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"text": "\n1399\nInterstitial hyperthermia and high dose rate brachytherapy in the treatment of anal cancer: a phase I/II study.\n\nKapp, KS\n\nKapp, DS\n\nStuecklschweiger, G\n\nBerger, A\n\nGeyer, E\n\nBeiträge in Fachzeitschriften\nISI:A1994MP35300024\n8270441.0\n10.1016/0360-3016(94)90157-0\nNone\nThe rate of local failure is sufficiently high following sphincter conserving surgery and radiation therapy for advanced anal cancers to warrant investigation of improved local treatment techniques. This Phase I/II study was undertaken to investigate the site-specific toxicities and response of Stage II and III anal cancers to interstitial thermoradiotherapy using a hot water interstitial system.\n Between September 1988 and March 1991, 14 patients with primary carcinomas of the anal canal, UICC Stage T2-3, N0-1, M0, were treated with split-course external beam irradiation to the pelvis (30 Gy + 20 Gy) and 1 or 2 interstitial Iridium-192 high dose rate (Ir-192 HDR) implants (6-8 Gy each) immediately followed by interstitial hyperthermia (HT). Patients with tumor diameters > 3 cm were scheduled to receive chemotherapy consisting of 2 courses of 5-fluorouracil and mitomycin C given concomitantly with external beam radiation. Interstitial hyperthermia was induced by circulating warm water through the needles that were implanted to hold the Ir-192 source. The treatment goal was to achieve and maintain a temperature of 42.5 degrees C over a time period of 40 min. A 3-point thermocouple probe inserted into one or two additional needles was used for thermometry. The temperatures were recorded by manual mapping along these needles at steps of 0.5 or 1 cm.\n A total of 20 Ir-192 HDR-HT implants were performed in 14 patients. All but two patients completed the external beam irradiation; five patients received concomitant chemotherapy. Analysis of thermal parameters showed that minimum intratumoral temperatures (Tmin) of 42 degrees C, 42.5 degrees C, 43 degrees C, and 44 degrees C were achieved in 64%, 37.5%, 14%, and 7% of patients, respectively. Intratumoral mean Tmin, mean average, and mean maximum temperatures for these patients were 41.7 degrees C, 42.4 degrees C, and 43.4 degrees C, respectively. Brachytherapy and HT were well tolerated. Clinical complete responses (cCR) were obtained in 11/14 (78.5%) patients, complete histopathological responses (pCR) in 10/14 (71%). Only one patient with pCR recurred and succumbed to her disease. Patients with persistent disease (1 minimal and 3 partial responders, including 1 cCR) underwent abdominal-perineal resection but subsequently died from local-regional recurrence. One patient with pCR died from unrelated causes. Median survival for all patients from onset of radiation to death or last follow-up is 26 months. Eight patients are alive disease-free after a follow-up ranging from 16-44 months (median: 30, mean: 30 months). Treatment complications were limited to two patients who developed persistent ulcers. Sphincter function was maintained in 50% of patients.\n This study demonstrates that interstitial warm water hyperthermia in combination with brachytherapy for anal carcinomas is feasible and did not add to complications when compared to studies employing external beam irradiation and brachytherapy alone. The thermal parameters obtained by the warm water system compare favorably to those reported by others using radiofrequency and microwave systems.\n\n\n"
},
{
"text": "\n176086\nComparison of the accuracy of human readers versus machine-learning algorithms for pigmented skin lesion classification: an open, web-based, international, diagnostic study.\n\nTschandl, P\n\nCodella, N\n\nAkay, BN\n\nArgenziano, G\n\nBraun, RP\n\nCabo, H\n\nGutman, D\n\nHalpern, A\n\nHelba, B\n\nHofmann-Wellenhof, R\n\nLallas, A\n\nLapins, J\n\nLongo, C\n\nMalvehy, J\n\nMarchetti, MA\n\nMarghoob, A\n\nMenzies, S\n\nOakley, A\n\nPaoli, J\n\nPuig, S\n\nRinner, C\n\nRosendahl, C\n\nScope, A\n\nSinz, C\n\nSoyer, HP\n\nThomas, L\n\nZalaudek, I\n\nKittler, H\n\nBeiträge in Fachzeitschriften\nISI:000473253800038\n31201137.0\n10.1016/S1470-2045(19)30333-X\nNone\nWhether machine-learning algorithms can diagnose all pigmented skin lesions as accurately as human experts is unclear. The aim of this study was to compare the diagnostic accuracy of state-of-the-art machine-learning algorithms with human readers for all clinically relevant types of benign and malignant pigmented skin lesions.