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"text": "\n129566\nA phase II randomized clinical trial on cerebral near-infrared spectroscopy plus a treatment guideline versus treatment as usual for extremely preterm infants during the first three days of life (SafeBoosC): study protocol for a randomized controlled trial.\n\nHyttel-Sorensen, S\n\nAustin, T\n\nvan Bel, F\n\nBenders, M\n\nClaris, O\n\nDempsey, E\n\nFumagalli, M\n\nGreisen, G\n\nGrevstad, B\n\nHagmann, C\n\nHellström-Westas, L\n\nLemmers, P\n\nLindschou, J\n\nNaulaers, G\n\nvan Oeveren, W\n\nPellicer, A\n\nPichler, G\n\nRoll, C\n\nSkoog, M\n\nWinkel, P\n\nWolf, M\n\nGluud, C\n\nBeiträge in Fachzeitschriften\nISI:000319189600001\n23782447.0\n10.1186/1745-6215-14-120\nPMC3680969\nEvery year in Europe about 25, 00 infants are born extremely preterm. These infants have a 20% mortality rate, and 25% of survivors have severe long-term cerebral impairment. Preventative measures are key to reduce mortality and morbidity in an extremely preterm population. The primary objective of the SafeBoosC phase II trial is to examine if it is possible to stabilize the cerebral oxygenation of extremely preterm infants during the first 72 hours of life through the application of cerebral near-infrared spectroscopy (NIRS) oximetry and implementation of an clinical treatment guideline based on intervention thresholds of cerebral regional tissue saturation rStO2.\n SafeBoosC is a randomized, blinded, multinational, phase II clinical trial. The inclusion criteria are: neonates born more than 12 weeks preterm; decision to conduct full life support; parental informed consent; and possibility to place the cerebral NIRS oximeter within 3 hours after birth. The infants will be randomized into one of two groups. Both groups will have a cerebral oximeter monitoring device placed within three hours of birth. In the experimental group, the cerebral oxygenation reading will supplement the standard treatment using a predefined treatment guideline. In the control group, the cerebral oxygenation reading will not be visible and the infant will be treated according to the local standards. The primary outcome is the multiplication of the duration and magnitude of rStO2 values outside the target ranges of 55% to 85%, that is, the 'burden of hypoxia and hyperoxia' expressed in '%hours'. To detect a 50% difference between the experimental and control group in %hours, 166 infants in total must be randomized. Secondary outcomes are mortality at term date, cerebral ultrasound score, and interburst intervals on an amplitude-integrated electroencephalogram at 64 hours of life and explorative outcomes include neurodevelopmental outcome at 2 years corrected age, magnetic resonance imaging at term, blood biomarkers at 6 and 64 hours after birth, and adverse events.\n Cerebral oximetry guided interventions have the potential to improve neurodevelopmental outcome in extremely preterm infants. It is a logical first step to test if it is possible to reduce the burden of hypoxia and hyperoxia.\n ClinicalTrial.gov, NCT01590316.\n\nPichler, Gerhard\n\n\n"
},
{
"text": "\n175789\nAssociation of Rare Coding Mutations With Alzheimer Disease and Other Dementias Among Adults of European Ancestry.\n\nPatel, D\n\nMez, J\n\nVardarajan, BN\n\nStaley, L\n\nChung, J\n\nZhang, X\n\nFarrell, JJ\n\nRynkiewicz, MJ\n\nCannon-Albright, LA\n\nTeerlink, CC\n\nStevens, J\n\nCorcoran, C\n\nGonzalez Murcia, JD\n\nLopez, OL\n\nMayeux, R\n\nHaines, JL\n\nPericak-Vance, MA\n\nSchellenberg, G\n\nKauwe, JSK\n\nLunetta, KL\n\nFarrer, LA\n\nAlzheimer’s Disease Sequencing Project\n\nBeiträge in Fachzeitschriften\nISI:000465424000082\n30924900.0\n10.1001/jamanetworkopen.2019.1350\nPMC6450321\nSome of the unexplained heritability of Alzheimer disease (AD) may be due to rare variants whose effects are not captured in genome-wide association studies because very large samples are needed to observe statistically significant associations.\n To identify genetic variants associated with AD risk using a nonstatistical approach.\n Genetic association study in which rare variants were identified by whole-exome sequencing in unrelated individuals of European ancestry from the Alzheimer's Disease Sequencing Project (ADSP). Data were analyzed between March 2017 and September 2018.\n Minor alleles genome-wide and in 95 genes previously associated with AD, AD-related traits, or other dementias were tabulated and filtered for predicted functional impact and occurrence in participants with AD but not controls. Support for several findings was sought in a whole-exome sequencing data set comprising 19 affected relative pairs from Utah high-risk pedigrees and whole-genome sequencing data sets from the ADSP and Alzheimer's Disease Neuroimaging Initiative.\n Among 5617 participants with AD (3202 [57.0%] women; mean [SD] age, 76.4 [9.3] years) and 4594 controls (2719 [59.0%] women; mean [SD] age, 86.5 [4.5] years), a total of 24 variants with moderate or high functional impact from 19 genes were observed in 10 or more participants with AD but not in controls. These variants included a missense mutation (rs149307620 [p.A284T], n = 10) in NOTCH3, a gene in which coding mutations are associated with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), that was also identified in 1 participant with AD and 1 participant with mild cognitive impairment in the whole genome sequencing data sets. Four participants with AD carried the TREM2 rs104894002 (p.Q33X) high-impact mutation that, in homozygous form, causes Nasu-Hakola disease, a rare disorder characterized by early-onset dementia and multifocal bone cysts, suggesting an intermediate inheritance model for the mutation. Compared with controls, participants with AD had a significantly higher burden of deleterious rare coding variants in dementia-associated genes (2314 vs 3354 cumulative variants, respectively; P = .006).\n Different mutations in the same gene or variable dose of a mutation may be associated with result in distinct dementias. These findings suggest that minor differences in the structure or amount of protein may be associated with in different clinical outcomes. Understanding these genotype-phenotype associations may provide further insight into the pathogenic nature of the mutations, as well as offer clues for developing new therapeutic targets.\n\nSchmidt, Helena\n\nSchmidt, Reinhold\n\n\n"
},
{
"text": "\n184000\nPerformance of the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in early disease, across sexes and ethnicities.\n\nJohnson, SR\n\nBrinks, R\n\nCostenbader, KH\n\nDaikh, D\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, WB\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, 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\nAringer, M\n\nBeiträge in Fachzeitschriften\nISI:000573924600031\n32816709.0\n10.1136/annrheumdis-2020-217162\nNone\nThe European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 Classification Criteria for systemic lupus erythematosus (SLE) have been validated with high sensitivity and specificity. We evaluated the performance of the new criteria with regard to disease duration, sex and race/ethnicity, and compared its performance against the Systemic Lupus International Collaborating Clinics (SLICC) 2012 and ACR 1982/1997 criteria.\n Twenty-one SLE centres from 16 countries submitted SLE cases and mimicking controls to form the validation cohort. The sensitivity and specificity of the EULAR/ACR 2019, SLICC 2012 and ACR 1982/1997 criteria were evaluated.\n The cohort consisted of female (n=1098), male (n=172), Asian (n=118), black (n=68), Hispanic (n=124) and white (n=941) patients; with an SLE duration of 1 to <3 years (n=196) and ≥5 years (n=879). Among patients with 1 to <3 years disease duration, the EULAR/ACR criteria had better sensitivity than the ACR criteria (97% vs 81%). The EULAR/ACR criteria performed well in men (sensitivity 93%, specificity 96%) and women (sensitivity 97%, specificity 94%). Among women, the EULAR/ACR criteria had better sensitivity than the ACR criteria (97% vs 83%) and better specificity than the SLICC criteria (94% vs 82%). Among white patients, the EULAR/ACR criteria had better sensitivity than the ACR criteria (95% vs 83%) and better specificity than the SLICC criteria (94% vs 83%). The EULAR/ACR criteria performed well among black patients (sensitivity of 98%, specificity 100%), and had better sensitivity than the ACR criteria among Hispanic patients (100% vs 86%) and Asian patients (97% vs 77%).\n The EULAR/ACR 2019 criteria perform well among patients with early disease, men, women, white, black, Hispanic and Asian patients. These criteria have superior sensitivity than the ACR criteria and/or superior specificity than the SLICC criteria across many subgroups.\n © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.\n\nGraninger, Winfried\n\n\n"
