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"text": "\n182672\nMapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the Global Burden of Disease Study 2017.\n\nLocal Burden of Disease Diarrhoea Collaborators\n\nBeiträge in Fachzeitschriften\nISI:000540993600024\n32513411.0\n10.1016/S0140-6736(20)30114-8\nPMC7314599\nAcross low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea.\n We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates.\n The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1-65·8), 17·4% (7·7-28·4), and 59·5% (34·2-86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage.\n By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health.\n Bill & Melinda Gates Foundation.\n Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.\n\nMärz, Winfried\n\n\n"
},
{
"text": "\n183036\nUrology in the Time of Coronavirus: Reduced Access to Urgent and Emergent Urological Care during the Coronavirus Disease 2019 Outbreak in Italy.\n\nPorreca, A\n\nColicchia, M\n\nD'Agostino, D\n\nAmenta, M\n\nCorsaro, A\n\nZaramella, S\n\nZegna, L\n\nGallo, F\n\nSchenone, M\n\nBozzini, G\n\nCalori, A\n\nPastore, AL\n\nAl Salhi, Y\n\nSciorio, C\n\nSpirito, L\n\nVarca, V\n\nMarenghi, C\n\nGreco, F\n\nAltieri, VM\n\nVerze, P\n\nBarba, C\n\nAntonelli, A\n\nCerruto, MA\n\nFalabella, R\n\nDi Bello, S\n\nLeonardo, C\n\nTufano, A\n\nVolpe, A\n\nUmari, P\n\nParma, P\n\nNidini, M\n\nPini, G\n\nBorghesi, M\n\nTerrone, C\n\nCacciamani, GE\n\nSighinolfi, MC\n\nBusetto, GM\n\nWennberg, AM\n\nFinocchiaro, M\n\nFalsaperla, M\n\nOderda, M\n\nCeruti, C\n\nRocco, B\n\nSchiavina, R\n\nBianchi, L\n\nMari, A\n\nDi Maida, F\n\nDalpiaz, O\n\nCelia, A\n\nPirozzi, M\n\nBove, P\n\nIacovelli, V\n\nCafarelli, A\n\nCindolo, L\n\nFerrari, G\n\nGatti, L\n\nPirola, G\n\nAnnino, F\n\nPucci, L\n\nRomagnoli, D\n\nArtibani, W\n\nMinervini, A\n\nBeiträge in Fachzeitschriften\nISI:000556412300018\n32434207.0\n10.1159/000508512\nPMC7360500\nThe coronavirus disease 2019 (COVID-19) pandemic has put a substantial burden on the Italian healthcare system, resulting in the restructuring of hospitals to care for COVID-19 patients. However, this has likely impacted access to care for patients experiencing other conditions. We aimed to quantify the impact of COVID-19 on access to care for patients with urgent/emergent urological conditions throughout Italy.\n A questionnaire was sent to 33 urological units in the AGILE consortium, asking clinicians to report on the number of urgent/emergent urological patients seen and/or undergoing surgery over a 3-week period during the peak of the COVID-19 outbreak and a reference week prior to the outbreak. ANOVA and linear regression models were used to quantify these changes.\n Data from 27 urological centres in Italy showed a decrease from 956 patients/week seen just prior to the outbreak to 291 patients/week seen by the end of the study period. There was a difference in the number of patients with urgent/emergent urological disease seen within/during the different weeks (all p values < 0.05). A significant decrease in the number of patients presenting with haematuria, urinary retention, urinary tract infection, scrotal pain, renal colic, or trauma and urgent/emergent cases that required surgery was reported (all p values < 0.05).\n In Italy, during the COVID-19 outbreak there has been a decrease in patients seeking help for urgent/emergent urological conditions. Restructuring of hospitals and clinics is mandatory to cope with the COVID-19 pandemic; however, the healthcare system should continue to provide adequate levels of care also to patients with other conditions.\n © 2020 S. Karger AG, Basel.\n\nDalpiaz, Orietta\n\n\n"
},
{
"text": "\n52562\nShort acting insulin analogues versus regular human insulin in patients with diabetes mellitus.\n\nSiebenhofer, A\n\nPlank, J\n\nBerghold, A\n\nJeitler, K\n\nHorvath, K\n\nNarath, M\n\nGfrerer, R\n\nPieber, TR\n\nBeiträge in Fachzeitschriften\nISI:000236932100007\n16625575.0\n10.1002/14651858.CD003287.pub4\nNone\nBACKGROUND: Short acting insulin analogue use for diabetic patients is still controversial, as reflected in many scientific debates. OBJECTIVES: To assess the effects of short acting insulin analogues versus regular human insulin. SEARCH STRATEGY: The Cochrane Library (Issue 3, 2005), MEDLINE, EMBASE until September 2005. SELECTION CRITERIA: Randomised controlled trials with an intervention duration of at least 4 weeks. DATA COLLECTION AND ANALYSIS: Trial selection and evaluation of study quality was done independently by two reviewers. MAIN RESULTS: Altogether 8274 participants took part in 49 randomised controlled studies. Most studies were of poor methodological quality. In patients with type 1 diabetes, the weighted mean difference (WMD) of HbA1c was -0.1% (95% CI: -0.2 to -0.1) in favour of insulin analogue, whereas in patients with type 2 diabetes the WMD was 0.0% (95% CI: -0.1 to 0.0). In subgroup analyses of different types of interventions in type 1 diabetic patients, the WMD in HbA1c was -0.2% (95% CI: -0.3 to -0.1) in favour of insulin analogue in studies using continuous subcutaneous insulin injections (CSII), whereas for conventional intensified insulin therapy (IIT) studies the WMD in HbA1c was -0.1% (95% CI: -0.1 to 0.0). The WMD of the overall mean hypoglycaemic episodes per patient per month was -0.2 (95% CI: -1.1 to 0.7) and -0.2 (95% CI: -0.5 to 0.1) for analogues in comparison to regular insulin in patients with type 1 diabetes and type 2 diabetes, respectively. For studies in type 1 diabetes patients the incidence of severe hypoglycaemia ranged from 0 to 247.3 (median 21.8) episodes per 100 person-years for insulin analogues and from 0 to 544 (median 46.1) for regular insulin, in type 2 the incidence ranged from 0 to 30.3 (median 0.3) episodes per 100 person-years for insulin analogues and from 0 to 50.4 (median 1.4) for regular insulin. No study was designed to investigate possible long term effects (e.g. mortality, diabetic complications), in particular in patients with diabetes related complications. AUTHORS' CONCLUSIONS: Our analysis suggests only a minor benefit of short acting insulin analogues in the majority of diabetic patients treated with insulin. Until long term efficacy and safety data are available we suggest a cautious response to the vigorous promotion of insulin analogues. For safety purposes, we need a long-term follow-up of large numbers of patients and well designed studies in pregnant women to determine the safety profile for both the mother and the unborn child.\n\nBerghold, Andrea\n\nHorvath, Karl\n\nJeitler, Klaus\n\nPieber, Thomas\n\nSiebenhofer-Kroitzsch, Andrea\n\n\n"
},
{