\n For this open, web-based, international, diagnostic study, human readers were asked to diagnose dermatoscopic images selected randomly in 30-image batches from a test set of 1511 images. The diagnoses from human readers were compared with those of 139 algorithms created by 77 machine-learning labs, who participated in the International Skin Imaging Collaboration 2018 challenge and received a training set of 10 015 images in advance. The ground truth of each lesion fell into one of seven predefined disease categories: intraepithelial carcinoma including actinic keratoses and Bowen's disease; basal cell carcinoma; benign keratinocytic lesions including solar lentigo, seborrheic keratosis and lichen planus-like keratosis; dermatofibroma; melanoma; melanocytic nevus; and vascular lesions. The two main outcomes were the differences in the number of correct specific diagnoses per batch between all human readers and the top three algorithms, and between human experts and the top three algorithms.\n Between Aug 4, 2018, and Sept 30, 2018, 511 human readers from 63 countries had at least one attempt in the reader study. 283 (55·4%) of 511 human readers were board-certified dermatologists, 118 (23·1%) were dermatology residents, and 83 (16·2%) were general practitioners. When comparing all human readers with all machine-learning algorithms, the algorithms achieved a mean of 2·01 (95% CI 1·97 to 2·04; p<0·0001) more correct diagnoses (17·91 [SD 3·42] vs 19·92 [4·27]). 27 human experts with more than 10 years of experience achieved a mean of 18·78 (SD 3·15) correct answers, compared with 25·43 (1·95) correct answers for the top three machine algorithms (mean difference 6·65, 95% CI 6·06-7·25; p<0·0001). The difference between human experts and the top three algorithms was significantly lower for images in the test set that were collected from sources not included in the training set (human underperformance of 11·4%, 95% CI 9·9-12·9 vs 3·6%, 0·8-6·3; p<0·0001).\n State-of-the-art machine-learning classifiers outperformed human experts in the diagnosis of pigmented skin lesions and should have a more important role in clinical practice. However, a possible limitation of these algorithms is their decreased performance for out-of-distribution images, which should be addressed in future research.\n None.\n Copyright © 2019 Elsevier Ltd. All rights reserved.\n\nHofmann-Wellenhof, Rainer\n\nZalaudek, Iris\n\n\n"
},
{
"text": "\n161303\nEarly, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment.\n\nNovak, I\n\nMorgan, C\n\nAdde, L\n\nBlackman, J\n\nBoyd, RN\n\nBrunstrom-Hernandez, J\n\nCioni, G\n\nDamiano, D\n\nDarrah, J\n\nEliasson, AC\n\nde Vries, LS\n\nEinspieler, C\n\nFahey, M\n\nFehlings, D\n\nFerriero, DM\n\nFetters, L\n\nFiori, S\n\nForssberg, H\n\nGordon, AM\n\nGreaves, S\n\nGuzzetta, A\n\nHadders-Algra, M\n\nHarbourne, R\n\nKakooza-Mwesige, A\n\nKarlsson, P\n\nKrumlinde-Sundholm, L\n\nLatal, B\n\nLoughran-Fowlds, A\n\nMaitre, N\n\nMcIntyre, S\n\nNoritz, G\n\nPennington, L\n\nRomeo, DM\n\nShepherd, R\n\nSpittle, AJ\n\nThornton, M\n\nValentine, J\n\nWalker, K\n\nWhite, R\n\nBadawi, N\n\nBeiträge in Fachzeitschriften\nISI:000410140700018\n28715518.0\n10.1001/jamapediatrics.2017.1689\nNone\nCerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months' corrected age.\n To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy-specific early intervention that should follow early diagnosis to optimize neuroplasticity and function.\n This study systematically searched the literature about early diagnosis of cerebral palsy in MEDLINE (1956-2016), EMBASE (1980-2016), CINAHL (1983-2016), and the Cochrane Library (1988-2016) and by hand searching. Search terms included cerebral palsy, diagnosis, detection, prediction, identification, predictive validity, accuracy, sensitivity, and specificity. The study included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Findings are reported according to the PRISMA statement, and recommendations are reported according to the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument.\n Six systematic reviews and 2 evidence-based clinical guidelines met inclusion criteria. All included articles had high methodological Quality Assessment of Diagnostic Accuracy Studies (QUADAS) ratings. In infants, clinical signs and symptoms of cerebral palsy emerge and evolve before age 2 years; therefore, a combination of standardized tools should be used to predict risk in conjunction with clinical history. Before 5 months' corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity). After 5 months' corrected age, the most predictive tools for detecting risk are magnetic resonance imaging (86%-89% sensitivity) (where safe and feasible), the Hammersmith Infant Neurological Examination (90% sensitivity), and the Developmental Assessment of Young Children (83% C index). Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and magnetic resonance imaging and the Hammersmith Infant Neurological Examination may be helpful in assisting clinical decisions. In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence.\n Early diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.\n\nEinspieler, Christa\n\n\n"