},
{
"text": "\n2079\nPrimary clinical response and long-term follow-up of solar keratoses treated with topically applied 5-aminolevulinic acid and irradiation by different wave bands of light.\n\nFink-Puches, R\n\nHofer, A\n\nSmolle, J\n\nKerl, H\n\nWolf, P\n\nBeiträge in Fachzeitschriften\nISI:000071231100020\n9440322.0\n10.1016/S1011-1344(97)00096-1\nNone\nPhotodynamic therapy with 5-aminolevulinic acid (ALA-PDT) is based on photosensitization by endogenous synthesis of protoporphyrin IX and its transient accumulation especially in malignant epithelially derived tissues. Recent studies have indicated that ALA-PDT is effective for the treatment of solar keratoses (SK), but there has been a lack of long-term clinical follow-up. The goal of the present study was to investigate the immediate and long-term effect of ALA-PDT on SK. Twenty-eight patients with a total of 251 SK were enrolled in the study. Standard treatment involved the topical application of 20% ALA, under occlusive and light-shielding dressing for 4 hours before exposure to UVA and/or different wave bands or wave band combinations of polychromatic visible light (full-spectrum visible light, and/or different wave bands of filtered visible light > 515, > 530, > 570, or > 610 nm) in one or two treatment sessions. The primary complete response rate of SK to ALA-PDT was 64% after one treatment, but 85% when the responses to a second treatment were included. Taken all treatments together, the complete response rate for lesions on face, scalp and neck was 93% for full-spectrum visible light, 96% for the combination of full-spectrum visible light and filtered light, 91% for different wave bands of filtered visible light, and 100% for the combination of long wave UVA and full-spectrum visible light, respectively. The complete response rate for lesions on forearms and hands was 51% for full-spectrum visible light and 33% for the combination of full-spectrum visible light and filtered light. The greater response rate for SK on the face, scalp, and neck was associated with a higher surface fluorescence and immediate response rate after ALA photosensitization at these sites (chi 2; p = 0.0001). However, due to the treatment protocol the mean light dose applied to lesions on the face, scalp and neck (50 J cm-2) was substantially higher than that for lesions on forearms and hands (35 J cm-2). In the long term follow-up of SK on face scalp and neck, the projected disease-free rate at 36 months after therapy was 71% for lesions treated with full-spectrum visible light versus 23% for lesions treated with different wave bands of filtered light (Log rank-Mantel Cox; p = 0.0001). These results indicate that treatment with full-spectrum visible light at higher light doses may be the most effective and promising form of light exposure in ALA-PDT of SK.\n\nFink-Puches, Regina\n\nHofer, Angelika\n\nKerl, Helmut\n\nSmolle, Josef\n\nWolf, Peter\n\n\n"
},
{
"text": "\n178930\nBlood metabolomics uncovers inflammation-associated mitochondrial dysfunction as a potential mechanism underlying ACLF.\n\nMoreau, R\n\nClària, J\n\nAguilar, F\n\nFenaille, F\n\nLozano, JJ\n\nJunot, C\n\nColsch, B\n\nCaraceni, P\n\nTrebicka, J\n\nPavesi, M\n\nAlessandria, C\n\nNevens, F\n\nSaliba, F\n\nWelzel, TM\n\nAlbillos, A\n\nGustot, T\n\nFernández, J\n\nMoreno, C\n\nBaldassarre, M\n\nZaccherini, G\n\nPiano, S\n\nMontagnese, S\n\nVargas, V\n\nGenescà, J\n\nSolà, E\n\nBernal, W\n\nButin, N\n\nHautbergue, T\n\nCholet, S\n\nCastelli, F\n\nJansen, C\n\nSteib, C\n\nCampion, D\n\nMookerjee, R\n\nRodríguez-Gandía, M\n\nSoriano, G\n\nDurand, F\n\nBenten, D\n\nBañares, R\n\nStauber, RE\n\nGronbaek, H\n\nCoenraad, MJ\n\nGinès, P\n\nGerbes, A\n\nJalan, R\n\nBernardi, M\n\nArroyo, V\n\nAngeli, P\n\nCANONIC Study Investigators of the EASL Clif Consortium\n\nGrifols Chair\n\nEuropean Foundation for the Study of Chronic Liver Failure (EF Clif)\n\nBeiträge in Fachzeitschriften\nISI:000520050900013\n31778751.0\n10.1016/j.jhep.2019.11.009\nNone\nAcute-on-chronic liver failure (ACLF), which develops in patients with cirrhosis, is characterized by intense systemic inflammation and organ failure(s). Because systemic inflammation is energetically expensive, its metabolic costs may result in organ dysfunction/failure. Therefore, we aimed to analyze the blood metabolome in patients with cirrhosis, with and without ACLF.\n We performed untargeted metabolomics using liquid chromatography coupled to high-resolution mass spectrometry in serum from 650 patients with AD (acute decompensation of cirrhosis, without ACLF), 181 with ACLF, 43 with compensated cirrhosis, and 29 healthy individuals.\n Of the 137 annotated metabolites identified, 100 were increased in patients with ACLF of any grade, relative to those with AD, and 38 comprised a distinctive blood metabolite fingerprint for ACLF. Among patients with ACLF, the intensity of the fingerprint increased across ACLF grades, and was similar in patients with kidney failure and in those without, indicating that the fingerprint reflected not only decreased kidney excretion but also altered cell metabolism. The higher the ACLF-associated fingerprint intensity, the higher the plasma levels of inflammatory markers, tumor necrosis factor α, soluble CD206, and soluble CD163. ACLF was characterized by intense proteolysis and lipolysis; amino acid catabolism; extra-mitochondrial glucose metabolism through glycolysis, pentose phosphate, and D-glucuronate pathways; depressed mitochondrial ATP-producing fatty acid β-oxidation; and extra-mitochondrial amino acid metabolism giving rise to metabotoxins.\n In ACLF, intense systemic inflammation is associated with blood metabolite accumulation and profound alterations in major metabolic pathways, in particular inhibition of mitochondrial energy production, which may contribute to the development of organ failures.\n Acute-on-chronic liver failure (ACLF), which develops in patients with cirrhosis, is characterized by intense systemic inflammation and organ failure(s). Because systemic inflammation is energetically expensive, its metabolic costs may result in organ dysfunction/failure. We identified a 38-metabolite blood fingerprint specific for ACLF that revealed mitochondrial dysfunction in peripheral organs. This may contribute to organ failures.\n Copyright © 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.\n\nStauber, Rudolf\n\n\n"
},
{