"text": "\n62159\nFunctional structure of the human vocal cord\n\nFriedrich, G\n\nKainz, J\n\nFreidl, W\n\nBeiträge in Fachzeitschriften\nISI:A1993LE06600001\n8323625.0\n10.1055/s-2007-997888\nNone\n19 laryngeal specimens (11 male, 8 female) were cut in horizontal serial sections, parallel to the free edge of the vocal cord. After staining, the structures of the glottis were measured microscopically and statistical analysis of the sex-related differences performed. The results show that the glottis can be divided not only into the well-known anterior and posterior glottis, but into five histological and functional distinctive portions. Within the anterior glottis, these parts are the freely vibrating midportion of the vocal cord, which is connected to the stiff laryngeal frame via an anterior and posterior transition zone. Within the posterior glottis there are two parts: the vocal process of the arytenoid cartilage (which is, according to Hirano, also the cartilage portion of the vocal cord) and the lateral wall of the posterior glottis. Statistical analysis of the data revealed significant sex differences, not only in the absolute measures but also on comparing the relative dimensions in respect of the total glottic length. The posterior glottis accounts for 37% of the total glottic length in men and for 42% in women and is therefore longer than generally accepted. We found statistically significant sex-related differences in the length of the posterior glottis, which is absolutely longer in men but relatively longer in women. The reason for this is the difference in the length of the midportion of the vocal cord. This zone is twice as long in men (8.5 mm) than in women (4.6 mm) and accounts for 37% of the total glottic length in men compared to 29% in women. As this portion is the most vibrating part of the vocal cord this could be an explanation for the unsolved phenomenon why the fundamental frequencies are 1:2 between men and women while all dimensions of the larynx are 1.5:1. The vibrating midportion of the vocal cord is connected to the stiff laryngeal framework by highly differentiated transition zones: the nodulus elasticus anterior and posterior. The lamina propria of the midportion shows a three-layered structure, orientated parallel to the free edge of the vocal cord. In the transition zones the deep layer of the lamina propria consists of interwoven bundles of collagen and elastic fibres, thus having the function of a "cushion ball" (Hirano). A functionally important portion is the vocal process of the arytenoid cartilage. The complex movements of the vocal process during abduction and adduction of the vocal cords produce a severe mechanical strain on the mucous membrane covering this part of the glottis.\n\nFreidl, Wolfgang\n\nFriedrich, Gerhard\n\nKainz, Josef\n\n\n"
},
{
"text": "\n78740\nPelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group\n\nPohlemann, T\n\nTscherne, H\n\nBaumgärtel, F\n\nEgbers, HJ\n\nEuler, E\n\nMaurer, F\n\nFell, M\n\nMayr, E\n\nQuirini, WW\n\nSchlickewei, W\n\nWeinberg, A\n\nBeiträge in Fachzeitschriften\nISI:A1996UD76100002\n8685720.0\nNone\nNone\nPelvic fractures are rare injuries (3-8%) when compared to fractures in other body regions. They are accompanied by high mortality (5-20%), and the survivors suffer from severe pain and pelvic-related handicaps. The German Pelvic Group (German Chapter of the AO-International & German Trauma Society) started a prospective multicenter study, including ten major trauma centers for collecting a high number of data in a short period of time (1991-1993). All pelvic injuries were documented consecutively using a special set of evaluation sheets. The study closed with 1, 22 patients. A 2-year follow-up was completed for 486 patients injured in 1991 and 1992 after type B and C injuries, complex pelvic trauma, acetabulum fractures and a random 25% of A-type injuries (overall follow-up rate 73%). The follow-up included special "out-come" criteria. Of the pelvic ring injuries without significant peripelvic soft tissue involvement, 63.6% were A-type fractures, 21.0% B-type injuries and 15.5% C-type injuries. The rate of operative stabilization was 3.9% after A-type injuries, 37.3% after B-type injuries and 54.3% after C-type injuries. In isolated acetabular fractures ORIF was performed in 38.6%. The total lethality was 7.9% with a significant difference between "complex" pelvic trauma (21.3%) and patients without concomitant peripelvic injuries (7.2%). In 0.9% the pelvic injury was reported as the main cause of death. Pain at follow-up was observed in every classification group, the rate of completely "pain-free" patients being 55% after A-type, 41% after B-type and 27% after C-type fractures. Malfunction of micturia was reported by 7.6% of all patients, sexual malfunction by 11.6% of the males ("erectile dysfunction") and 2.2% of the female ("dysparneuria"). Scaled by the recently developed "outcome score", the radiological result showed anatomical healing after 90.8% of the B-type and 74.6% of the C-type injuries. On the other hand, the clinical result was rated as good or excellent in only 70% of the B-type and 54% of the C-type injuries. Although progress in indications and treatment techniques has shown improved radiological results after unstable pelvic ring injuries when compared to earlier studies, the clinical result still remains unsatisfactory. Further analyses and studies must be conducted to identify the prognostic factors for the late sequelae. Whether it is possible influence these factors by additional surgical intervention cannot be answered at present.\n\nWeinberg, Annelie-Martina\n\n\n"
},
{
"text": "\n168865\nMaltreatment during childhood: a risk factor for the development of endometriosis?\n\nLiebermann, C\n\nKohl Schwartz, AS\n\nCharpidou, T\n\nGeraedts, K\n\nRauchfuss, M\n\nWölfler, M\n\nvon Orelli, S\n\nHäberlin, F\n\nEberhard, M\n\nImesch, P\n\nImthurn, B\n\nLeeners, B\n\nBeiträge in Fachzeitschriften\nISI:000440947500010\n29947745.0\n10.1093/humrep/dey111\nNone\nIs maltreatment during childhood (MC), e.g. sexual abuse, physical abuse, emotional abuse and neglect, associated with diagnosis of endometriosis?\n Childhood sexual abuse, emotional abuse/neglect and inconsistency experiences were associated with the diagnosis of endometriosis while no such association was found for physical abuse/neglect and other forms of maltreatment.\n Symptoms of endometriosis such as chronic pelvic pain, fatigue and depression, are correlated with MC, as are immune reactions linked to endometriosis. These factors support a case for a potential role of MC in the development of endometriosis.\n The study was designed as a multicentre retrospective case-control study. Women with a diagnosis of endometriosis were matched to control women from the same clinic/doctor's office with regard to age (±3 years) and ethnic background. A total of 421 matched pairs were included in the study.\n Women with endometriosis and control women were recruited in university hospitals, district hospitals, and doctors' offices in Germany, Switzerland and Austria. A German-language version of the Childhood Trauma Questionnaire (CTQ) was used to evaluate MC. Diagnosis of endometriosis was confirmed histologically and classified according to ASRM criteria.