},
{
"text": "\n164021\nLong-term follow-up of IPEX syndrome patients after different therapeutic strategies: An international multicenter retrospective study.\n\nBarzaghi, F\n\nAmaya Hernandez, LC\n\nNeven, B\n\nRicci, S\n\nKucuk, ZY\n\nBleesing, JJ\n\nNademi, Z\n\nSlatter, MA\n\nUlloa, ER\n\nShcherbina, A\n\nRoppelt, A\n\nWorth, A\n\nSilva, J\n\nAiuti, A\n\nMurguia-Favela, L\n\nSpeckmann, C\n\nCarneiro-Sampaio, M\n\nFernandes, JF\n\nBaris, S\n\nOzen, A\n\nKarakoc-Aydiner, E\n\nKiykim, A\n\nSchulz, A\n\nSteinmann, S\n\nNotarangelo, LD\n\nGambineri, E\n\nLionetti, P\n\nShearer, WT\n\nForbes, LR\n\nMartinez, C\n\nMoshous, D\n\nBlanche, S\n\nFisher, A\n\nRuemmele, FM\n\nTissandier, C\n\nOuachee-Chardin, M\n\nRieux-Laucat, F\n\nCavazzana, M\n\nQasim, W\n\nLucarelli, B\n\nAlbert, MH\n\nKobayashi, I\n\nAlonso, L\n\nDiaz De Heredia, C\n\nKanegane, H\n\nLawitschka, A\n\nSeo, JJ\n\nGonzalez-Vicent, M\n\nDiaz, MA\n\nGoyal, RK\n\nSauer, MG\n\nYesilipek, A\n\nKim, M\n\nYilmaz-Demirdag, Y\n\nBhatia, M\n\nKhlevner, J\n\nRichmond Padilla, EJ\n\nMartino, S\n\nMontin, D\n\nNeth, O\n\nMolinos-Quintana, A\n\nValverde-Fernandez, J\n\nBroides, A\n\nPinsk, V\n\nBallauf, A\n\nHaerynck, F\n\nBordon, V\n\nDhooge, C\n\nGarcia-Lloret, ML\n\nBredius, RG\n\nKałwak, K\n\nHaddad, E\n\nSeidel, MG\n\nDuckers, G\n\nPai, SY\n\nDvorak, CC\n\nEhl, S\n\nLocatelli, F\n\nGoldman, F\n\nGennery, AR\n\nCowan, MJ\n\nRoncarolo, MG\n\nBacchetta, R\n\nPrimary Immune Deficiency Treatment Consortium (PIDTC) and the Inborn Errors Working Party (IEWP) of the European Society for Blood and Marrow Transplantation (EBMT)\n\nBeiträge in Fachzeitschriften\nISI:000426974800024\n29241729.0\n10.1016/j.jaci.2017.10.041\nPMC6050203\nImmunodysregulation polyendocrinopathy enteropathy x-linked (IPEX) syndrome is a monogenic autoimmune disease caused by FOXP3 mutations. Because it is a rare disease, the natural history and response to treatments, including allogeneic hematopoietic stem cell transplantation (HSCT) and immunosuppression (IS), have not been thoroughly examined.\n This analysis sought to evaluate disease onset, progression, and long-term outcome of the 2 main treatments in long-term IPEX survivors.\n Clinical histories of 96 patients with a genetically proven IPEX syndrome were collected from 38 institutions worldwide and retrospectively analyzed. To investigate possible factors suitable to predict the outcome, an organ involvement (OI) scoring system was developed.\n We confirm neonatal onset with enteropathy, type 1 diabetes, and eczema. In addition, we found less common manifestations in delayed onset patients or during disease evolution. There is no correlation between the site of mutation and the disease course or outcome, and the same genotype can present with variable phenotypes. HSCT patients (n = 58) had a median follow-up of 2.7 years (range, 1 week-15 years). Patients receiving chronic IS (n = 34) had a median follow-up of 4 years (range, 2 months-25 years). The overall survival after HSCT was 73.2% (95% CI, 59.4-83.0) and after IS was 65.1% (95% CI, 62.8-95.8). The pretreatment OI score was the only significant predictor of overall survival after transplant (P = .035) but not under IS.\n Patients receiving chronic IS were hampered by disease recurrence or complications, impacting long-term disease-free survival. When performed in patients with a low OI score, HSCT resulted in disease resolution with better quality of life, independent of age, donor source, or conditioning regimen.\n Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.\n\nSeidel, Markus\n\n\n"
},
{