"text": "\n103277\nCongestive heart failure in childhood. An epidemiologic study.\n\nSommers, C\n\nNagel, BH\n\nNeudorf, U\n\nSchmaltz, AA\n\nBeiträge in Fachzeitschriften\nISI:000233424800019\n16333593.0\n10.1007/s00059-005-2596-6\nNone\nBACKGROUND: In contrast to the adult age group epidemiologic studies on congestive heart failure (CHF) in infancy and childhood are lacking. METHODS: Retrospective study of all patients admitted to the University Children's Hospital Essen, Germany, between 1989 and 1998 with the ICD 9 code for congenital and acquired heart diseases, cardiomyopathies, arrhythmias, arterial und pulmonary hypertension, and other cardiovascular anomalies. CHF was defined by the typical symptoms, start and end of CHF by commencement and end of anticongestive therapy (ACE inhibitors and/or diuretics and/or digoxin). Prevalence and incidence of CHF were determined and related to all patients with congenital and acquired heart diseases and to all general pediatric inpatients at the Children's Hospital from 1989 to 1998. Within 10 years 1, 55 children with heart diseases were admitted, 918 boys and 837 girls. 1, 97 children suffered from congenital heart diseases, 167 from rhythm disturbances, 110 from cardiomyopathies and acquired heart diseases, while prematures and patients with systemic or pulmonary hypertension are not furthermore topic of this study. RESULTS: CHF occurred in 587 (33.4%) out of 1, 55 children with all congenital and acquired heart diseases, and in 507 (39.1%) out of 1, 97 children with congenital heart defects (CHD). When postoperative CHF was excluded, CHF occurred in 23.7% of children with CHD. Cumulative incidence of CHF was 334 out of 1, 00 patients with all heart diseases and 233 out of 1, 00 general pediatric inpatients. For patients with CHD the incidence of CHF was 289 out of 1, 00 patients with all heart diseases and 20.1 out of 1, 00 general pediatric inpatients. Prevalence of CHF for children with heart diseases was 279 in 1, 00 and 17.3 in 1, 00 general pediatric inpatients, for children with CHD 261 in 1, 00 and 16.1 in 1, 00 general pediatric inpatients. CHF occurred in 70.6% during the 1st year of life and lasted for a mean of 15 months. Only in patients with cardiomyopathies and acquired heart diseases the incidence in infancy was not so pronounced. In 78% of patients with CHD CHF ends after an operation. Mortality: during the 10-year interval 111 out of 1, 55 patients with heart diseases died, 81 of them for CHF. That gives an overall mortality of 6.3%, 18% following heart surgery or cardiac catheterization, 74% with signs of CHF. In patients with CHD mortality was 6.2%. Out of the 587 children with CHF, 81 (14%) died. 67% of deaths occurred during the 1st year of life, in patients with CHD even in 71%. CONCLUSION: CHF is uncommon in infants and children with congenital or acquired heart disease, but has considerable mortality. As surgical or interventional therapy is well established in nearly all patients with CHD, prognosis is much better compared to adults. A prospective evaluation by a nationwide registry is necessary.\n\n\n"
},
{
"text": "\n175778\nFirst international descriptive and interventional survey for cholesterol and non-cholesterol sterol determination by gas- and liquid-chromatography-Urgent need for harmonisation of analytical methods.\n\nLütjohann, D\n\nBjörkhem, I\n\nFriedrichs, S\n\nKerksiek, A\n\nLövgren-Sandblom, A\n\nGeilenkeuser, WJ\n\nAhrends, R\n\nAndrade, I\n\nAnsorena, D\n\nAstiasarán, I\n\nBaila-Rueda, L\n\nBarriuso, B\n\nBecker, S\n\nBretillon, L\n\nBrowne, RW\n\nCaccia, C\n\nCeglarek, U\n\nCenarro, A\n\nCrick, PJ\n\nFauler, G\n\nGarcia-Llatas, G\n\nGray, R\n\nGriffiths, WJ\n\nGylling, H\n\nHarding, S\n\nHelmschrodt, C\n\nIuliano, L\n\nJanssen, HG\n\nJones, P\n\nKaipiainen, L\n\nKannenberg, F\n\nLagarda, MJ\n\nLeoni, V\n\nLottenberg, AM\n\nMacKay, DS\n\nMatysik, S\n\nMcDonald, J\n\nMenendez-Carreño, M\n\nMyrie, SB\n\nSutti Nunes, V\n\nOstlund, RE\n\nPolisecki, E\n\nRamos, F\n\nRideout, TC\n\nSchaefer, EJ\n\nSchmitz, G\n\nWang, Y\n\nZerbinati, C\n\nDiczfalusy, U\n\nSchött, HF\n\nBeiträge in Fachzeitschriften\nISI:000471087300013\n30940596.0\n10.1016/j.jsbmb.2019.03.025\nPMC6525271\nSerum concentrations of lathosterol, the plant sterols campesterol and sitosterol and the cholesterol metabolite 5α-cholestanol are widely used as surrogate markers of cholesterol synthesis and absorption, respectively. Increasing numbers of laboratories utilize a broad spectrum of well-established and recently developed methods for the determination of cholesterol and non-cholesterol sterols (NCS). In order to evaluate the quality of these measurements and to identify possible sources of analytical errors our group initiated the first international survey for cholesterol and NCS. The cholesterol and NCS survey was structured as a two-part survey which took place in the years 2013 and 2014. The first survey part was designed as descriptive, providing information about the variation of reported results from different laboratories. A set of two lyophilized pooled sera (A and B) was sent to twenty laboratories specialized in chromatographic lipid analysis. The different sterols were quantified either by gas chromatography-flame ionization detection, gas chromatography- or liquid chromatography-mass selective detection. The participants were requested to determine cholesterol and NCS concentrations in the provided samples as part of their normal laboratory routine. The second part was designed as interventional survey. Twenty-two laboratories agreed to participate and received again two different lyophilized pooled sera (C and D). In contrast to the first international survey, each participant received standard stock solutions with defined concentrations of cholesterol and NCS. The participants were requested to use diluted calibration solutions from the provided standard stock solutions for quantification of cholesterol and NCS. In both surveys, each laboratory used its own internal standard (5α-cholestane, epicoprostanol or deuterium labelled sterols). Main outcome of the survey was, that unacceptably high interlaboratory variations for cholesterol and NCS concentrations are reported, even when the individual laboratories used the same calibration material. We discuss different sources of errors and recommend all laboratories analysing cholesterol and NCS to participate in regular quality control programs.\n Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.\n\n\n"
},
{
"text": "\n180254\nRisk of hypoglycaemia with insulin degludec versus insulin glargine U300 in insulin-treated patients with type 2 diabetes: the randomised, head-to-head CONCLUDE trial.\n\nPhilis-Tsimikas, A\n\nKlonoff, DC\n\nKhunti, K\n\nBajaj, HS\n\nLeiter, LA\n\nHansen, MV\n\nTroelsen, LN\n\nLadelund, S\n\nHeller, S\n\nPieber, TR\n\nCONCLUDE Study Group\n\nBeiträge in Fachzeitschriften\nISI:000509337300001\n31984443.0\n10.1007/s00125-019-05080-9\nPMC7054369\nA head-to-head randomised trial was conducted to evaluate hypoglycaemia safety with insulin degludec 200 U/ml (degludec U200) and insulin glargine 300 U/ml (glargine U300) in individuals with type 2 diabetes treated with basal insulin.\n This randomised (1:1), open-label, treat-to-target, multinational trial included individuals with type 2 diabetes, aged ≥18 years with HbA1c ≤80 mmol/mol (9.5%) and BMI ≤45 kg/m2. Participants were previously treated with basal insulin with or without oral glucose-lowering drugs (excluding insulin secretagogues) and had to fulfil at least one predefined criterion for hypoglycaemia risk. Both degludec U200 and glargine U300 were similarly titrated to a fasting blood glucose target of 4.0-5.0 mmol/l. Endpoints were assessed during a 36 week maintenance period and a total treatment period up to 88 weeks. There were three hypoglycaemia endpoints: (1) overall symptomatic hypoglycaemia (either severe, an event requiring third-party assistance, or confirmed by blood glucose [<3.1 mmol/l] with symptoms); (2) nocturnal symptomatic hypoglycaemia (severe or confirmed by blood glucose with symptoms, between 00:01 and 05:59 h); and (3) severe hypoglycaemia. The primary endpoint was the number of overall symptomatic hypoglycaemic events in the maintenance period. Secondary hypoglycaemia endpoints included the number of nocturnal symptomatic events and number of severe hypoglycaemic events during the maintenance period.