\n Women with endometriosis reported significantly more often than control women a history of sexual abuse (20%/14%, P = 0.0197), emotional abuse (44%/28%, P < 0.0001), emotional neglect (50%/42%, P = 0.0123) and inconsistency experiences (53%/41%, P = 0.0007). No statistically significant differences could be demonstrated for physical abuse/neglect (31%/26%, P = 0.1738). Combinations of different abuse/neglect experiences were described significantly more often in women with endometriosis. Frequencies of other MC, i.e. violence against the mother (8%/7%, P = 0.8222), drug abuse in the family (5%/3%, P = 0.0943), mentally handicapped family members (1%/1%, P = 0.7271), suicidal intentions in the family (6%/4%, P = 0.2879) and family members in prison (1%/1%, P = 0.1597) were not statistically different in women with endometriosis and control women.\n Some control women might present asymptomatic endometriosis, which would lead to underestimation of our findings. The exclusion of pregnant women may have biased the results. Statistical power for sub-analyses of physical abuse/neglect and sexual abuse was limited.\n A link to MC needs to be considered in women with endometriosis. As there are effective strategies to avoid long-term consequences of MC, healthcare professionals should inquire about such experiences in order to be able to provide treatment for the consequences as early as possible.\n None.\n Endo_QoL NCT 02511626.\n\nWölfler, Monika Martina\n\n\n"
},
{
"text": "\n137724\nAntioxidants, inflammation and cardiovascular disease.\n\nMangge, H\n\nBecker, K\n\nFuchs, D\n\nGostner, JM\n\nBeiträge in Fachzeitschriften\nNone\n24976919.0\n10.4330/wjc.v6.i6.462\nPMC4072837\nMultiple factors are involved in the etiology of cardiovascular disease (CVD). Pathological changes occur in a variety of cell types long before symptoms become apparent and diagnosis is made. Dysregulation of physiological functions are associated with the activation of immune cells, leading to local and finally systemic inflammation that is characterized by production of high levels of reactive oxygen species (ROS). Patients suffering from inflammatory diseases often present with diminished levels of antioxidants either due to insufficient dietary intake or, and even more likely, due to increased demand in situations of overwhelming ROS production by activated immune effector cells like macrophages. Antioxidants are suggested to beneficially interfere with diseases-related oxidative stress, however the interplay of endogenous and exogenous antioxidants with the overall redox system is complex. Moreover, molecular mechanisms underlying oxidative stress in CVD are not fully elucidated. Metabolic dybalances are suggested to play a major role in disease onset and progression. Several central signaling pathways involved in the regulation of immunological, metabolic and endothelial function are regulated in a redox-sensitive manner. During cellular immune response, interferon γ-dependent pathways are activated such as tryptophan breakdown by the enzyme indoleamine 2, -dioxygenase (IDO) in monocyte-derived macrophages, fibroblasts, endothelial and epithelial cells. Neopterin, a marker of oxidative stress and immune activation is produced by GTP-cyclohydrolase I in macrophages and dendritic cells. Nitric oxide synthase (NOS) is induced in several cell types to generate nitric oxide (NO). NO, despite its low reactivity, is a potent antioxidant involved in the regulation of the vasomotor tone and of immunomodulatory signaling pathways. NO inhibits the expression and function of IDO. Function of NOS requires the cofactor tetrahydrobiopterin (BH4), which is produced in humans primarily by fibroblasts and endothelial cells. Highly toxic peroxynitrite (ONOO(-)) is formed solely in the presence of superoxide anion (O2 (-)). Neopterin and kynurenine to tryptophan ratio (Kyn/Trp), as an estimate of IDO enzyme activity, are robust markers of immune activation in vitro and in vivo. Both these diagnostic parameters are able to predict cardiovascular and overall mortality in patients at risk. Likewise, a significant association exists between increase of neopterin concentrations and Kyn/Trp ratio values and the lowering of plasma levels of vitamin-C, -E and -B. Vitamin-B deficiency is usually accompanied by increased plasma homoycsteine. Additional determination of NO metabolites, BH4 and plasma antioxidants in patients with CVD and related clinical settings can be helpful to improve the understanding of redox-regulation in health and disease and might provide a rationale for potential antioxidant therapies in CVD.\n\nMangge, Harald\n\n\n"
},
{
"text": "\n147107\nIdentifying clinically relevant prognostic subgroups of postmenopausal women with node-positive hormone receptor-positive early-stage breast cancer treated with endocrine therapy: a combined analysis of ABCSG-8 and ATAC using the PAM50 risk of recurrence score and intrinsic subtype.\n\nGnant, M\n\nSestak, I\n\nFilipits, M\n\nDowsett, M\n\nBalic, M\n\nLopez-Knowles, E\n\nGreil, R\n\nDubsky, P\n\nStoeger, H\n\nRudas, M\n\nJakesz, R\n\nFerree, S\n\nCowens, JW\n\nNielsen, T\n\nSchaper, C\n\nFesl, C\n\nCuzick, J\n\nBeiträge in Fachzeitschriften\nISI:000359312100020\n25935792.0\n10.1093/annonc/mdv215\nNone\nIn the adjuvant treatment of hormone receptor-positive (HR+) breast cancer, variables like tumour size, grade and nodal status have great impact on therapy decisions. As most node-positive patients with HR+ breast cancer currently receive adjuvant chemotherapy improved methods for characterization of individuals' metastasis risk are needed to reduce overtreatment.\n Tissue specimens from node-positive patients of the ABCSG-8 and ATAC trials who received adjuvant tamoxifen and/or anastrozole were included in this study. Analysing RNA from paraffin blocks using the PAM50 test, the primary objective was to evaluate the prognostic information of the risk of recurrence (ROR) score added to combined clinical standard variables in patients with one positive node (1N+) and in patients with two or three positive nodes (2-3N+), using log-likelihood ratio tests.\n At a median follow-up of 9.6 years, distant metastases occurred in 97 (18%) of 543 node-positive patients. In a multivariate analysis, the PAM50-derived ROR score provided reliable prognostic information in addition to and beyond established clinical factors for 1N+ (P < 0.0001) and 2-3N+ patients (P = 0.0002). Ten-year distant recurrence risk was significantly increased in the high-risk compared with the low-risk group derived from ROR score for 1N+ [25.5%, 95% confidence interval (CI) 17.5% to 36.1%versus 6.6%, 95% CI 3.3% to 12.8%] and compared with the combined low/intermediate risk group for 2-3N+ patients (33.7%, 95% CI 25.5% to 43.8% versus 12.5%, 95% CI 6.6% to 22.8%). Additionally, the luminal A intrinsic subtype (IS) exhibited significantly lower risk of distant recurrence compared with the luminal B subtype in 1N+ and 2-3N+ patients.\n PAM50 ROR score and IS can identify node-positive patient subgroups with limited risk of metastasis after endocrine therapy, for whom adjuvant chemotherapy can be spared. The PAM50 test is a valuable tool in determining treatment of node-positive early-stage breast cancer patients.\n © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.\n\nBalic, Marija\n\nStoeger, Herbert\n\n\n"