"text": "\n145562\nHydraulic resistance of biofilms\n\nDreszer, C\n\nVrouwenvelder, JS\n\nPaulitsch-Fuchs, AH\n\nZwijnenburg, A\n\nKruithof, JC\n\nFlemming, HC\n\nBeiträge in Fachzeitschriften\nISI:000314115500047\nNone\n10.1016/j.memsci.2012.11.030\nNone\nBiofilms may interfere with membrane performance in at least three ways: (i) increase of the transmembrane pressure drop, (ii) increase of feed channel (feed-concentrate) pressure drop, and (iii) increase of transmembrane passage. Given the relevance of biofouling, it is surprising how few data exist about the hydraulic resistance of biofilms that may affect the transmembrane pressure drop and membrane passage. In this study, biofilms were generated in a lab scale cross flow microfiltration system at two fluxes (20 and 100 L m(-2) h(-1)) and constant cross flow (0.1 m s(-1)). As a nutrient source, acetate was added (1.0 mg L-1 acetate C) besides a control without nutrient supply. A microfiltration (MF) membrane was chosen because the MF membrane resistance is very low compared to the expected biofilm resistance and, thus, biofilm resistance can be determined accurately. Transmembrane pressure drop was monitored. As biofilm parameters, thickness, total cell number, TOC, and extracellular polymeric substances (EPS) were determined, it was demonstrated that no internal membrane fouling occurred and that the fouling layer actually consisted of a grown biofilm and was not a filter cake of accumulated bacterial cells. At 20 L m(-2) h(-1) flux with a nutrient dosage of 1 mg L-1 acetate C, the resistance after 4 days reached a value of 6 x 10(12) m(-1). At 100 L m(-2) h(-1) flux under the same conditions, the resistance was 5 x 10(13) m(-1). No correlation of biofilm resistance to biofilm thickness was found; Biofilms with similar thickness could have different resistance depending on the applied flux. The cell number in biofilms was between 4 x 10(7) and 5 x 10(8) cells cm(-2). At this number, bacterial cells make up less than a half percent of the overall biofilm volume and therefore did not hamper the water flow through the biofilm significantly. A flux of 100 L m(-2) h(-1) with nutrient supply caused higher cell numbers, more biomass, and higher biofilm resistance than a flux of 20 L m(-2) h(-1). However, the biofilm thickness after 4 days at a flux of 100 L m(-2) h(-1) (97 mu m) was in the same order of magnitude as the thickness of a biofilm at a flux of 20 L m(-2) h(-1) (114 mu m). An increase of flux caused an increased biofilm resistance while a decrease of flux caused a decreased resistance. The effect was reversible. It is suggested that the biofilm resistance is mainly attributed to EPS, probably due to the tortuosity ("hair-in-sink-effect") of the biopolymers to water molecules travelling across the biofilm. The data show clearly that biofilm resistance (6 x 10(12) m(-1)) was high compared to the intrinsic resistance of the employed MF membrane (5 x 10(11) m(-1)). However, in nanofiltration (intrinsic membrane resistance ca. 2 x 10(13) m(-1)) and reverse osmosis membranes (intrinsic resistance ca. 9 x 10(13) m(-1)), the biofilm will not contribute significantly to the overall resistance. (C) 2012 Elsevier By. All rights reserved.\n\nPaulitsch-Fuchs, Astrid Helga\n\n\n"
},
{
"text": "\n187360\nLong-term efficacy and safety of drug-coated balloons versus drug-eluting stents for small coronary artery disease (BASKET-SMALL 2): 3-year follow-up of a randomised, non-inferiority trial.\n\nJeger, RV\n\nFarah, A\n\nOhlow, MA\n\nMangner, N\n\nMöbius-Winkler, S\n\nWeilenmann, D\n\nWöhrle, J\n\nStachel, G\n\nMarkovic, S\n\nLeibundgut, G\n\nRickenbacher, P\n\nOsswald, S\n\nCattaneo, M\n\nGilgen, N\n\nKaiser, C\n\nScheller, B\n\nBASKET-SMALL 2 Investigators\n\nBeiträge in Fachzeitschriften\nNone\n33091360.0\n10.1016/S0140-6736(20)32173-5\nNone\nIn the treatment of de-novo coronary small vessel disease, drug-coated balloons (DCBs) are non-inferior to drug-eluting stents (DESs) regarding clinical outcome up to 12 months, but data beyond 1 year is sparse. We aimed to test the long-term efficacy and safety of DCBs regarding clinical endpoints in an all-comer population undergoing percutaneous coronary intervention.\n In this prespecified long-term follow-up of a multicentre, randomised, open-label, non-inferiority trial, patients from 14 clinical sites in Germany, Switzerland, and Austria with de-novo lesions in coronary vessels <3 mm and an indication for percutaneous coronary intervention were randomly assigned 1:1 to DCB or second-generation DES and followed over 3 years for major adverse cardiac events (ie, cardiac death, non-fatal myocardial infarction, and target-vessel revascularisation [TVR]), all-cause death, probable or definite stent thrombosis, and major bleeding (Bleeding Academic Research Consortium bleeding type 3-5). Analyses were performed on the full analysis set according to the modified intention-to-treat principle. Dual antiplatelet therapy was recommended for 1 month after DCB and 6 months after DES with stable symptoms, but 12 months with acute coronary syndromes. The study is registered with ClinicalTrials.gov, NCT01574534 and is ongoing.