\n Of the 1609 randomised participants, 733 of 805 (91.1%) in the degludec U200 arm and 734 of 804 (91.3%) in the glargine U300 arm completed the trial (87.3% and 87.8% completed on treatment, respectively). Baseline characteristics were comparable between the two treatment arms. For the primary endpoint, the rate of overall symptomatic hypoglycaemia was not significantly lower with degludec U200 vs glargine U300 (rate ratio [RR] 0.88 [95% CI 0.73, 1.06]). As there was no significant difference between treatments for the primary endpoint, the confirmatory testing procedure for superiority was stopped. The pre-specified confirmatory secondary hypoglycaemia endpoints were analysed using pre-specified statistical models but were now considered exploratory. These endpoints showed a lower rate of nocturnal symptomatic hypoglycaemia (RR 0.63 [95% CI 0.48, 0.84]) and severe hypoglycaemia (RR 0.20 [95% CI 0.07, 0.57]) with degludec U200 vs glargine U300.\n There was no significant difference in the rate of overall symptomatic hypoglycaemia with degludec U200 vs glargine U300 in the maintenance period. The rates of nocturnal symptomatic and severe hypoglycaemia were nominally significantly lower with degludec U200 during the maintenance period compared with glargine U300.\n ClinicalTrials.gov NCT03078478 FUNDING: This trial was funded by Novo Nordisk (Bagsvaerd, Denmark).\n\nPieber, Thomas\n\n\n"
},
{
"text": "\n152097\nVertebral Scheuermann's disease in Europe: prevalence, geographic variation and radiological correlates in men and women aged 50 and over.\n\nArmbrecht, G\n\nFelsenberg, D\n\nGanswindt, M\n\nLunt, M\n\nKaptoge, SK\n\nAbendroth, K\n\nAroso, A\n\nBanzer, D\n\nBhalla, AK\n\nDequeker, J\n\nEastell, R\n\nHoszowski, K\n\nLyritis, G\n\nDelmas, PD\n\nMasaryk, P\n\nMiazgowski, T\n\nCannata, J\n\nNuti, R\n\nOei, L\n\nPoor, G\n\nRedlund-Johnell, I\n\nReid, DM\n\nReisinger, W\n\nSchatz, H\n\nTodd, CJ\n\nWoolf, AD\n\nJavaid, K\n\nRivadeneira, F\n\nSilman, AJ\n\nCooper, C\n\nO'Neill, TW\n\nReeve, J\n\nEuropean Vertebral Osteoporosis Study and European Prospective Osteoporosis Study Groups\n\nBeiträge in Fachzeitschriften\nISI:000361639700013\n26021761.0\n10.1007/s00198-015-3170-6\nNone\nIn 27 centres across Europe, the prevalence of deforming spinal Scheuermann's disease in age-stratified population-based samples of over 10, 00 men and women aged 50+ averaged 8% in each sex, but was highly variable between centres. Low DXA BMD was un-associated with Scheuermann's, helping the differential diagnosis from osteoporosis.\n This study aims to assess the prevalence of Scheuermann's disease of the spine across Europe in men and women over 50 years of age, to quantitate its association with bone mineral density (BMD) and to assess its role as a confounder for the radiographic diagnosis of osteoporotic fracture.\n In 27 centres participating in the population-based European Vertebral Osteoporosis Study (EVOS), standardised lateral radiographs of the lumbar and of the thoracic spine from T4 to L4 were assessed in all those of adequate quality. The presence of Scheuermann's disease, a confounder for prevalent fracture in later life, was defined by the presence of at least one Schmorl's node or irregular endplate together with kyphosis (sagittal Cobb angle >40° between T4 and T12) or a wedged-shaped vertebral body. Alternatively, the (rare) Edgren-Vaino sign was taken as diagnostic. The 6-point-per-vertebral-body (13 vertebrae) method was used to assess osteoporotic vertebral shape and fracture caseness. DXA BMD of the L2-L4 and femoral neck regions was measured in subsets. We also assessed the presence of Scheuermann's by alternative published algorithms when these used the radiographic signs we assessed.\n Vertebral radiographic images from 4486 men and 5655 women passed all quality checks. Prevalence of Scheuermann's varied considerably between centres, and based on random effect modelling, the overall European prevalence using our method was 8% with no significant difference between sexes. The highest prevalences were seen in Germany, Sweden, the UK and France and low prevalences were seen in Hungary, Poland and Slovakia. Centre-level prevalences in men and women were highly correlated. Scheuermann's was not associated with BMD of the spine or hip.\n Since most of the variation in population impact of Scheuermann's was unaccounted for by the radiological and anthropometric data, the search for new genetic and environmental determinants of this disease is encouraged.\n\nWeber, Kurt\n\n\n"
},
{
"text": "\n181730\nInternet-Based Health Information-Seeking Behavior of Students Aged 12 to 14 Years: Mixed Methods Study.\n\nMaitz, E\n\nMaitz, K\n\nSendlhofer, G\n\nWolfsberger, C\n\nMautner, S\n\nKamolz, LP\n\nGasteiger-Klicpera, B\n\nBeiträge in Fachzeitschriften\nISI:000535386300001\n32209532.0\n10.2196/16281\nPMC7284399\nMany children and adolescents are surrounded by smartphones, tablets, and computers and know how to search the internet for almost any information. However, very few of them know how to select proper information from reliable sources. This can become a problem when health issues are concerned, where it is vital to identify incorrect or misleading information. The competence to critically evaluate digital information on health issues is of increasing importance for adolescents.\n The aim of this study was to assess how children and adolescents rate their internet-based health literacy and how their actual literacy differs from their ratings. In addition, there was a question on how their search performance is related to their self-efficacy. To evaluate these questions, a criteria-based analysis of the quality of the websites they visited was performed. Finally, the possibility to increase their internet-based health literacy in a 3-day workshop was explored.\n A workshop with a focus on health literacy was attended by 14 children and adolescents in an Austrian secondary school. After prior assessments (Culture Fair Intelligence Test, revised German version; Reading Speed and Reading Comprehension Test for Grades 6 to 12, German; electronic health literacy scale [eHEALS]; and General Self-Efficacy Scale, Reversed Version, German), the students were asked to perform an internet-based search on a health-related issue. Browser histories and screenshots of all internet searches were gathered, clustered, and analyzed. After the workshop, the health literacy of the students was assessed again by using the eHEALS.\n The 14 students opened a total of 85 homepages, but only eight of these homepages were rated as good or fair by two experts (independent rating) based on specific criteria. The analysis showed that the students judged their own internet-based health literacy much higher than the actual value, and students who had rated themselves better did not visit websites of high quality. Internet-based health literacy correlated significantly with the self-efficacy of the students (rs=0.794, P=.002).\n Our study showed that it is possible to draw the attention of students to critical aspects of internet search and to slightly improve their search competence in a workshop. Targeted improvement of health literacy is urgently required, and students need special instruction for this purpose. Further investigations in this area with larger sets of data, which could be feasible with the help of a computer program, are urgently needed.\n ©Emanuel Maitz, Katharina Maitz, Gerald Sendlhofer, Christina Wolfsberger, Selma Mautner, Lars-Peter Kamolz, Barbara Gasteiger-Klicpera. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.05.2020.\n\nKamolz, Lars-Peter\n\nMaitz, Emanuel\n\nMautner, Selma\n\nSendlhofer, Gerald\n\nWolfsberger, Christina H.\n\n\n"
},
{
