameters were recorded at the time of liver biopsy and alcohol consumption was recorded during follow-up. We performed Cox proportional hazard survival analysis to identify factors associated with 5-year survival.\n One hundred and twenty-one patients were included (male: 64%, mean age: 51.5 ± 10.3 years, presence of cirrhosis: 84%). The median model for end-stage liver disease and mDF scores were 14 (IQR 11.7-16.1) and 19 (IQR 11.1-24), respectively. During follow-up, 30% of the patients remained abstinent. Survival rates at 1, 6, 12, 24, and 60 months were 96.7 ± 1.6%, 90.1 ± 2.7%, 80.8 ± 3.6%, 69.9 ± 4.3%, and 50.7 ± 4.9%, respectively. The majority of deaths (80%) were liver related. In multivariable analysis, encephalopathy at baseline and alcohol abstinence were predictive of 5-year survival. The 5-year survival rates of patients without and with encephalopathy at baseline were 60.5 ± 5.8% and 29.7 ± 8.0%, respectively, and the 5-year survival rates of abstinent and non-abstinent patients were 74.0 ± 8.0% and 40.9 ± 5.8%, respectively.\n The mortality rate of patients with alcoholic hepatitis and an mDF <32 is around 50% at 5 years. Hepatic encephalopathy at baseline and lack of alcohol abstinence impair long-term prognosis. New treatment strategies, including measures to ensure abstinence, are required.\n Patients with alcoholic hepatitis that is of intermediate severity have a low risk of short-term mortality but not much is known regarding long-term outcomes for these patients. This study clearly indicates that patients with intermediate disease characteristics have poor long-term outcomes. The presence of hepatic encephalopathy at the time of diagnosis and the absence of alcohol abstinence during follow-up are factors that predict poor long-term mortality.\n Copyright © 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.\n\nLackner, Karoline\n\nRainer, Florian\n\nSarocchi, Francesca\n\nSpindelböck, Walter Johann\n\nStauber, Rudolf\n\n\n"
},
{
"text": "\n2006\nPopulation-based geographic variations in DXA bone density in Europe: the EVOS Study. European Vertebral Osteoporosis.\n\nLunt, M\n\nFelsenberg, D\n\nAdams, J\n\nBenevolenskaya, L\n\nCannata, J\n\nDequeker, J\n\nDodenhof, C\n\nFalch, JA\n\nJohnell, O\n\nKhaw, KT\n\nMasaryk, P\n\nPols, H\n\nPoor, G\n\nReid, D\n\nScheidt-Nave, C\n\nWeber, K\n\nSilman, AJ\n\nReeve, J\n\nBeiträge in Fachzeitschriften\nISI:A1997XD93400002\n9205628.0\n10.1007%2FBF01622286\nNone\nThe purpose of this study was to investigate variations in bone density between 16 European populations, 13 of which were participants in the European Vertebral Osteoporosis Study (EVOS). Men and women aged 50-80 years were recruited randomly from local population registers, stratified in 5-year age bands. The other three centres recruited similarly. Random samples of 20-100% of EVOS subjects were invited for dual-energy X-ray absorptiometry (DXA) densitometry of the lumbar spine and/or proximal femur using Hologic, Lunar or Norland pencil beam machines or, in one centre, a Sopha fan-beam machine. Cross-calibration of the different machines was undertaken using the European Spine Phantom prototype (ESPp). Highly significant differences in mean bone density were demonstrated between centres, giving rise to between centre SDs in bone density that were about a quarter of a population SD. These differences persisted when centres using Hologic machines and centres using Lunar machines were considered separately. The centres were ranked differently according to whether male or female subjects were being considered and according to site of measurement (L2-4, femoral neck or femoral trochanter). As expected, bone mineral density (BMD) had a curvilinear relationship with age, and apparent rates of decrease slowed as age advanced past 50 years in both sexes. In the spine, not only did male BMD usually appear to increase with age, but there was a highly significant difference between centres in the age effect in both sexes, suggesting a variability in the impact of osteoarthritis between centres. Weight was consistently positively associated with BMD, but the effects of height and armspan were less consistent. Logarithmic transformation was needed to normalize the regressions of BMD on the independent variates, and after transformation, all sites except the femoral neck in females showed significant increases in SD with age. Interestingly, the effect of increasing weight was to decrease dispersion in proximal femur measurements in both sexes, further accentuating the tendency in women for low body mass index to be associated with osteoporosis as defined by densitometry. It is concluded that there are major differences between BMD values in European population samples which, with variations in anthropometric variables, have the potential to contribute substantially to variations in rates of osteoporotic fracture risk in Europe.\n\nWeber, Kurt\n\n\n"