\n Between April 10, 2012, and Feb 1, 2017, of 883 patients assessed, 758 (86%) patients were randomly assigned to the DCB group (n=382) or the DES group (n=376). The Kaplan-Meier estimate of the rate of major adverse cardiac events was 15% in both the DCB and DES groups (hazard ratio [HR] 0·99, 95% CI 0·68-1·45; p=0·95). The two groups were also very similar concerning the single components of adverse cardiac events: cardiac death (Kaplan-Meier estimate 5% vs 4%, HR 1·29, 95% CI 0·63-2·66; p=0·49), non-fatal myocardial infarction (both Kaplan-Meier estimate 6%, HR 0·82, 95% CI 0·45-1·51; p=0·52), and TVR (both Kaplan-Meier estimate 9%, HR 0·95, 95% CI 0·58-1·56; p=0·83). Rates of all-cause death were very similar in DCB versus DES patients (both Kaplan-Meier estimate 8%, HR 1·05, 95% CI 0·62-1·77; p=0·87). Rates of probable or definite stent thrombosis (Kaplan-Meier estimate 1% vs 2%; HR 0·33, 95% CI 0·07-1·64; p=0·18) and major bleeding (Kaplan-Meier estimate 2% vs 4%, HR 0·43, 95% CI 0·17-1·13; p=0·088) were numerically lower in DCB versus DES, however without reaching significance.\n There is maintained efficacy and safety of DCB versus DES in the treatment of de-novo coronary small vessel disease up to 3 years.\n Swiss National Science Foundation, Basel Cardiovascular Research Foundation, and B Braun Medical.\n Copyright © 2020 Elsevier Ltd. All rights reserved.\n\nSchmidt, Albrecht\n\n\n"
},
{
"text": "\n6258\nDefining incident vertebral deformities in population studies: a comparison of morphometric criteria.\n\nLunt, M\n\nIsmail, AA\n\nFelsenberg, D\n\nCooper, C\n\nKanis, JA\n\nReeve, J\n\nSilman, AJ\n\nO'Neill, TW\n\nEuropean Prospective Osteoporosis Study Group\n\nBeiträge in Fachzeitschriften\nISI:000178720300007\n12378370.0\n10.1007/s001980200112\nNone\nVarious morphometric criteria have been used to define incident vertebral deformity. The aim of this analysis was to compare the relative validity of two established criteria and a novel method in which these criteria were combined. Men and women aged 50 years and over were recruited from population registers across Europe and had lateral spinal radiographs performed using a standard protocol. A subsample of individuals had bone mineral density (BMD) at the spine or femoral neck. Subjects were followed prospectively and a subsample had repeat spinal radiographs a median of 3.8 years after the baseline survey. All radiographs were evaluated morphometrically in the radiology coordinating center in Berlin. Anterior, middle and posterior height were recorded in all vertebrae from T4 to L4. On the basis of these morphometric measurements incident vertebral deformity was defined using one of three methods: (i) the change method - a change in any vertebral height of 20% or more between films, plus the additional requirement that a vertebral body have changed in absolute vertebral height by 4 mm or more; (ii) the point prevalence method, where a vertebra satisfies criteria for a prevalent deformity (McCloskey-Kanis) on the follow-up, though not the baseline film; (iii) a combination of the height reduction and the point prevalence criteria. Paired films were also evaluated qualitatively by an experienced radiologist for the presence of incident vertebral deformity. Logistic regression was used to compare the three morphometric methods using known risk factors for vertebral deformity including age, baseline vertebral deformity and BMD, and the qualitative evaluation. Computer simulation was used to determine the potential degree of bias and loss of statistical efficiency due to misclassification for each of the three methods, using the radiologist's assessment of incident deformity as the reference. Six thousand eight hundred subjects were included in this analysis. Of these 450 had sustained an incident vertebral deformity according to at least one of the three morphometric methods. The distribution of risk factors was similar in the subjects who satisfied only one morphometric criterion and those who satisfied neither. However, the subjects who satisfied both criteria had a very different distribution of risk factors: they were older, more likely to