"text": "\n6257\nThe relationship between bone density and incident vertebral fracture in men and women.\n\nO'Neill, TW\n\nLunt, M\n\nSilman, AJ\n\nFelsenberg, D\n\nBenevolenskaya, LI\n\nBhalla, AK\n\nCannata, JB\n\nCooper, C\n\nCrabtree, N\n\nDequeker, J\n\nHoszowski, K\n\nJajic, I\n\nKanis, JA\n\nKragl, G\n\nLopes, VA\n\nLorenc, R\n\nLyritis, G\n\nMasaryk, P\n\nMiazgowski, T\n\nParisi, G\n\nPols, HAP\n\nPoor, G\n\nReid, DM\n\nScheidt-Nave, C\n\nStepan, J\n\nTodd, C\n\nWeber, K\n\nWoolf, AD\n\nReeve, J\r\n\n\nBeiträge in Fachzeitschriften\nISI:000179399700012\nNone\n10.1359/jbmr.2002.17.12.2214\nNone\nBone mineral density (BMD) is an important predictor of future fracture risk in women; however, there are few prospective data in men. The aim of this analysis was to determine whether there are differences in the relationship between BMD and incident vertebral fracture in men and women. Men and women were recruited from population-based registers in 21 European centers. Those recruited were interviewed and had spinal radiographs performed. The radiographs were assessed morphometrically and prevalent vertebral deformity was defined using the McCloskey-Kanis method. Repeat spinal radiographs were performed at a mean of 3.8 years after the baseline radiographs. Incident fractures were defined using a combination of the point prevalence and 20% reduction in vertebral height (plus a 4-mm reduction in absolute height) criteria. BMD measurements were made in a subsample of those recruited. Poisson regression was used to explore the influence of gender, age, prevalent deformity, and BMD on the incidence of vertebral fracture. Thirty-four hundred sixty-one men and women had both paired spinal radiographs and bone density measurements performed. BMD at the spine and femoral neck was higher in men than in women. After adjusting for age, the risk of incident vertebral fracture was greater in women than in men (relative risk [RR] = 2.3; 95% CI, 1.5-3.6) and increased by a factor of 1.4 (95% CI, 1.2-1.8), 1.5 (95% CI, 1.2-1.8), and 1.6 (95% CI, 1.3-1.9) per decrease of 0.1 g/cm(2) in BMD at the spine, femoral neck, and trochanter, respectively. After adjusting for BMD at the spine or trochanter, the gender difference in the predicted age-specific incidence of vertebral fracture was no longer significant (RR = 1.1 and 95% CI, 0.6-1.9 at the spine; RR = 1.5 and 95% CI, 0.8-2.7 at the trochanter), although it persisted after adjusting for femoral neck BMD (RR = 1.9; 95% CI, 1.1-3.3). The presence of a prevalent vertebral deformity was a strong risk factor for future vertebral fracture, although the strength of the association was reduced after adjustment for age, sex, and spine BMD. However, adjustment for the presence of a baseline vertebral deformity did not alter the main findings. In conclusion, at a given age and spine (although not femoral neck) bone density, the risk of incident vertebral fracture is similar in men and women. Incident vertebral fractures are more common in women than men because at any age their spine BMD is lower.\n\nWeber, Kurt\n\n\n"
},
{
"text": "\n128860\nInverse relationship between fractionated electrograms and atrial fibrosis in persistent atrial fibrillation: combined magnetic resonance imaging and high-density mapping.\n\nJadidi, AS\n\nCochet, H\n\nShah, AJ\n\nKim, SJ\n\nDuncan, E\n\nMiyazaki, S\n\nSermesant, M\n\nLehrmann, H\n\nLederlin, M\n\nLinton, N\n\nForclaz, A\n\nNault, I\n\nRivard, L\n\nWright, M\n\nLiu, X\n\nScherr, D\n\nWilton, SB\n\nRoten, L\n\nPascale, P\n\nDerval, N\n\nSacher, F\n\nKnecht, S\n\nKeyl, C\n\nHocini, M\n\nMontaudon, M\n\nLaurent, F\n\nHaïssaguerre, M\n\nJaïs, P\n\nBeiträge in Fachzeitschriften\nISI:000323899900007\n23727084.0\n10.1016/j.jacc.2013.03.081\nNone\nThis study sought to evaluate the relationship between fibrosis imaged by delayed-enhancement (DE) magnetic resonance imaging (MRI) and atrial electrograms (Egms) in persistent atrial fibrillation (AF).\n Atrial fractionated Egms are strongly related to slow anisotropic conduction. Their relationship to atrial fibrosis has not yet been investigated.\n Atrial high-resolution MRI of 18 patients with persistent AF (11 long-lasting persistent AF) was registered with mapping geometry (NavX electro-anatomical system (version 8.0, St. Jude Medical, St. Paul, Minnesota)). DE areas were categorized as dense or patchy, depending on their DE content. Left atrial Egms during AF were acquired using a high-density, 20-pole catheter (514 ± 77 sites/map). Fractionation, organization/regularity, local mean cycle length (CL), and voltage were analyzed with regard to DE.\n Patients with long-lasting persistent versus persistent AF had larger left atrial (LA) surface area (134 ± 38 cm(2) vs. 98 ± 9 cm(2), p = 0.02), a higher amount of atrial DE (70 ± 16 cm(2) vs. 49 ± 10 cm(2), p = 0.01), more complex fractionated atrial Egm (CFAE) extent (54 ± 16 cm(2) vs. 28 ± 15 cm(2), p = 0.02), and a shorter baseline AF CL (147 ± 10 ms vs. 182 ± 14 ms, p = 0.01). Continuous CFAE (CFEmean [NavX algorithm that quantifies Egm fractionation] <80 ms) occupied 38 ± 19% of total LA surface area. Dense DE was detected at the left posterior left atrium. In contrast, the right posterior left atrium contained predominantly patchy DE. Most CFAE (48 ± 14%) occurred at non-DE LA sites, followed by 41 ± 12% CFAE at patchy DE and 11 ± 6% at dense DE regions (p = 0.005 and p = 0.008, respectively); 19 ± 6% CFAE sites occurred at border zones of dense DE. Egms were less fractionated, with longer CL and lower voltage at dense DE versus non-DE regions: CFEmean: 97 ms versus 76 ms, p < 0.0001; local CL: 153 ms versus 143 ms, p < 0.0001; mean voltage: 0.63 mV versus 0.86 mV, p < 0.0001.\n Atrial fibrosis as defined by DE MRI is associated with slower and more organized electrical activity but with lower voltage than healthy atrial areas. Ninety percent of continuous CFAE sites occur at non-DE and patchy DE LA sites. These findings are important when choosing the ablation strategy in persistent AF.\n Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.\n\nScherr, Daniel\n\n\n"
},
{
"text": "\n156191\nWhat's the best minimal invasive approach to pediatric nephrectomy and heminephrectomy: conventional laparoscopy (CL), single-site (LESS) or robotics (RAS)?\n\nTill, H\n\nBasharkhah, A\n\nHock, A\n\nBeiträge in Fachzeitschriften\nISI:000399038400008\n27867846.0\n10.21037/tp.2016.09.01\nPMC5107386\nConventional laparoscopy (CL) using 3-5 mm ports has become the goldstandard for pediatric nephrectomy (N), heminephrectomy (HN) and heminephrecto-ureterectomy (HNU) for many years now. Recently the spectrum of minimal invasive surgery (MIS) has been extended by variants like laparoendoscopic single-site surgery (LESS) or robot-assisted surgery (RAS). However such technical developments tend to drive surgical euphoria and feasibility studies, but may miss adequate academic research about function and proven patients' benefits. This article delivers a comprehensive analysis of present pediatric studies comparing at least two MIS approaches to N, HN and HNU.\n A systematic literature-based search for studies published between 2011-2016 about CL versus LESS or RAS for pediatric N, HN, and HNU was performed using multiple electronic databases and sources. The level of evidence was determined using the Oxford Centre for Evidence-based Medicine (OCEBM) criteria. Single arm observational studies about N, HN or HNU using CL, LESS or RAS as well as publications including adult patients were excluded.