},
{
"text": "\n143667\nLimb salvage and functional outcomes among patients with traumatic popliteal artery injury: a review of 64 cases.\n\nVielgut, I\n\nGregori, M\n\nHolzer, LA\n\nGlehr, M\n\nHashemi, S\n\nPlatzer, P\n\nBeiträge in Fachzeitschriften\nISI:000358549600010\n25720572.0\n10.1007/s00508-015-0715-9\nNone\nTraumatic popliteal arterial injury carries the greatest risk of limb loss among all peripheral vascular injuries and is associated with high levels of morbidity and worse functional outcomes. The purpose of this study is to analyse the functional outcome among patients with popliteal artery injury (PAI) due to blunt and penetrating trauma and identify influencing factors.\n We critically reviewed 64 cases of PAI due to blunt and penetrating trauma treated at our institution over a 20-year period. We evaluated the influence of parameters, such as patient demographics, injury mechanism, initial ISS and performed interventions, on limb amputation rates and functional outcomes. Functional outcome was examined within the 12-months follow-up using the Functional Independence Measure (FIM) score for feeding, expression and locomotion. FIM scores for each category ranged from 1 (full assistance required) to 4 (fully independent), with a maximum total FIM score of 12 representing full independence.\n The mechanism of injury was blunt in 55 % and penetrating in 45 % of the patients. The overall amputation rate in our series was 28 %. Out of these, 83.3 % of all performed amputations in our series were due to blunt trauma and 88.6 % of all blunt trauma patients were severely injured (ISS > 9) or polytraumatized (ISS > 15). Blunt mechanism of injury has also shown a negative effect on the functional outcome. Analysis of the 1-year clinical follow-up showed that 30 patients (65.3 %) returned to their normal activity level within 1 year after trauma. A total of 16 patients (34.7 %) were recorded to have limited activity levels, 76.5 % of them sustained a blunt trauma. Using the FIM score to quantify the level of disability, we detected significantly worse results in both FIM total (8.8 vs. 10.4) and FIM locomotion score (3.1 vs. 2.7) following blunt trauma.\n The main findings of the present study were that PAI due to blunt trauma is associated with a high percentage of severely injured or even polytraumatized patients. Amputation rates following blunt trauma were significantly higher compared to penetrating trauma. Functional independence measurement, assessed 12 months after injury, also showed significantly worse results in both FIM total and FIM locomotion score after blunt trauma. Other factors that seem to have a negative influence on the outcome in terms of amputation rates after PAI are patient's age, presence of associated injuries and prolonged lower extremity ischemia.\n\nGlehr, Mathias\n\nHolzer, Lukas\n\nVielgut, Ines\n\n\n"
},
{
"text": "\n152175\n[Comparison of Treatments for an Infected Pilonidal Sinus: Differences in Scar Quality and Outcome Between Secondary Wound Healing and Limberg Flap in a Prospective Study].\n\nDahmann, S\n\nLebo, PB\n\nMeyer-Marcotty, MV\n\nBeiträge in Fachzeitschriften\nISI:000374840300011\n27096210.0\n10.1055/s-0041-111322\nNone\nThere are various options for wound treatment after the excision of a pilonidal sinus. The aim of our study was to compare secondary healing to Limberg flap wound closure, with a focus on scar quality and patient complaints, rate of recurrence, period of absence from work as well as functional and aesthetic results one year after surgery.\n 33 out of 55 patients who underwent pilonidal sinus excision in our department (KlinikumStadtSoest, Soest, Germany) between 2011 and 2012 were enrolled in the study. 