be female, more likely to have had a previous vertebral deformity and more likely to have an incident fracture in the opinion of an experienced radiologist. Using computer simulation, at low incidence levels, combining the criteria led to greater statistical efficiency and less bias in estimating associations with risk factors. Thus in this analysis the combination of the point prevalence and 20% change in height criterion for defining incident vertebral deformity showed a stronger relationship with clinical risk factors than either single criterion. Its application in population-based studies would increase the likelihood of detecting risk factors for incident vertebral deformity for a given sample size.\n\nWeber, Kurt\n\n\n"
},
{
"text": "\n146422\nPatellar tendinopathy: histopathological examination and follow-up of surgical treatment.\n\nPećina, M\n\nBojanić, I\n\nIvković, A\n\nBrčić, L\n\nSmoljanović, T\n\nSeiwerth, S\n\nBeiträge in Fachzeitschriften\nISI:000281535100003\n21059324.0\nNone\nNone\nThe aim of this study was to determine the exact localization of the histopathological process (bone, bone-tendon junction or tendon), and to determine whether the underlying pathologic process is predominantly of inflammatory or degenerative nature, then to evaluate the outcome of the surgical treatment of patellar tendinopathy.\n A prospective cohort study was performed in order to analyze the outcome of surgical treatment of patellar tendinopathy, as well as to document histopathological changes in bone, bone-tendon junction, and in the patellar ligament in 34 professional athletes treated with patellar apicotomy. All the patients included in the study were classified as stage 3 according to Blazina and showed no improvement after at least 6 months of conservative treatment. The postoperative follow-up was from 1 to 8 years with a mean value of 4.7 years.\n The postoperative results were analyzed using a semiquantitative scoring system where the functional outcome was classified as very good if the athlete returned to his sporting activity without any negative side effects, good if the athlete resumed his sporting activities with modest painful sensations present only at the maximum level of physical exertion, and poor if any reduction of athletic activity was present. In twenty patients a histopathological examination of resected bone and tendon tissue was performed. The specimens were stained with hematoxylin-eosin and examined under a light microscope using polarization. Special stains used were Alcian blue, to detect any increase in ground substance, and Prussian blue which enhances conspicuity of hyaline degeneration and enables detection of hemosiderin. Immunohistochemistry was performed in order to analyze presence of blood vessels, leukocytes and histiocytes.\n Very good results were achieved in 20 of operated knees, good results were achieved in 12 of knees and poor results were achieved in 2 of operated knees. Pathological changes in the bone were found in 35% of analyzed specimens, abnormality at the bone-tendon junction were found in 75% of the specimens, and changes in the patellar tendon were found in all extracted specimens. The histopatholological nature of the lesions found within the tendon tissue in all of the analyzed specimens belongs to the group of degenerative changes.\n Currently a consenus has been established that the expression tendinitis is "out", and the term tendinopathy should be used instead. No inflammatory cells and no increase in prostaglandins can be detected in the tendons. Histopathological studies of the tissue fibrils affected by tendinosis characteristically demonstrate hypercellularity, hypervascularity, lack of inflammatory infiltrates, and disorganization and loosening of collagen fibers.\n The clinical results and histopathological examination in our series justified our operative method. In the chronic stage these lesions are irreversible and constitute permanent intratendinous lesions. It thus seems logical to excise these lesions from their origin at the apex of the patella and entry into the adjacent tendon. It is also recommended on the basis of our and other authors' research that the term patellar tendinopathy should be used instead of tendonitis/tendinitis.\n\nBrcic, Luka\n\n\n"
},
{