\n A total of 11 studies met defined inclusion criteria, reporting on CL versus LESS or RAS. No studies of OCEBM Level 1 or 2 were identified. Performing CL for N and HN limited evidence indicated reduced analgesic requirements and shorter hospital stay over open surgery, but longer operating time. Preservation of renal function of the remaining moiety after CL-HN was 95%. Importantly, of patients losing their remaining moiety, median age at surgery was 9 months (range, 4-42 months), and all except 1 (6/7) had an upper pole HN. Several authors compared TNP versus RPN access for CL and confirmed a longer operating time for RPN versus TPN-NU. Moreover one study reported a longer ureteric stump in RPN versus TPN-HNU (range, 2-5 cm vs. 3-7 mm). Disadvantages of LESS or RAS over CL were longer operative time and higher total costs (RAS). There were no differences regarding complications, success rates, or short-term outcomes between pediatric RAS versus CL. No long-term studies about preservation of renal function or length of ureteric stump using LESS or RAS could be retrieved.\n Several approaches to MIS-NU and HNU are available today. CL represents the method of choice for any age group. TPN or RPN can be chosen according to age of the patient. LESS and RAS offer distinct advantages, but also lack evident patients' benefits over CL at present. Hopefully, as pediatric MIS advances over the next decade, larger studies comparing CL, LESS or RAS directly for pediatric NU and HNU will be published to gain a higher level of evidence what's really best for the child.\n\nTill, Holger\n\n\n"
},
{
"text": "\n174205\nGuidance to 2018 good practice: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma.\n\nBousquet, J\n\nBedbrook, A\n\nCzarlewski, W\n\nOnorato, GL\n\nArnavielhe, S\n\nLaune, D\n\nMathieu-Dupas, E\n\nFonseca, J\n\nCosta, E\n\nLourenço, O\n\nMorais-Almeida, M\n\nTodo-Bom, A\n\nIllario, M\n\nMenditto, E\n\nCanonica, GW\n\nCecchi, L\n\nMonti, R\n\nNapoli, L\n\nVentura, MT\n\nDe Feo, G\n\nFokkens, WJ\n\nChavannes, NH\n\nReitsma, S\n\nCruz, AA\n\nda Silva, J\n\nSerpa, FS\n\nLarenas-Linnemann, D\n\nFuentes Perez, JM\n\nHuerta-Villalobos, YR\n\nRivero-Yeverino, D\n\nRodriguez-Zagal, E\n\nValiulis, A\n\nDubakiene, R\n\nEmuzyte, R\n\nKvedariene, V\n\nAnnesi-Maesano, I\n\nBlain, H\n\nBonniaud, P\n\nBosse, I\n\nDauvilliers, Y\n\nDevillier, P\n\nFontaine, JF\n\nPépin, JL\n\nPham-Thi, N\n\nPortejoie, F\n\nPicard, R\n\nRoche, N\n\nRolland, C\n\nSchmidt-Grendelmeier, P\n\nKuna, P\n\nSamolinski, B\n\nAnto, JM\n\nCardona, V\n\nMullol, J\n\nPinnock, H\n\nRyan, D\n\nSheikh, A\n\nWalker, S\n\nWilliams, S\n\nBecker, S\n\nKlimek, L\n\nPfaar, O\n\nBergmann, KC\n\nMösges, R\n\nZuberbier, T\n\nRoller-Wirnsberger, RE\n\nTomazic, PV\n\nHaahtela, T\n\nSalimäki, J\n\nToppila-Salmi, S\n\nValovirta, E\n\nVasankari, T\n\nGemicioğlu, B\n\nYorgancioglu, A\n\nPapadopoulos, NG\n\nProkopakis, EP\n\nTsiligianni, IG\n\nBosnic-Anticevich, S\n\nO'Hehir, R\n\nIvancevich, JC\n\nNeffen, H\n\nZernotti, ME\n\nKull, I\n\nMelén, E\n\nWickman, M\n\nBachert, C\n\nHellings, PW\n\nBrusselle, G\n\nPalkonen, S\n\nBindslev-Jensen, C\n\nEller, E\n\nWaserman, S\n\nBoulet, LP\n\nBouchard, J\n\nChu, DK\n\nSchünemann, HJ\n\nSova, M\n\nDe Vries, G\n\nvan Eerd, M\n\nAgache, I\n\nAnsotegui, IJ\n\nBewick, M\n\nCasale, T\n\nDykewick, M\n\nEbisawa, M\n\nMurray, R\n\nNaclerio, R\n\nOkamoto, Y\n\nWallace, DV\n\nThe MASK study group\n\nBeiträge in Fachzeitschriften\nISI:000460903700001\n30911372.0\n10.1186/s13601-019-0252-0\nPMC6413444\nMobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases.\n MASK implements ICT technologies for individualized and predictive medicine to develop novel care pathways by a multi-disciplinary group centred around the patients.\n Include patients, health care professionals (pharmacists and physicians), authorities, patient's associations, private and public sectors.\n MASK is deployed in 23 countries and 17 languages. 26, 00 users have registered.\n MASK is participating in EU projects (POLLAR: impact of air POLLution in Asthma and Rhinitis, EIT Health, DigitalHealthEurope, Euriphi and Vigour).\n (i) Adherence to treatment is the major problem of allergic disease, (ii) Self-management strategies should be considerably expanded (behavioural), (iii) Change management is essential in allergic diseases, (iv) Education strategies should be reconsidered using a patient-centred approach and (v) Lessons learnt for allergic diseases can be expanded to chronic diseases.\n\nRoller-Wirnsberger, Regina\n\nTomazic, Peter Valentin\n\n\n"
},
{
"text": "\n183512\nShould we be imaging lymph nodes at initial diagnosis of early-stage mycosis fungoides? Results from the PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) international study.\n\nHodak, E\n\nSherman, S\n\nPapadavid, E\n\nBagot, M\n\nQuerfeld, C\n\nQuaglino, P\n\nPrince, HM\n\nOrtiz-Romero, PL\n\nStadler, R\n\nKnobler, R\n\nGuenova, E\n\nEstrach, T\n\nPatsatsi, A\n\nLeshem, YA\n\nPrague-Naveh, H\n\nBerti, E\n\nAlberti-Violetti, S\n\nCowan, R\n\nJonak, C\n\nNikolaou, V\n\nMitteldorf, C\n\nAkilov, O\n\nGeskin, L\n\nMatin, R\n\nBeylot-Barry, M\n\nVakeva, L\n\nSanches, JA\n\nServitje, O\n\nWeatherhead, S\n\nWobser, M\n\nYoo, J\n\nBayne, M\n\nBates, A\n\nDunnill, G\n\nMarschalko, M\n\nBuschots, AM\n\nWehkamp, U\n\nEvison, F\n\nHong, E\n\nAmitay-Laish, I\n\nStranzenbach, R\n\nVermeer, M\n\nWillemze, R\n\nKempf, W\n\nCerroni, L\n\nWhittaker, S\n\nKim, YH\n\nScarisbrick, JJ\n\nCutaneous Lymphoma International Consortium (CLIC) institutions\n\nBeiträge in Fachzeitschriften\nISI:000567642800001\n32574377.0\n10.1111/bjd.19303\nNone\nEarly-stage mycosis fungoides (MF) includes involvement of dermatopathic lymph nodes (LNs) or early lymphomatous LNs. There is a lack of unanimity among current guidelines regarding the indications for initial staging imaging in early-stage presentation of MF in the absence of enlarged palpable LNs.\n To investigate how often imaging is performed in patients with early-stage presentation of MF, to assess the yield of LN imaging, and to determine what disease characteristics promoted imaging.\n A review of clinicopathologically confirmed newly diagnosed patients with cutaneous patch/plaque (T1/T2) MF from PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) data.\n PROCLIPI enrolled 375 patients with stage T1/T2 MF: 304 with classical MF and 71 with folliculotropic MF. Imaging was performed in 169 patients (45%): 83 with computed tomography, 18 with positron emission tomography-computed tomography and 68 with ultrasound. Only nine of these (5%) had palpable enlarged (≥ 15 mm) LNs, with an over-representation of plaques, irrespectively of the 10% body surface area cutoff that distinguishes T1 from T2. Folliculotropic MF was not more frequently imaged than classical MF. Radiologically enlarged LNs (≥ 15 mm) were detected in 30 patients (18%); only seven had clinical lymphadenopathy. On multivariate analysis, plaque presentation was the sole parameter significantly associated with radiologically enlarged LNs. Imaging of only clinically enlarged LNs upstaged 4% of patients (seven of 169) to at least IIA, whereas nonselective imaging upstaged another 14% (24 of 169). LN biopsy, performed in eight of 30 patients, identified N3 (extensive lymphomatous involvement) in two and N1 (dermatopathic changes) in six.\n Physical examination was a poor determinant of LN enlargement or involvement. Presence of plaques was associated with a significant increase in identification of enlarged or involved LNs in patients with early-stage presentation of MF, which may be important when deciding who to image. Imaging increases the detection rate of stage IIA MF, and identifies rare cases of extensive lymphomatous nodes, upstaging them to advanced-stage IVA2.\n © 2020 British Association of Dermatologists.\n\nCerroni, Lorenzo\n\n\n"
},
{