16 of these 33 patients had chosen secondary wound healing and 17 were treated with a Limberg flap for defect coverage. First and foremost, we aimed to objectify scar quality and elasticity by measuring the parameters of skin distensibility and mobility. To this end, we used a self-developed method to ascertain the sacral lumbar skin distension quotient (SL quotient) as well as sacral skin mobility. 100 healthy volunteers served as a control group. Also we collected information about pain, time of absence from work and frequency of recurrence and asked patients about their satisfaction with the functional and aesthetic results.\n The results for the sacral lumbar skin distension quotient were significantly better after Limberg flap wound closure compared with secondary wound healing. As regards distensibility, there was a marked trend to more favourable values in the Limberg group. No differences in distensibility and mobility were observed between the Limberg group and the control group, whereas skin distensibility was significantly reduced (p=0.001) in secondary healing compared with the control group. Time off work was significantly longer in secondary healing (mean 63 days) than after Limberg flap (mean 29 days). No differences were identified regarding patient satisfaction, pain scores and frequency of recurrence.\n Wound closure via Limberg flap after the excision of an infected pilonidal sinus not only helps to reduce absence from work, but also produces a scar which is more distensible and movable compared with secondary healing. Patient satisfaction and pain scores were very good in both groups, with no differences observed by us. We are planning to collect more data with a bigger sample of patients and a longer follow-up period in future studies. For the time being, we will continue to provide both treatment methods to our patients.\n © Georg Thieme Verlag KG Stuttgart · New York.\n\nLebo, Patricia Beatrice\n\n\n"
},
{
"text": "\n145290\nLearning curve for the detection of pouch of Douglas obliteration and deep infiltrating endometriosis of the rectum.\n\nTammaa, A\n\nFritzer, N\n\nStrunk, G\n\nKrell, A\n\nSalzer, H\n\nHudelist, G\n\nBeiträge in Fachzeitschriften\nISI:000336483400010\n24777849.0\n10.1093/humrep/deu078\nNone\nHow long does it take to be proficient in diagnosing pouch of Douglas (POD) obliteration and deep infiltrating endometriosis (DIE) of the rectum with transvaginal sonography (TVS)?\n Sonographers familiar with the general use of TVS are expected to be proficient in the diagnosis of endometriosis nodules of the rectum and the detection of POD obliteration using the 'sliding sign' after ∼40 examinations, performed in a referral clinic for pelvic pain.\n With rectal DIE, the reasons for the obvious diagnostic problems are complex. Menstrual pain or cramps are still considered to be 'normal' and do not provide a reason for patients and even health-care providers to seek expert help. Furthermore, the performance of TVS for diagnosing pelvic endometriosis has been shown to be accurate only in experienced hands.\n This prospective study included 121 selected patients with suspected endometriosis.\n Symptomatic patients, referred to a pelvic pain clinic, were examined by an expert sonographer (E.S.) and consecutively by two trainees (T1/2).\n The learning curve using the cumulative sum shows that the trainees, listed as T1/T2, reached the predefined level of proficiency in detecting bowel nodules after examining 42 and 37 patients, for T1 and T2, respectively. The prevalence rate of bowel nodules demonstrated by the ES was 21%. The sensitivity, specificity, positive and negative predictive values (PPV, NPV) as well as the accuracy for TVS of T1 and T2 in comparison with the results of ES were 72 and 89, 96 and 95, 87 and 80, 90 and 98, and 89 and 94%, respectively. The prevalence rate of POD obliteration, as demonstrated by a negative sliding sign, was 27%. The trainees reached the predefined level of proficiency after examining 42 and 33 patients, for T1 and T2, respectively. The sensitivity, specificity, PPV, NPV as well as the accuracy of TVS for T1 and T2 in comparison with the results of the ES were 83 and 89, 95 and 95, 91 and 80, 90 and 98, and 91 and 94%, respectively.\n We performed this analysis in a tertiary referral centre with a high number of advanced cases of DIE, not reflecting a standard population.\n Integrated in TVS training courses, typical sonographic video clips for DIE of the rectum, including the use of disease-specific signs, could help to improve diagnostic accuracy in DIE and shorten diagnostic delays.\n No funding was received for this study. None of the authors has any competing interests.\n\n\n"