},
{
"text": "\n148792\nEffect of Self-Monitoring and Medication Self-Titration on Systolic Blood Pressure in Hypertensive Patients at High Risk of Cardiovascular Disease: The TASMIN-SR Randomized Clinical Trial\n\nZweiker, R\n\nBeiträge in Fachzeitschriften\nISI:000364641800008\nNone\nNone\nNone\nImportance: Self-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups. Objective: To determine the effect of self-monitoring with self-titration of antihypertensive medication compared with usual care on systolic blood pressure among patients with cardiovascular disease, diabetes, or chronic kidney disease. Design, Setting, and Patients: A primary care, unblinded, randomized clinical trial involving 552 patients who were aged at least 35 years with a history of stroke, coronary heart disease, diabetes, or chronic kidney disease and with baseline blood pressure of at least 130/80 mmHg being treated at 59 UK primary care practices was conducted between March 2011 and January 2013. Interventions: Self-monitoring of blood pressure combined with an individualized self-titration algorithm. During the study period, the office visit blood pressure measurement target was 130/80 mmHg and the home measurement target was 120/75 mmHg. Control patients received usual care consisting of seeing their health care clinician for routine blood pressure measurement and adjustment of medication if necessary. Main Outcomes and Measures: The primary outcome was the difference in systolic blood pressure between intervention and control groups at the 12-month office visit. Results: Primary outcome data were available from 450 patients (81 %). The mean baseline blood pressure was 143.1/80.5 mmHg in the intervention group and 143.6/79.5 mmHg in the control group. After 12 months, the mean blood pressure had decreased to 128.2/73.8 mmHg in the intervention group and to 137.8/76.3 mmHg in the control group, a difference of 9.2 mmHg (95-% CI, 5.7-12.7) in systolic and 3.4 mmHg (95-% CI, 1.8-5.0) in diastolic blood pressure following correction for baseline blood pressure. Multiple imputation for missing values gave similar results: the mean baseline was 143.5/80.2 mmHg in the intervention group vs 144.2/79.9 mmHg in the control group, and at 12 months, the mean was 128.6/73.6 mmHg in the intervention group vs 138.2/76.4 mmHg in the control group, with a difference of 8, mmHg (95-% CI, 4.9-12.7) for systolic and 3.1 mmHg (95-% CI, 0.7-5.5) for diastolic blood pressure between groups. These results were comparable in all subgroups, without excessive adverse events. Conclusions and Relevance: Among patients with hypertension at high risk of cardiovascular disease, self-monitoring with self-titration of antihypertensive medication compared with usual care resulted in lower systolic blood pressure at 12 months.\n\nZweiker, Robert\n\n\n"
},
{
"text": "\n172540\nOsteointegration of a Novel Silk Fiber-Based ACL Scaffold by Formation of a Ligament-Bone Interface.\n\nTeuschl, AH\n\nTangl, S\n\nHeimel, P\n\nSchwarze, UY\n\nMonforte, X\n\nRedl, H\n\nNau, T\n\nBeiträge in Fachzeitschriften\nISI:000460055500017\n30653344.0\n10.1177/0363546518818792\nNone\nGiven the unsatisfactory results and reported drawbacks of anterior cruciate ligament (ACL) reconstruction, such as donor site morbidity and the limited choice of grafts in revision surgery, new regenerative approaches based on tissue-engineering strategies are currently under investigation.\n To determine (1) if a novel silk fiber-based ACL scaffold is able to initiate osteointegration in the femoral and tibial bone tunnels under in vivo conditions and (2) if the osteointegration process will be improved by intraoperatively seeding the scaffolds with the autologous stromal vascular fraction, an adipose-derived, stem cell-rich isolate from knee fat pads.\n Controlled laboratory study.\n A total of 33 sheep underwent ACL resection and were then randomly assigned to 2 experimental groups: ACL reconstruction with a scaffold alone and ACL reconstruction with a cell-seeded scaffold. Half of the sheep in each group were randomly chosen and euthanized 6 months after surgery and the other half at 12 months. To analyze the integration of the silk-based scaffold in the femoral and tibial bone tunnels, hard tissue histology and micro-computed tomography measurements were performed.\n Hard tissue histological workup showed that in all treatment groups, with or without the application of the autologous stromal vascular fraction, an interzone of collagen fibers had formed between bone and silk-based graft. This collagen-fiber continuity partly consisted of Sharpey fibers, comparable with tendon-bone healing known for autografts and allografts. Insertion sites were more broad based at 6 months and more concentrated on the slightly protruding, bony knoblike structures at 12 months. Histologically, no differences between the treatment groups were detectable. Analysis of micro-computed tomography measurements revealed a significantly higher tissue density for the cell-seeded scaffold group as compared with the scaffold-alone group in the tibial but not femoral bone tunnel after 12 months of implantation.\n The novel silk fiber-based scaffold for ACL regeneration demonstrated integration into the bone tunnels via the formation of a fibrous interzone similar to allografts and autografts. Histologically, additional cell seeding did not enhance osteointegration. No significant differences between 6 and 12 months could be detected. After 12 months, there was still a considerable amount of silk present, and a longer observation period is necessary to see if a true ligament-bone enthesis will be formed.\n ACL regeneration with a silk fiber-based scaffold with and without additional cell seeding may provide an alternative treatment option to current techniques of surgical reconstruction.\n\nSchwarze, Uwe Yacine\n\n\n"
},
{
"text": "\n1516\nLipoprotein(a) serum concentration and apolipoprotein(a) phenotype correlate with severity and presence of ischemic cerebrovascular disease.