"text": "\n137975\nSafety and Efficacy of Periprocedural Anticoagulation With Enoxaparin in Patients Undergoing Peripheral Endovascular Revascularization.\n\nBrodmann, M\n\nDorr, A\n\nHafner, F\n\nGary, T\n\nFroehlich, H\n\nKvas, E\n\nDeutschmann, H\n\nPilger, E\n\n\n\nBeiträge in Fachzeitschriften\nISI:000337572400010\n23785050.0\n10.1177/1076029613492877\nNone\nPeriprocedural anticoagulation is primarily used in endovascular procedures to prevent acute reocclusion of the target vessel, but periprocedural anticoagulation might also have an impact on long-term outcome. Consecutive bleeding events are feared complications. Despite changes in peripheral endovascular revascularizations (EVRs), the periprocedural management has remained unchanged for years. Unfractionated heparin is still the treatment of choice during and immediately after EVR.\n We performed a prospective, single-center, open-label phase III study comparing 2 different regimes of enoxaparin peri-interventional to peripheral EVR stratified into low- and high-risk groups according to the acute and long-term reocclusion risk due to their vessel morphology. In both groups, 0.5 mg/kg of enoxaparin as a bolus was administered intravenously 10 to 15 minutes before the start of the procedure. In the low-risk group, 40 mg of enoxaparin were administered once daily for 7 days; whereas in the high-risk group, 1 mg/kg of enoxaparin was administered subcutaneously (sc) 2 times a day for 48 hours after the procedure and afterward 40 mg of enoxaparin was administered sc once daily for 5 days.\n For the analysis of the per protocol population, 44 patients remained in the low-risk group and 140 in the high-risk group. Concerning the primary safety end point, a total of 25 (13.59%) bleeding events occurred until day 30; 5 (11.36%) of them in the low-risk group and 20 (14.29%) in the high-risk group (P = .809 for low vs high risk). None of the bleeding events observed were major according to Thrombolysis In Myocardial Infarction criteria. Concerning our primary efficacy end point, none of the patients showed an acute reocclusion classified as a significant decrease in ankle-brachial index (ABI) or elevated peak systolic velocity ratio confirmed by duplex sonography until day 30. Concerning the second end point of prevention of chronic reobstruction, at day 180 ABI has decreased in the low-risk group from mean 0.94 at day 30 to mean 0.89 and from 1.28 at day 30 to 0.85 after 6 months in the high-risk group. No significant reobstruction was found in the low-risk group, whereas 5 significant reobstruction events were objectified in the high-risk group, all of them in the femoropopliteal arterial segment at day 180.\n We conclude that low-molecular-weight heparin either in a low-dose or high-dose regime during a peripheral EVR is safe concerning bleeding complications and acute reobstructions. The long-term follow-up showed no significant difference between our high- and low-risk groups concerning reobstruction. The periprocedural anticoagulation seems to have no influence on the long-term patency rate after peripheral EVR.\n © The Author(s) 2013.\n\nBrodmann, Marianne\n\nDeutschmann, Hannes\n\nGary, Thomas\n\nHafner, Franz\n\nPilger, Ernst\n\n\n"
},
{
"text": "\n179034\nLong-term outcome of LRBA deficiency in 76 patients after various treatment modalities as evaluated by the immune deficiency and dysregulation activity (IDDA) score.\n\nTesch, VK\n\nAbolhassani, H\n\nShadur, B\n\nZobel, J\n\nMareika, Y\n\nSharapova, S\n\nKarakoc-Aydiner, E\n\nRivière, JG\n\nGarcia-Prat, M\n\nMoes, N\n\nHaerynck, F\n\nGonzales-Granado, LI\n\nSantos Pérez, JL\n\nMukhina, A\n\nShcherbina, A\n\nAghamohammadi, A\n\nHammarström, L\n\nDogu, F\n\nHaskologlu, S\n\nİkincioğulları, AI\n\nKöstel Bal, S\n\nBaris, S\n\nKilic, SS\n\nKaraca, NE\n\nKutukculer, N\n\nGirschick, H\n\nKolios, A\n\nKeles, S\n\nUygun, V\n\nStepensky, P\n\nWorth, A\n\nvan Montfrans, JM\n\nPeters, AMJ\n\nMeyts, I\n\nAdeli, M\n\nMarzollo, A\n\nPadem, N\n\nKhojah, AM\n\nChavoshzadeh, Z\n\nAvbelj Stefanija, M\n\nBakhtiar, S\n\nFlorkin, B\n\nMeeths, M\n\nGamez, L\n\nGrimbacher, B\n\nSeppänen, MRJ\n\nLankester, A\n\nGennery, AR\n\nSeidel, MG\n\nInborn Errors, Clinical, and Registry Working Parties of the European Society for Blood and Marrow Transplantation and the European Society for Immunodeficiencies\n\nBeiträge in Fachzeitschriften\nISI:000531063400017\n31887391.0\n10.1016/j.jaci.2019.12.896\nNone\nRecent findings strongly support hematopoietic stem cell transplantation (HSCT) in patients with severe presentation of LPS-responsive beige-like anchor protein (LRBA) deficiency, but long-term follow-up and survival data beyond previous patient reports or meta-reviews are scarce for those patients who do not receive a transplant.\n This international retrospective study was conducted to elucidate the longitudinal clinical course of patients with LRBA deficiency who do and do not receive a transplant.\n We assessed disease burden and treatment responses with a specially developed immune deficiency and dysregulation activity score, reflecting the sum and severity of organ involvement and infections, days of hospitalization, supportive care requirements, and performance indices.\n Of 76 patients with LRBA deficiency from 29 centers (median follow-up, 10 years; range, 1-52), 24 underwent HSCT from 2005 to 2019. The overall survival rate after HSCT (median follow-up, 20 months) was 70.8% (17 of 24 patients); all deaths were due to nonspecific, early, transplant-related mortality. Currently, 82.7% of patients who did not receive a transplant (43 of 52; age range, 3-69 years) are alive. Of 17 HSCT survivors, 7 are in complete remission and 5 are in good partial remission without treatment (together, 12 of 17 [70.6%]). In contrast, only 5 of 43 patients who did not receive a transplant (11.6%) are without immunosuppression. Immune deficiency and dysregulation activity scores were significantly lower in patients who survived HSCT than in those receiving conventional treatment (P = .005) or in patients who received abatacept or sirolimus as compared with other therapies, and in patients with residual LRBA expression. Higher disease burden, longer duration before HSCT, and lung involvement were associated with poor outcome.\n The lifelong disease activity, implying a need for immunosuppression and risk of malignancy, must be weighed against the risks of HSCT.\n Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.\n\nSeidel, Markus\n\nTesch, Victoria Katharina\n\nZobel, Joachim\n\n\n"
},
{
"text": "\n186888\nPellegrini-Stieda disease: a heterogeneous disorder not synonymous with ossification/calcification of the tibial collateral ligament-anatomic and imaging investigation.\n\nMendes, LF\n\nPretterklieber, ML\n\nCho, JH\n\nGarcia, GM\n\nResnick, DL\n\nChung, CB\n\nBeiträge in Fachzeitschriften\nISI:000241797800007\n16988801.0\n10.1007/s00256-006-0174-5\nNone\nOssification/calcification around the medial femoral condyle has been known as Pellegrini-Stieda (PS) disease for almost 100 years. Little attention has been given to magnetic resonance (MR) imaging characteristics. Our purpose is to demonstrate the anatomy in the medial femoral compartment and imaging findings of PS disease, determining the sites and patterns of ossification.\n In a cadaveric study seven specimens were dissected to show the anatomic relations of the tibial collateral ligament (TCL) and the tendon of the ischiocondylar part of the adductor magnus muscle, in the medial femoral epicondyle. In order to determine the nature of ossification/calcification in PS disease, MR imaging and radiographic findings in nine patients were analyzed by two observers with attention to the specific site, shape, and orientation of the ossification and its relationship to the tibial collateral ligament (TCL) and adductor magnus tendon. Available clinical history was recorded. A classification system addressing different sites and patterns of ossification was developed.