},
{
"text": "\n175244\nEndoscopic carpal tunnel release: a 5-year experience.\n\nNazerani, S\n\nKalantar Motamedi, MH\n\nNazerani, T\n\nSaraii, A\n\nKeramati, MR\n\nBeiträge in Fachzeitschriften\nNone\n25717450.0\n10.5812/traumamon.18058\nPMC4310161\nEndoscopic carpal tunnel release (ECTR) has gained recognition as an alternative to the current gold standard, the open carpal tunnel release (OCTR). Detailed technical points for the ECTR have not been explained in the literature, especially for surgeons who are considering trying this technique.\n In this paper, we present our 5-year experience with the ECTR and special emphasis will be placed on less frequently discussed technical points, such as the optimal site to make the skin incision and the signs to look for in a completely divided retinaculum.\n In this prospective nonrandomized clinical trial, 176 patients with carpal tunnel syndrome who underwent surgical operation using the Agee uni-portal endoscopic carpal tunnel release technique, over a period of 5 years, were included. The "Hand Questionnaire", a standard questionnaire for hand surgery, was used to evaluate the patients at one, three, six and twelve month post-operative time points. Pain and scar tenderness were measured using the visual analog scale system. We propose the 'most proximally present wrist crease' for the skin incision and the 'proximal to distal sequential division of the retinaculum' as our methods of choice. Two signs, named 'railroad' and 'drop in', are proposed and these will be discussed in detail as hallmarks of complete retinaculum release.\n Of the 176 patients who underwent the ECTR operation, 164 cases (93.2%) had no or very little pain at the one year postoperative visit, and nearly all of the patients reported no relapse of symptoms at the previously mentioned postoperative time points. Patient satisfaction and functional recovery was comparable to other published ECTR studies, and showed better short-term results of this technique over the OCTR. One deep seated infection, three cases of transient index finger paresthesia due to scope pressure on the median nerve, and one case of median nerve branch transection, were observed. Scar complications, including; tenderness, redness and pain, were significantly lower in the proximally placed incision in comparison with the distally placed incision (P < 0.005).\n The 'most proximally present wrist crease' and the 'distal to proximal division of the retinaculum' using the two signs of 'railroad' and 'drop in' to confirm a complete division of retinaculum are proposed techniques that should be considered in order to produce good outcomes in ECTR. The 'railroad' sign is the parallel standing of the retinaculum edges, and the 'drop in' sign is the dropping of the retinaculum edge into the scope denote a completely divided retinaculum.\n\nNazerani Hooshmand, Tina\n\n\n"
},
{
"text": "\n2189\nRandomized comparison of total androgen blockade alone versus combined with weekly epirubicin in advanced prostate cancer.\n\nPummer, K\n\nLehnert, M\n\nStettner, H\n\nHubmer, G\n\nBeiträge in Fachzeitschriften\nISI:A1997XP01500012\n9267791.0\nNone\nNone\nHormone deprivation is the gold standard for the treatment of metastatic prostate cancer. However, prostate cancer being primarily a heterogeneous tumor comprising hormone-dependent, hormone-sensitive, and hormone-insensitive cells, at least the latter remain unaffected by hormonal manipulations, thus making disease progression almost inevitable. In quest of a more comprehensive therapy we therefore studied the concept of early combined chemoendocrine therapy in a prospective randomized multicenter trial. The purpose of this study was to evaluate whether patients with previously untreated advanced prostate cancer benefit from combining total androgen blockade (TAB) with weekly epirubicin chemotherapy (E-TAB). From April 1988 to January 1991, 145 previously untreated patients with either metastatic (n = 117) or locally advanced (n = 28) histologically confirmed prostate cancer were randomly allocated to treatment with TAB by bilateral orchiectomy and flutamide 250 mg t.i.d. or TAB plus weekly epirubicin 25 mg/m2 i.v. for 18 weeks (E-TAB). The study endpoints were progression-free survival and overall survival. In addition the effects of treatment