\n\nJürgens, G\n\nTaddei-Peters, WC\n\nKöltringer, P\n\nPetek, W\n\nChen, Q\n\nGreilberger, J\n\nMacomber, PF\n\nButman, BT\n\nStead, AG\n\nRansom, JH\n\nBeiträge in Fachzeitschriften\nISI:A1995RX18500019\n7570736.0\n10.1161/01.STR.26.10.1841\nNone\nBACKGROUND AND PURPOSE: Serum lipoprotein(a) [Lp(a)] levels are genetically determined and considered to be an independent risk factor for atherosclerosis. The aim of this study was to provide a complete analysis of Lp(a) serum levels, apolipoprotein(a) phenotypes, and other lipid parameters for different forms of severity of symptomatic ischemic cerebrovascular disorders as well as for different stages of carotid atherosclerosis. METHODS: Lp(a) concentration, apolipoprotein(a) phenotype, triglyceride, low-density lipoprotein, high-density lipoprotein, and total cholesterol levels of blind-coded specimens as well as degree of carotid artery stenosis were assessed in a consecutive series of patients with ischemic cerebrovascular disease. We evaluated 265 male (34%) and female (66%) patients (mean age, 51 +/- 7.4 years) with transient ischemic attack (55.8%), prolonged reversible ischemic neurological deficits (28.3%), and cerebral infarction (15.9%) as well as 288 male (30%) and female (70%) control subjects (mean age, 51 +/- 7.1 years). All subjects were white. RESULTS: Lp(a), total, and low-density lipoprotein cholesterol were statistically significantly elevated in all patients compared with control subjects. Lp(a) correlated with the severity of symptomatic cerebrovascular disease and the degree of carotid stenosis. Logistic regression analysis revealed Lp(a) as the best single marker for the presence of cerebrovascular disease (P < .001) followed by high-density lipoprotein cholesterol (P = .003) and triglycerides (P = .049). With a cutoff of 20 mg/dL of Lp(a), the odds ratio for a subject to have had ischemic stroke with elevated Lp(a) was 20.3 and 23.7 depending on the method of the Lp(a) estimation, whereas the odds ratio when the sonography score was > 0 was 15.4. The investigation of the distribution of the apo(a) phenotypes revealed that 16.73% of the control subjects had major isoforms < or = 580 kD molecular weight (B, F, S1, S2) versus 42.65% of the patients' group (P < .001). These isoforms were also present in 14.71% of all individuals with a sonography score of 0 but in 52.30% of all individuals with a sonography score > 0 (P < .001). CONCLUSIONS: This case-control study shows that an elevated Lp(a) level is the primary factor associated with the presence of ischemic cerebrovascular disease and that the increased portion of the smaller-molecular-weight apo(a) isoforms in patients and individuals with a sonography score > 0 points toward an inherited predisposition for this disease.\n\nGreilberger, Joachim\n\nJürgens, Günther\n\n\n"
},
{
"text": "\n53064\nCopper can promote oxidation of LDL by markedly different mechanisms.\n\nZiouzenkova, O\n\nSevanian, A\n\nAbuja, PM\n\nRamos, P\n\nEsterbauer, H\n\nBeiträge in Fachzeitschriften\nISI:000072770800012\n9559873.0\n10.1016/S0891-5849(97)00324-9\nNone\nOxidation of LDL (0.1 microM) in PBS with copper concentrations ranging from 0.03 to 10 microM, equal to 0.3-100 Cu2+/LDL, was investigated by monitoring the formation of conjugated dienes at 234 nm. With all 8 LDL samples examined, the kinetics changed strongly at submicromolar Cu2+ concentrations. Based on time-course of the formation of conjugated dienes, cholesteryl linoleate hydroxides and hydroperoxides as well as the antioxidant consumption, two oxidation types were distinguished. Type A oxidations, observed at relatively high Cu2+ concentrations of 10-100 Cu2+/ LDL, represented the conventional kinetics of LDL oxidation with an inhibition period (= lag-time) followed by a propagation phase. In contrast, type C oxidations proceeded after a negligibly short lag time followed by a distinct propagation phase. The rate of this propagation increased rapidly to 0.5 mol diene/mol LDL and then slowed down in the presence of alpha-, amma-tocopherols and carotenoids, which were consumed faster than tocopherols. The increase in diene absorption was due to the formation of both hydroxides and hydroperoxides suggesting a high initial decomposition of hydroperoxides. At submicromolar concentrations of about 0.1 to 0.5 microM, type C and type A oxidation can be combined resulting in 4 consecutive oxidation phases, i.e. 1st inhibition and 1st propagation (belonging to type C), followed by 2nd inhibition and 2nd propagation (belonging to type A). Increasing copper concentrations lowered the 1st propagation and shortened the 2nd inhibition periods until they melted into one apparent kinetic phase. Decreasing [Cu2+] increased the 1st propagation and 2nd inhibition but lowered the 2nd propagation phase until it completely disappeared. A threshold copper concentration, denoted as Cu(lim), can be calculated as a kinetic constant based on the Cu2+-dependence for the rate of 2nd propagation. Below Cu(lim), LDL oxidation proceeds only via type C kinetics. The Cu2+-dependence of the oxidation kinetics suggests that LDL contains two different Cu2+ biding sites. Cu2+ at the low-affinity binding sites, with half-saturation at 5-50 Cu2+/LDL, initiates and accelerates the 2nd propagation by decomposing lipid hydroperoxides. Cu2+ bound to the high-affinity binding sites, with half-saturation at 0.3-2.0 Cu2+/LDL, is responsible for the 1st propagation. Arguments in favor and against this propagation being due to tocopherol mediated peroxidation (TMP) are discussed. If the lag-time concept is extended to the conjugated diene curves seen for combined oxidation profiles, then a true inhibition phase does not apply to this time interval, but instead represents the time elapsed before the onset of the 2nd propagation phase.\n\nAbuja, Peter Michael\n\n\n"
},
{
"text": "\n172093\nQuantitative analysis of manual annotation of clinical text samples.\n\nMiñarro-Giménez, JA\n\nCornet, R\n\nJaulent, MC\n\nDewenter, H\n\nThun, S\n\nGøeg, KR\n\nKarlsson, D\n\nSchulz, S\n\nBeiträge in Fachzeitschriften\nISI:000455662000005\n30654902.0\n10.1016/j.ijmedinf.2018.12.011\nNone\nSemantic interoperability of eHealth services within and across countries has been the main topic in several research projects. It is a key consideration for the European Commission to overcome the complexity of making different health information systems work together. This paper describes a study within the EU-funded project ASSESS CT, which focuses on assessing the potential of SNOMED CT as core reference terminology for semantic interoperability at European level.\n This paper presents a quantitative analysis of the results obtained in ASSESS CT to determine the fitness of SNOMED CT for semantic interoperability.\n The quantitative analysis consists of concept coverage, term coverage and inter-annotator agreement analysis of the annotation experiments related to six European languages (English, Swedish, French, Dutch, German and Finnish) and three scenarios: (i) ADOPT, where only SNOMED CT was used by the annotators; (ii) ALTERNATIVE, where a fixed set of terminologies from UMLS, excluding SNOMED CT, was used; and (iii) ABSTAIN, where any terminologies available in the current national infrastructure of the annotators' country were used. For each language and each scenario, we configured the different terminology settings of the annotation experiments.\n There was a positive correlation between the number of concepts in each terminology setting and their concept and term coverage values. Inter-annotator agreement is low, irrespective of the terminology setting.\n No significant differences were found between the analyses for the three scenarios, but availability of SNOMED CT for the assessed language is associated with increased concept coverage. Terminology setting size and concept and term coverage correlate positively up to a limit where more concepts do not significantly impact the coverage values. The results did not confirm the hypothesis of an inverse correlation between concept coverage and IAA due to a lower amount of choices available. The overall low IAA results pose a challenge for interoperability and indicate the need for further research to assess whether consistent terminology implementation is possible across Europe, e.g., improving term coverage by adding localized versions of the selected terminologies, analysing causes of low inter-annotator agreement, and improving tooling and guidance for annotators. The much lower term coverage for the Swedish version of SNOMED CT compared to English together with the similarly high concept coverage obtained with English and Swedish SNOMED CT reflects its relevance as a hub to connect user interface terminologies and serving a variety of user needs.\n Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.\n\nSchulz, Stefan\n\n\n"