"text": "\n162829\nGuidelines for the use of flow cytometry and cell sorting in immunological studies.\n\nCossarizza, A\n\nChang, HD\n\nRadbruch, A\n\nAkdis, M\n\nAndrä, I\n\nAnnunziato, F\n\nBacher, P\n\nBarnaba, V\n\nBattistini, L\n\nBauer, WM\n\nBaumgart, S\n\nBecher, B\n\nBeisker, W\n\nBerek, C\n\nBlanco, A\n\nBorsellino, G\n\nBoulais, PE\n\nBrinkman, RR\n\nBüscher, M\n\nBusch, DH\n\nBushnell, TP\n\nCao, X\n\nCavani, A\n\nChattopadhyay, PK\n\nCheng, Q\n\nChow, S\n\nClerici, M\n\nCooke, A\n\nCosma, A\n\nCosmi, L\n\nCumano, A\n\nDang, VD\n\nDavies, D\n\nDe Biasi, S\n\nDel Zotto, G\n\nDella Bella, S\n\nDellabona, P\n\nDeniz, G\n\nDessing, M\n\nDiefenbach, A\n\nDi Santo, J\n\nDieli, F\n\nDolf, A\n\nDonnenberg, VS\n\nDörner, T\n\nEhrhardt, GRA\n\nEndl, E\n\nEngel, P\n\nEngelhardt, B\n\nEsser, C\n\nEverts, B\n\nDreher, A\n\nFalk, CS\n\nFehniger, TA\n\nFilby, A\n\nFillatreau, S\n\nFollo, M\n\nFörster, I\n\nFoster, J\n\nFoulds, GA\n\nFrenette, PS\n\nGalbraith, D\n\nGarbi, N\n\nGarcía-Godoy, MD\n\nGeginat, J\n\nGhoreschi, K\n\nGibellini, L\n\nGoettlinger, C\n\nGoodyear, CS\n\nGori, A\n\nGrogan, J\n\nGross, M\n\nGrützkau, A\n\nGrummitt, D\n\nHahn, J\n\nHammer, Q\n\nHauser, AE\n\nHaviland, DL\n\nHedley, D\n\nHerrera, G\n\nHerrmann, M\n\nHiepe, F\n\nHolland, T\n\nHombrink, P\n\nHouston, JP\n\nHoyer, BF\n\nHuang, B\n\nHunter, CA\n\nIannone, A\n\nJäck, HM\n\nJávega, B\n\nJonjic, S\n\nJuelke, K\n\nJung, S\n\nKaiser, T\n\nKalina, T\n\nKeller, B\n\nKhan, S\n\nKienhöfer, D\n\nKroneis, T\n\nKunkel, D\n\nKurts, C\n\nKvistborg, P\n\nLannigan, J\n\nLantz, O\n\nLarbi, A\n\nLeibundGut-Landmann, S\n\nLeipold, MD\n\nLevings, MK\n\nLitwin, V\n\nLiu, Y\n\nLohoff, M\n\nLombardi, G\n\nLopez, L\n\nLovett-Racke, A\n\nLubberts, E\n\nLudewig, B\n\nLugli, E\n\nMaecker, HT\n\nMartrus, G\n\nMatarese, G\n\nMaueröder, C\n\nMcGrath, M\n\nMcInnes, I\n\nMei, HE\n\nMelchers, F\n\nMelzer, S\n\nMielenz, D\n\nMills, K\n\nMirrer, D\n\nMjösberg, J\n\nMoore, J\n\nMoran, B\n\nMoretta, A\n\nMoretta, L\n\nMosmann, TR\n\nMüller, S\n\nMüller, W\n\nMünz, C\n\nMulthoff, G\n\nMunoz, LE\n\nMurphy, KM\n\nNakayama, T\n\nNasi, M\n\nNeudörfl, C\n\nNolan, J\n\nNourshargh, S\n\nO'Connor, JE\n\nOuyang, W\n\nOxenius, A\n\nPalankar, R\n\nPanse, I\n\nPeterson, P\n\nPeth, C\n\nPetriz, J\n\nPhilips, D\n\nPickl, W\n\nPiconese, S\n\nPinti, M\n\nPockley, AG\n\nPodolska, MJ\n\nPucillo, C\n\nQuataert, SA\n\nRadstake, TRDJ\n\nRajwa, B\n\nRebhahn, JA\n\nRecktenwald, D\n\nRemmerswaal, EBM\n\nRezvani, K\n\nRico, LG\n\nRobinson, JP\n\nRomagnani, C\n\nRubartelli, A\n\nRuckert, B\n\nRuland, J\n\nSakaguchi, S\n\nSala-de-Oyanguren, F\n\nSamstag, Y\n\nSanderson, S\n\nSawitzki, B\n\nScheffold, A\n\nSchiemann, M\n\nSchildberg, F\n\nSchimisky, E\n\nSchmid, SA\n\nSchmitt, S\n\nSchober, K\n\nSchüler, T\n\nSchulz, AR\n\nSchumacher, T\n\nScotta, C\n\nShankey, TV\n\nShemer, A\n\nSimon, AK\n\nSpidlen, J\n\nStall, AM\n\nStark, R\n\nStehle, C\n\nStein, M\n\nSteinmetz, T\n\nStockinger, H\n\nTakahama, Y\n\nTarnok, A\n\nTian, Z\n\nToldi, G\n\nTornack, J\n\nTraggiai, E\n\nTrotter, J\n\nUlrich, H\n\nvan der Braber, M\n\nvan Lier, RAW\n\nVeldhoen, M\n\nVento-Asturias, S\n\nVieira, P\n\nVoehringer, D\n\nVolk, HD\n\nvon Volkmann, K\n\nWaisman, A\n\nWalker, R\n\nWard, MD\n\nWarnatz, K\n\nWarth, S\n\nWatson, JV\n\nWatzl, C\n\nWegener, L\n\nWiedemann, A\n\nWienands, J\n\nWillimsky, G\n\nWing, J\n\nWurst, P\n\nYu, L\n\nYue, A\n\nZhang, Q\n\nZhao, Y\n\nZiegler, S\n\nZimmermann, J\n\nBeiträge in Fachzeitschriften\nISI:000415363800006\n29023707.0\n10.1002/eji.201646632\nNone\nNone\n\nKroneis, Thomas\n\n\n"
},
{
"text": "\n178149\nPapillary urothelial neoplasm of low malignant potential (PUN-LMP): Still a meaningful histo-pathological grade category for Ta, noninvasive bladder tumors in 2019?\n\nHentschel, AE\n\nvan Rhijn, BWG\n\nBründl, J\n\nCompérat, EM\n\nPlass, K\n\nRodríguez, O\n\nHenríquez, JDS\n\nHernández, V\n\nde la Peña, E\n\nAlemany, I\n\nTurturica, D\n\nPisano, F\n\nSoria, F\n\nČapoun, O\n\nBauerová, L\n\nPešl, M\n\nBruins, HM\n\nRunneboom, W\n\nHerdegen, S\n\nBreyer, J\n\nBrisuda, A\n\nScavarda-Lamberti, A\n\nCalatrava, A\n\nRubio-Briones, J\n\nSeles, M\n\nMannweiler, S\n\nBosschieter, J\n\nKusuma, VRM\n\nAshabere, D\n\nHuebner, N\n\nCotte, J\n\nMertens, LS\n\nCohen, D\n\nLunelli, L\n\nCussenot, O\n\nSheikh, SE\n\nVolanis, D\n\nCoté, JF\n\nRouprêt, M\n\nHaitel, A\n\nShariat, SF\n\nMostafid, AH\n\nNieuwenhuijzen, JA\n\nZigeuner, R\n\nDominguez-Escrig, JL\n\nHacek, J\n\nZlotta, AR\n\nBurger, M\n\nEvert, M\n\nHulsbergen-van de Kaa, CA\n\nvan der Heijden, AG\n\nKiemeney, LALM\n\nSoukup, V\n\nMolinaro, L\n\nGontero, P\n\nLlorente, C\n\nAlgaba, F\n\nPalou, J\n\nN'Dow, J\n\nBabjuk, M\n\nvan der Kwast, TH\n\nSylvester, RJ\n\nBeiträge in Fachzeitschriften\nISI:000533854600015\n31704141.0\n10.1016/j.urolonc.2019.10.002\nNone\nPapillary urothelial neoplasm of low malignant potential (PUN-LMP) was introduced as a noninvasive, noncancerous lesion and a separate grade category in 1998. Subsequently, PUN-LMP was reconfirmed by World Health Organization (WHO) 2004 and WHO 2016 classifications for urothelial bladder tumors.