\n The anatomic study showed that the TCL and the adductor magnus tendon insert at different sites in the medial femoral condyle and there is no continuation; however, some fibers of the posterior bundle of the TCL overlap the anterior aspect of the adductor magnus tendon. The imaging study showed that shape, orientation, and location of the abnormal calcification and ossification were similar on radiographic and MR imaging analysis. Ossification had an inferior orientation in six cases, a superior orientation in two cases, and both in one case. Four patterns of ossification were noted: (I) a beak-like appearance with an inferior orientation and femoral attachment was present in five cases; (II) a drop-like appearance with an inferior orientation, parallel to the femur, was evident in one case; (III) an elongated appearance with a superior orientation, parallel to the femur, was seen in two cases; and (IV) a beak-like appearance with an inferior and superior orientation, attached to the femur, was seen in one case. The ossification was present in the TCL in six cases, in the adductor magnus tendon in two cases, and in both in one case. The coronal plane was best in detecting and categorizing the ossification.\n Our data indicate that ossification in PS disease is not confined to the TCL but may also involve the adductor magnus tendon. In some cases, it can be related to the anatomic proximity (overlap) of the fibers of these two structures. PS disease should not be regarded as synonymous with ossification of the TCL. The ossification may be classified into four types. No clinical differences among these types appear to exist.\n\n\n"
},
{
"text": "\n157362\nGenetic variation at 16q24.2 is associated with small vessel stroke.\n\nTraylor, M\n\nMalik, R\n\nNalls, MA\n\nCotlarciuc, I\n\nRadmanesh, F\n\nThorleifsson, G\n\nHanscombe, KB\n\nLangefeld, C\n\nSaleheen, D\n\nRost, NS\n\nYet, I\n\nSpector, TD\n\nBell, JT\n\nHannon, E\n\nMill, J\n\nChauhan, G\n\nDebette, S\n\nBis, JC\n\nLongstreth, WT\n\nIkram, MA\n\nLauner, LJ\n\nSeshadri, S\n\nMETASTROKE, UK Young Lacunar DNA Study, NINDS Stroke Genetics Network, Neurology Working Group of the CHARGE Consortium\n\nHamilton-Bruce, MA\n\nJimenez-Conde, J\n\nCole, JW\n\nSchmidt, R\n\nSłowik, A\n\nLemmens, R\n\nLindgren, A\n\nMelander, O\n\nGrewal, RP\n\nSacco, RL\n\nRundek, T\n\nRexrode, K\n\nArnett, DK\n\nJohnson, JA\n\nBenavente, OR\n\nWasssertheil-Smoller, S\n\nLee, JM\n\nPulit, SL\n\nWong, Q\n\nRich, SS\n\nde Bakker, PI\n\nMcArdle, PF\n\nWoo, D\n\nAnderson, CD\n\nXu, H\n\nHeitsch, L\n\nFornage, M\n\nJern, C\n\nStefansson, K\n\nThorsteinsdottir, U\n\nGretarsdottir, S\n\nLewis, CM\n\nSharma, P\n\nSudlow, CL\n\nRothwell, PM\n\nBoncoraglio, GB\n\nThijs, V\n\nLevi, C\n\nMeschia, JF\n\nRosand, J\n\nKittner, SJ\n\nMitchell, BD\n\nDichgans, M\n\nWorrall, BB\n\nMarkus, HS\n\nInternational Stroke Genetics Consortium\n\nBeiträge in Fachzeitschriften\nISI:000397280100008\n27997041.0\n10.1002/ana.24840\nPMC5366092\nGenome-wide association studies (GWAS) have been successful at identifying associations with stroke and stroke subtypes, but have not yet identified any associations solely with small vessel stroke (SVS). SVS comprises one quarter of all ischemic stroke and is a major manifestation of cerebral small vessel disease, the primary cause of vascular cognitive impairment. Studies across neurological traits have shown that younger-onset cases have an increased genetic burden. We leveraged this increased genetic burden by performing an age-at-onset informed GWAS meta-analysis, including a large younger-onset SVS population, to identify novel associations with stroke.\n We used a three-stage age-at-onset informed GWAS to identify novel genetic variants associated with stroke. On identifying a novel locus associated with SVS, we assessed its influence on other small vessel disease phenotypes, as well as on messenger RNA (mRNA) expression of nearby genes, and on DNA methylation of nearby CpG sites in whole blood and in the fetal brain.\n We identified an association with SVS in 4, 03 cases and 50, 28 controls on chromosome 16q24.2 (odds ratio [OR; 95% confidence interval {CI}] = 1.16 [1.10-1.22]; p = 3.2 × 10(-9) ). The lead single-nucleotide polymorphism (rs12445022) was also associated with cerebral white matter hyperintensities (OR [95% CI] = 1.10 [1.05-1.16]; p = 5.3 × 10(-5) ; N = 3, 70), but not intracerebral hemorrhage (OR [95% CI] = 0.97 [0.84-1.12]; p = 0.71; 1, 45 cases, 1, 81 controls). rs12445022 is associated with mRNA expression of ZCCHC14 in arterial tissues (p = 9.4 × 10(-7) ) and DNA methylation at probe cg16596957 in whole blood (p = 5.3 × 10(-6) ).\n 16q24.2 is associated with SVS. Associations of the locus with expression of ZCCHC14 and DNA methylation suggest the locus acts through changes to regulatory elements. Ann Neurol 2017;81:383-394.\n © 2016 The Authors. Annals of Neurology published by Wiley Periodicals, Inc. on behalf of American Neurological Association.\n\nSchmidt, Reinhold\n\n\n"
},
{
"text": "\n178087\nMassive open online courses (MOOCs) for long-distance education in geriatric medicine across Europe A pilot project launched by the consortium of the project "Screening for Chronic Kidney Disease among Older People": SCOPE project\n\nRoller-Wirnsberger, R\n\nZitta, S\n\nHerzog, C\n\nDornan, H\n\nLindner, S\n\nRehatschek, H\n\nHye, F\n\nKolosovski, L\n\nWirnsberger, G\n\nCorsonello, A\n\nTap, L\n\nKostka, T\n\nGuligowska, A\n\nMattace-Raso, F\n\nGil, P\n\nFuentes, LG\n\nArtzi-Medvedik, R\n\nYehoshua, I\n\nFormiga, F\n\nMoreno-Gonzalez, R\n\nSieber, C\n\nFreiberger, E\n\nArnlov, J\n\nCarlsson, AC\n\nLattanzio, F\n\nBeiträge in Fachzeitschriften\nISI:000490886700001\nNone\n10.1007/s41999-019-00252-7\nNone\nPurpose To cover the increasing need for professional knowledge, skills and competences in the care of older people, new learning techniques have been developed. Using the Internet to provide educational material has come into focus of many academic institutions as the learning content can easily be transferred to a larger audience. Since the first launch of a "massive open online course" (MOOC) in 2008, this educational format has raised increasing interest among education experts. The current publication provides insight into the new format of MOOCs in general and specifically describes a MOOC developed by a Pan-European Consortium "Screening for Chronic Kidney Disease (CKD) among Older People across Europe" (SCOPE), a project funded by the European Commission under the umbrella of the Horizon 2020 program. Methods Technical background, learning theories and content of the MOOC of the SCOPE project are presented in this overview. Results The MOOC of the SCOPE project is provided on the MOOC ICT platform iMoox. The courses are built up of video clips, textual descriptions, graphics, animations and audio designed with a clear structure and learning goals. The concise video clips with a maximum length of 15-20 min are equipped with additional learning material such as documents, links and asynchronous communication opportunities. Conclusion MOOCs are recognized as a contemporary approach to transfer required knowledge and skills not only in general but also in geriatric medicine, as the health and social care environment is ever-changing and becoming more complex. Key summary pointsAim The aim of the paper is to give insight into MOOCs in general and to specifically describe a MOOC developed in the course of the SCOPE project "Screening for Chronic Kidney Disease (CKD) among older People across Europe". Findings The major target of the MOOC was the improvement of knowledge for a broad audience. The SCOPE MOOCs are freely accessible, structured in three modules, offer additional learning material and guarantee knowledge dissemination about aging and chronic kidney diseases. Message The MOOCs represent a contemporary example of how modern technology is supporting a transition to modern training in geriatrics.\n\nHerzog, Carolin\n\nHye, Florian\n\nLindner, Sonja\n\nRehatschek, Herwig\n\nRoller-Wirnsberger, Regina\n\nWirnsberger, Gerhard\n\nZitta, Sabine\n\n\n"
}
]
}