},
{
"text": "\n177342\n2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus.\n\nAringer, M\n\nCostenbader, K\n\nDaikh, D\n\nBrinks, R\n\nMosca, M\n\nRamsey-Goldman, R\n\nSmolen, JS\n\nWofsy, D\n\nBoumpas, DT\n\nKamen, DL\n\nJayne, D\n\nCervera, R\n\nCostedoat-Chalumeau, N\n\nDiamond, B\n\nGladman, DD\n\nHahn, B\n\nHiepe, F\n\nJacobsen, S\n\nKhanna, D\n\nLerstrøm, K\n\nMassarotti, E\n\nMcCune, J\n\nRuiz-Irastorza, G\n\nSanchez-Guerrero, J\n\nSchneider, M\n\nUrowitz, M\n\nBertsias, G\n\nHoyer, BF\n\nLeuchten, N\n\nTani, C\n\nTedeschi, SK\n\nTouma, Z\n\nSchmajuk, G\n\nAnic, B\n\nAssan, F\n\nChan, TM\n\nClarke, AE\n\nCrow, MK\n\nCzirják, L\n\nDoria, A\n\nGraninger, W\n\nHalda-Kiss, B\n\nHasni, S\n\nIzmirly, PM\n\nJung, M\n\nKumánovics, G\n\nMariette, X\n\nPadjen, I\n\nPego-Reigosa, JM\n\nRomero-Diaz, J\n\nRúa-Figueroa Fernández, Í\n\nSeror, R\n\nStummvoll, GH\n\nTanaka, Y\n\nTektonidou, MG\n\nVasconcelos, C\n\nVital, EM\n\nWallace, DJ\n\nYavuz, S\n\nMeroni, PL\n\nFritzler, MJ\n\nNaden, R\n\nDörner, T\n\nJohnson, SR\n\nBeiträge in Fachzeitschriften\nISI:000485946700016\n31383717.0\n10.1136/annrheumdis-2018-214819\nNone\nTo develop new classification criteria for systemic lupus erythematosus (SLE) jointly supported by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR).\n This international initiative had four phases. (1) Evaluation of antinuclear antibody (ANA) as an entry criterion through systematic review and meta-regression of the literature and criteria generation through an international Delphi exercise, an early patient cohort and a patient survey. (2) Criteria reduction by Delphi and nominal group technique exercises. (3) Criteria definition and weighting based on criterion performance and on results of a multi-criteria decision analysis. (4) Refinement of weights and threshold scores in a new derivation cohort of 1001 subjects and validation compared with previous criteria in a new validation cohort of 1270 subjects.\n The 2019 EULAR/ACR classification criteria for SLE include positive ANA at least once as obligatory entry criterion; followed by additive weighted criteria grouped in seven clinical (constitutional, haematological, neuropsychiatric, mucocutaneous, serosal, musculoskeletal, renal) and three immunological (antiphospholipid antibodies, complement proteins, SLE-specific antibodies) domains, and weighted from 2 to 10. Patients accumulating ≥10 points are classified. In the validation cohort, the new criteria had a sensitivity of 96.1% and specificity of 93.4%, compared with 82.8% sensitivity and 93.4% specificity of the ACR 1997 and 96.7% sensitivity and 83.7% specificity of the Systemic Lupus International Collaborating Clinics 2012 criteria.\n These new classification criteria were developed using rigorous methodology with multidisciplinary and international input, and have excellent sensitivity and specificity. Use of ANA entry criterion, hierarchically clustered and weighted criteria reflect current thinking about SLE and provide an improved foundation for SLE research.\n © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.\n\nGraninger, Winfried\n\n\n"
},
{
"text": "\n64551\nFalls explain between-center differences in the incidence of limb fracture across Europe.\n\nRoy, DK\n\nPye, SR\n\nLunt, M\n\nO'Neill, TW\n\nTodd, C\n\nRaspe, H\n\nReeve, J\n\nSilman, AJ\n\nWeber, K\n\nDequeker, J\n\nJajic, I\n\nStepan, J\n\nDelmas, PD\n\nMarchand, F\n\nReisinger, W\n\nBanzer, D\n\nFelsenberg, D\n\nJanott, J\n\nKragl, G\n\nSchiedt-Nave, C\n\nFelsch, B\n\nRaspe, H\n\nMatthis, C\n\nLyritis, G\n\nPoor, G\n\nGennari, C\n\nPols, HA\n\nFalch, JA\n\nMiazgowski, T\n\nHoszowski, K\n\nLorenc, R\n\nBruges Armas, J\n\nLopes Vaz, A\n\nBenevolenskaya, LI\n\nMasaryk, P\n\nRapado, A\n\nCannata, JB\n\nNaves-Diaz, M\n\nJohnell, O\n\nDilsen, G\n\nReid, DM\n\nBhalla, AK\n\nTodd, C\n\nReeve, J\n\nFinn, JD\n\nIsmail, A\n\nLunt, M\n\nO'Neill, TW\n\nPye, SR\n\nRoy, DK\n\nKanis, JA\n\nCooper, C\n\nWoolf, AD\n\nEuropean Prospective Osteoporosis Study (EPOS) Group\n\nBeiträge in Fachzeitschriften\nISI:000180111300012\n12531567.0\n10.1016/S8756-3282(02)00909-2\nNone\nThere is important geographic variation in the occurrence of the major osteoporotic fractures across Europe. The aim of this study was to determine whether between-center variation in limb fracture rates across Europe could be explained by variation in the incidence of falls. Men and women, aged 50-79 years, were recruited from population-based registers in 30 European centers. Subjects were followed by postal questionnaire to ascertain the occurrence of incident fractures, and were also asked about the occurrence and number of recent falls. Self-reported fractures were confirmed, where possible, by review of the radiographs, medical record, or subject interview. The age- and gender-adjusted incidence of falls was calculated by center using Poisson regression. Poisson regression was also used to assess the extent to which between-center differences in the incidence of limb fractures could be explained by differences in the age- and gender-adjusted incidence of falls at those centers. In all, 6302 men (mean age 63.9 years) and 6761 women (mean age 63.1 years) completed at least one questionnaire concerning fractures and falls. During a median follow-up time of 3 years, 3647 falls were reported by men and 4783 by women. After adjusting for age and gender, there was evidence of significant between-center differences in the occurrence of falls. There was also between-center variation in the occurrence of upper limb, lower limb, and distal forearm fractures. Variation in the age- and gender-adjusted center-specific fall rates explained 24%, 14%, and 6% of the between-center variation in incidence of distal forearm and upper and lower limb fractures, respectively. Given the constraints inherent in such an analysis, in men and women aged 50-79 years, variation in fall rates could explain a significant proportion of the between-center variation in the incidence of limb fracture across Europe.\n\nWeber, Kurt\n\n\n"
},
{