on quality of life were assessed by two methods. At regular intervals patients self-assessed ten qualities of physical, functional and emotional health using 5-point scales. In order to evaluate the time without disease progression and treatment-induced adverse effects, a modified Q-TWiST (quality-adjusted time without symptoms and toxicity) model was applied. At a median follow-up of 81 months, progression-free survival and overall survival in the TAB and E-TAB groups were 12 and 18 months (p < 0.02) and 22 and 30 months (p = 0.12), respectively. In patients with > 5 sites of bone metastasis (D2max), the corresponding periods were 9 and 14 months (p = 0.005) and 17 and 27 months (p = 0.06), respectively. Subjective quality of life assessment showed no impairment of quality of life by epirubicin treatment. Stage D and D2max patients treated with E-TAB had an average gain in Q-TWiST of 5 months (p = 0.098) and 8 months (p = 0.03), respectively, compared to the TAB treatment. Objective toxicities were generally mild with either treatment. In conclusion, the combination of TAB and epirubicin was well tolerated by patients with advanced prostate cancer and resulted in a significant extension of progression-free survival. This effect of E-TAB on objective treatment outcome was accompanied by prolonged time without treatment-induced adverse effects and tumor progression, i.e., time with good quality of life. Therefore, further studies with E-TAB appear warranted in patients with advanced prostate cancer.\n\nPummer, Karl\n\n\n"
},
{
"text": "\n64544\nNumber and type of vertebral deformities: epidemiological characteristics and relation to back pain and height loss. European Vertebral Osteoporosis Study Group.\n\nIsmail, AA\n\nCooper, C\n\nFelsenberg, D\n\nVarlow, J\n\nKanis, JA\n\nSilman, AJ\n\nO'Neill, TW\n\nand and the European Vertebral Osteoporosis Study Group\n\nBeiträge in Fachzeitschriften\nISI:000080177200004\n10450408.0\n10.1007/s001980050138\nNone\nVertebral deformity is the classical hallmark of osteoporosis. Three types of vertebral deformity are usually described: crush, wedge and biconcave deformities. However, there are few data concerning the descriptive epidemiology of the individual deformity types, and differences in their underlying pathogenesis and clinical impact remain uncertain. The aim of this study was to compare the epidemiological characteristics of the three types of vertebral deformity and to explore the relationships of the number and type of deformity with back pain and height loss. Age-stratified random samples of men and women aged 50 years and over were recruited from population registers in 30 European centers (EVOS study). Subjects were invited to attend for an interviewer-administered questionnaire and lateral spinal radiographs. The presence, type and number of vertebral deformities was determined using the McCloskey-Kanis algorithm. A total of 13, 62 men and women were studied; mean age in men was 64.4 years (SD 8.5), and in women 63.8 years (SD 8.5 years). There was evidence of variation in the occurrence of wedge, crush and biconcave deformity by age, sex and vertebral level. Wedge deformities were the most frequent deformity and tended to cluster at the mid-thoracic and thoraco-lumbar regions of the spine in both men and women. Similar predilection for these sites was observed for crush and to a lesser extent biconcave deformities though this was much less marked than for wedge deformities. In both sexes the frequency of biconcave deformities was higher in the lumbar than the thoracic spine and unlike the other deformity types it did not decline in frequency at lower lumbar vertebral levels. The prevalence of all three types of vertebral deformity increased with age and was more marked in women. There were no important differences in the effect of age on the different deformity types. All types of deformity were associated with height loss, which was greatest for individuals with crush deformity. Back pain was also associated with all types of deformity. Overall, these results do not suggest important differences in pathophysiology between the three deformity types. Biomechanical factors appear to be important in determining their distribution within the spine. All deformity types are linked with adverse outcomes, though crush deformities showed greater height loss than the other deformity types.\n\nWeber, Kurt\n\n\n"
}
]
}