"text": "\n127131\nGenome-wide association study for circulating levels of PAI-1 provides novel insights into its regulation.\n\nHuang, J\n\nSabater-Lleal, M\n\nAsselbergs, FW\n\nTregouet, D\n\nShin, SY\n\nDing, J\n\nBaumert, J\n\nOudot-Mellakh, T\n\nFolkersen, L\n\nJohnson, AD\n\nSmith, NL\n\nWilliams, SM\n\nIkram, MA\n\nKleber, ME\n\nBecker, DM\n\nTruong, V\n\nMychaleckyj, JC\n\nTang, W\n\nYang, Q\n\nSennblad, B\n\nMoore, JH\n\nWilliams, FM\n\nDehghan, A\n\nSilbernagel, G\n\nSchrijvers, EM\n\nSmith, S\n\nKarakas, M\n\nTofler, GH\n\nSilveira, A\n\nNavis, GJ\n\nLohman, K\n\nChen, MH\n\nPeters, A\n\nGoel, A\n\nHopewell, JC\n\nChambers, JC\n\nSaleheen, D\n\nLundmark, P\n\nPsaty, BM\n\nStrawbridge, RJ\n\nBoehm, BO\n\nCarter, AM\n\nMeisinger, C\n\nPeden, JF\n\nBis, JC\n\nMcKnight, B\n\nÖhrvik, J\n\nTaylor, K\n\nFranzosi, MG\n\nSeedorf, U\n\nCollins, R\n\nFranco-Cereceda, A\n\nSyvänen, AC\n\nGoodall, AH\n\nYanek, LR\n\nCushman, M\n\nMüller-Nurasyid, M\n\nFolsom, AR\n\nBasu, S\n\nMatijevic, N\n\nvan Gilst, WH\n\nKooner, JS\n\nHofman, A\n\nDanesh, J\n\nClarke, R\n\nMeigs, JB\n\nDIAGRAM Consortium\n\nKathiresan, S\n\nReilly, MP\n\nCARDIoGRAM Consortium\n\nKlopp, N\n\nHarris, TB\n\nWinkelmann, BR\n\nGrant, PJ\n\nHillege, HL\n\nWatkins, H\n\nC4D Consortium\n\nSpector, TD\n\nBecker, LC\n\nTracy, RP\n\nMärz, W\n\nUitterlinden, AG\n\nEriksson, P\n\nCambien, F\n\nCARDIOGENICS Consortium\n\nMorange, PE\n\nKoenig, W\n\nSoranzo, N\n\nvan der Harst, P\n\nLiu, Y\n\nO'Donnell, CJ\n\nHamsten, A\n\nBeiträge in Fachzeitschriften\nISI:000313115300031\n22990020.0\n10.1182/blood-2012-06-436188\nPMC3520624\nWe conducted a genome-wide association study to identify novel associations between genetic variants and circulating plasminogen activator inhibitor-1 (PAI-1) concentration, and examined functional implications of variants and genes that were discovered. A discovery meta-analysis was performed in 19 599 subjects, followed by replication analysis of genome-wide significant (P < 5 × 10(-8)) single nucleotide polymorphisms (SNPs) in 10 796 independent samples. We further examined associations with type 2 diabetes and coronary artery disease, assessed the functional significance of the SNPs for gene expression in human tissues, and conducted RNA-silencing experiments for one novel association. We confirmed the association of the 4G/5G proxy SNP rs2227631 in the promoter region of SERPINE1 (7q22.1) and discovered genome-wide significant associations at 3 additional loci: chromosome 7q22.1 close to SERPINE1 (rs6976053, discovery P = 3.4 × 10(-10)); chromosome 11p15.2 within ARNTL (rs6486122, discovery P = 3.0 × 10(-8)); and chromosome 3p25.2 within PPARG (rs11128603, discovery P = 2.9 × 10(-8)). Replication was achieved for the 7q22.1 and 11p15.2 loci. There was nominal association with type 2 diabetes and coronary artery disease at ARNTL (P < .05). Functional studies identified MUC3 as a candidate gene for the second association signal on 7q22.1. In summary, SNPs in SERPINE1 and ARNTL and an SNP associated with the expression of MUC3 were robustly associated with circulating levels of PAI-1.\n\nMärz, Winfried\n\nSilbernagel, Günther\n\n\n"
},
{
"text": "\n140808\nBest oxygenation index on day 1: a reliable marker for outcome and survival in infants with congenital diaphragmatic hernia.\n\nRuttenstock, E\n\nWright, N\n\nBarrena, S\n\nKrickhahn, A\n\nCastellani, C\n\nDesai, AP\n\nRintala, R\n\nTovar, J\n\nTill, H\n\nZani, A\n\nSaxena, A\n\nDavenport, M\n\nBeiträge in Fachzeitschriften\nISI:000348524500004\n25560249.0\n10.1055/s-0034-1393960\nNone\nSevere lung hypoplasia and persistent pulmonary hypertension are the main determining factors of survival in infants with congenital diaphragmatic hernia (CDH). The oxygenation index (ratio of delivered oxygen and its arterial level) closely reflects lung function. Single-institution studies have reported that best oxygenation index on day 1 of life (BOI-d1) is the most reliable postnatal predictor of survival in CDH. The aim of this study was to evaluate the predictive value of BOI-d1 in four disparate high volume centers in Europe.\n A retrospective, multicenter study of infants with CDH born between 2000 and 2009 in four European tertiary institutions was conducted. Ethical approval was obtained from institutional review boards. Centers no. 1 and. 4 offered extracorporeal membrane oxygenation (ECMO), whereas center no. 3 offered fetal endoluminal tracheal occlusion (FETO) in fetuses defined as poor prognosis (lung-to-head ratio [LHR]≤ 1.0 and "liver-up" position). Prenatal LHR and perinatal variables, including gestational age, birth weight, defect side, liver position, BOI-d1, and patch requirement, were analyzed. Receiver operating characteristic curves were used to determine cutoff values for continuous variables. Comparison was made between survivors and nonsurvivors using univariate analysis and logistic regression analysis, p<0.05 was considered significant.\n A total of 235 infants (center no. 1, n=29; no. 2, n=64; no. 3, n=113; and no. 4, n=29) were included. One infant required (2%) ECMO and 66 (28%) had FETO. LHR was available in 83 patients (36%). Overall survival (discharge from hospital) and 28-day survival were 67.6% (n=159) and 72.3% (n=170), respectively. Univariate analysis showed that significant categorical predictors of 28-day survival were liver-down position (p<0.0001), LHR >1 (p=0.003), and primary repair (p=0.02) but not defect side (p=0.83). Area under the receiver operating characteristic (AUROC) curve for continuous variables; gestational age, birth weight, and BOI-d1 were 0.70, 0.68, and 0.88, respectively. AUROC for BOI-d1 (28-day survival) was 0.91 and had sensitivities (73 and 91%) and specificities (92 and 80%) for cutoffs of 40 and 82, respectively.\n This multicenter study showed, that except from the defect side, all the prenatal variables studied have predictive value but the most useful is BOI-d1. This is simple to calculate and represents an excellent marker for lung function and a reliable early postnatal predictor of survival.\n Georg Thieme Verlag KG Stuttgart · New York.\n\nCastellani, Christoph\n\nTill, Holger\n\n\n"
},
{
"text": "\n157620\nECCO Essential Requirements for Quality Cancer Care: Soft Tissue Sarcoma in Adults and Bone Sarcoma. A critical review.\n\nAndritsch, E\n\nBeishon, M\n\nBielack, S\n\nBonvalot, S\n\nCasali, P\n\nCrul, M\n\nDelgado Bolton, R\n\nDonati, DM\n\nDouis, H\n\nHaas, R\n\nHogendoorn, P\n\nKozhaeva, O\n\nLavender, V\n\nLovey, J\n\nNegrouk, A\n\nPereira, P\n\nRoca, P\n\nde Lempdes, GR\n\nSaarto, T\n\nvan Berck, B\n\nVassal, G\n\nWartenberg, M\n\nYared, W\n\nCosta, A\n\nNaredi, P\n\nBeiträge in Fachzeitschriften\nISI:000393533500010\n28109409.0\n10.1016/j.critrevonc.2016.12.002\nNone\nECCO essential requirements for quality cancer care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to patients who have a specific tumour type. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe. Sarcoma: essential requirements for quality care • Sarcomas - which can be classified into soft tissue and bone sarcomas - are rare, but all rare cancers make up more than 20% of cancers in Europe, and there are substantial inequalities in access to high-quality care. Sarcomas, of which there are many subtypes, comprise a particularly complex and demanding challenge for healthcare systems and providers. This paper presents essential requirements for quality cancer care of soft tissue sarcomas in adults and bone sarcomas. • High-quality care must only be carried out in specialised sarcoma centres (including paediatric cancer centres) which have both a core multidisciplinary team and an extended team of allied professionals, and which are subject to quality and audit procedures. Access to such units is far from universal in all European countries. • It is essential that, to meet European aspirations for high-quality comprehensive cancer control, healthcare organisations implement the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis and follow-up, to treatment, to improve survival and quality of life for patients.\n Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality service for soft tissue sarcomas in adults and bone sarcomas. The ECCO expert group is aware that it is not possible to propose a 'one size fits all' system for all countries, but urges that access to multidisciplinary teams is guaranteed to all patients with sarcoma.\n Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.\n\nAndritsch, Elisabeth\n\n\n"
},
{
"text": "\n4585\nThe effect of sample treatment on separation profiles of tear fluid proteins: qualitative and semi-quantitative protein determination by an automated analysis system.\n\nSchmut, O\n\nHorwath-Winter, J\n\nZenker, A\n\nTrummer, G\n\nBeiträge in Fachzeitschriften\nISI:000179867400004\n12486511.0\n10.1007/s00417-002-0537-0\nNone\nPURPOSE: Qualitative and quantitative determination of tear fluid components is of increasing interest in ophthalmology. Until now, for diagnosis and course control of some diseases of the anterior parts of the eye, different methods for tear fluid protein analysis are available. Results can be obtained by polyacrylamide gel electrophoresis (PAGE), immunochemistry, and high-performance liquid chromatography (HPLC). A new method for protein separation, identification and semi-quantitative determination on a chip-based micro-fluidic technique is used for the first time to investigate tear fluids. METHODS: Normal human reflex tears were obtained by stimulation with China mint oil and collected using glass capillary tubes. A lab-on-a-chip technology (developed by Agilent Technologies, Waldbronn, Germany, in co-operation with Caliper Technologies, Mountain View, California, USA) was used for separation and semi-quantitative determination of tear proteins. Tear fluid was separated on the Agilent 2100 Bioanalyzer in combination with the Protein 200 LabChip kit and the dedicated protein assay software. Time and temperature of the incubation with sample buffer were varied, and the influence of these parameters on protein separation profiles was studied. Tear proteins were also analysed by PAGE, and the results obtained by both methods were compared. RESULTS: The different proteins of tear fluid can be separated by the Agilent 2100 Bioanalyzer method in very short time. By this method, the molecular weight as well as the concentration of proteins can be determined. Data are automatically stored in digital format and can be retrieved and shared. Results of this technology were comparable with the protein pattern obtained by PAGE. It was confirmed by both methods that, depending on incubation time of tear fluid with sample buffer and on temperature, different protein pattern can be obtained from the tears of one specimen. CONCLUSION: Tear proteins - in contrast to serum or aqueous humour proteins - are very sensitive to changes in sample buffer temperature as well as incubation time with buffer. To obtain comparable results for tear fluid proteins, the sample buffer applied and the incubation time and temperature must be observed carefully. This can be demonstrated by both the new Agilent 2100 Bioanalyzer method and PAGE. These results are of importance when comparing tear fluid protein pattern for the diagnosis and course control of dry-eye syndrome and of other diseases of the anterior part of the eye.\n\nHorwath-Winter, Jutta\n\n\n"
},
{
"text": "\n142866\nComparison of posterior internal anal sphincter myectomy and intrasphincteric botulinum toxin injection for treatment of internal anal sphincter achalasia: a meta-analysis.\n\nFriedmacher, F\n\nPuri, P\n\nBeiträge in Fachzeitschriften\nISI:000307521600002\n22806601.0\n10.1007/s00383-012-3123-5\nNone\nInternal anal sphincter (IAS) achalasia is a clinical condition with presentation similar to Hirschsprung's disease, but with the presence of ganglion cells on rectal suction biopsy (RSB). The diagnosis is made by anorectal manometry (ARM), which demonstrates the absence of the rectosphincteric reflex on rectal balloon inflation. The recommended treatment of choice is posterior IAS myectomy. Recently, intrasphincteric botulinum toxin (Botox) injection has been effectively used for treatment of IAS achalasia. The aim of this meta-analysis was to compare the efficacy of posterior IAS myectomy with intrasphincteric Botox injection for treatment of IAS achalasia.\n A systematic literature search for relevant articles was conducted using the following databases: MEDLINE( ® ), EMBASE(®), ISI Web of Science(SM) and the Cochrane Library. A meta-analysis was performed with the studies where IAS achalasia was diagnosed based on the results of ARM and RSB. Odds ratio (OR) with 95 % confidence intervals were calculated.\n Sixteen prospective and retrospective studies, published from 1973 to 2009, were identified. A total of 395 patients with IAS achalasia were included in this meta-analysis. Fifty-eight percent of patients underwent IAS myectomy and 42 % Botox injection. Regular bowel movements were significantly more frequent after IAS myectomy (OR 0.53, [95 % CI 0.29-0.99]; p = 0.04). There was no significant difference in continued use of laxatives or rectal enemas (OR 0.92, [95 % CI 0.34-2.53], p = 0.89) and in overall complication rates between both procedures (OR 0.68, [95 % CI 0.38-1.21]; p = 0.19). Looking at specific complications, the rate of transient faecal incontinence was significantly higher after Botox injection (OR 0.07, [95 % CI 0.01-0.54]; p < 0.01). Constipation and soiling were not significantly different between both procedures (OR 0.66, [95 % CI 0.30-1.48]; p = 0.31 and OR 0.24, [95 % CI 0.03-2.07]; p = 0.25). The rate of non-response was significantly higher after Botox injection (OR 0.52, [95 % CI 0.27-0.99]; p = 0.04). Subsequent surgical treatment was significantly more frequent after Botox injection (OR 0.18, [95 % CI 0.07-0.44]; p < 0.0001). Short- and long-term improvements were significantly more frequent after IAS myectomy (OR 0.56, [95 % CI 0.32-0.97]; p = 0.04 and OR 0.25, [95 % CI 0.15-0.41]; p < 0.0001).\n This meta-analysis indicates that in patients with IAS achalasia, posterior IAS myectomy appears to be a more effective treatment option compared to intrasphincteric Botox injection. After Botox injection, the rate of transient faecal incontinence, non-response and subsequent surgical procedures were significantly higher compared to IAS myectomy.\n\n\n"
}
]
}