\n To analyze the proportion of PUN-LMP diagnosis over time and to determine its prognostic value compared to Ta-LG (low-grade) and Ta-HG (high-grade) carcinomas. To assess the intraobserver variability of an experienced uropathologist assigning (WHO) 2004/2016 grades at 2 time points.\n Individual patient data of 3, 11 primary Ta bladder tumors from 17 hospitals in Europe and Canada were available. Transurethral resection of the tumor was performed between 1990 and 2018. Time to recurrence and progression were analyzed with cumulative incidence functions, log-rank tests and multivariable Cox-regression stratified by institution. Intraobserver variability was assessed by examining the same 314 transurethral resection of the tumorslides twice, in 2004 and again in 2018.\n PUN-LMP represented 3.8% (127/3, 11) of Ta tumors. The same pathologist found 71/314 (22.6%) PUN-LMPs in 2004 and only 20/314 (6.4%) in 2018. Overall, the proportion of PUN-LMP diagnosis substantially decreased over time from 31.3% (1990-2000) to 3.2% (2000-2010) and to 1.1% (2010-2018). We found no difference in time to recurrence between the three WHO 2004/2016 Ta-grade categories (log-rank, P = 0.381), nor for LG vs. PUN-LMP (log-rank, P = 0.238). Time to progression was different for all grade categories (log-rank, P < 0.001), but not between LG and PUN-LMP (log-rank, P = 0.096). Multivariable analyses on recurrence and progression showed similar results for all 3 grade categories and for LG vs. PUN-LMP.\n The proportion of PUN-LMP has decreased to very low levels in the last decade. Contrary to its reconfirmation in the WHO 2016 classification, our results do not support the continued use of PUN-LMP as a separate grade category in Ta tumors because of the similar prognosis for PUN-LMP and Ta-LG carcinomas.\n Copyright © 2019 Elsevier Inc. All rights reserved.\n\nMannweiler, Sebastian\n\nSeles, Maximilian\n\nZigeuner, Richard\n\n\n"
},
{
"text": "\n181066\nWhat are the Implications of Excessive Internet Searches for Medical Information by Orthopaedic Patients?\n\nBlackburn, J\n\nFischerauer, SF\n\nTalaei-Khoei, M\n\nChen, NC\n\nOh, LS\n\nVranceanu, AM\n\nBeiträge in Fachzeitschriften\nISI:000509670400013\n31764332.0\n10.1097/CORR.0000000000000888\nPMC6907317\nCyberchondria may be defined as heightened distress evoked through excessive searches of the internet for medical information. In healthy people, cyberchondria is associated with a greater intolerance of uncertainty and greater health anxiety. These relationships are likely bidirectional. People who have a greater intolerance of uncertainty may be more likely to search the internet for medical information and have greater health anxiety. This greater health anxiety may lead to an increased likelihood of engaging in further internet searches and greater intolerance of uncertainty. These three constructs are important for patients because they impact patient function and health care costs. We were specifically interested in understanding the role of cyberchondria in the association between intolerance of uncertainty and health anxiety among orthopaedic patients because it has not been explored before and because knowledge about these interactions could inform treatment recommendations.\n Does cyberchondria mediate (that is, explain) the association between intolerance of uncertainty and health anxiety in orthopaedic patients searching for medical information on the internet, after controlling for potentially confounding variables?\n This was a cross-sectional study of 104 patients who had searched the internet for any medical information about their current condition. A research assistant approached 155 patients attending two orthopaedic outpatient clinics, one hand and upper extremity service and one sports medicine clinic, during a 3-month period. Ten patients declined to participate and 41 patients were excluded, predominantly because they had never searched for medical information online. The patients completed the Cyberchondria Severity Scale, Intolerance of Uncertainty Scale-short version, Short Health Anxiety Inventory, and a numerical rating scale for pain intensity at baseline, as well as demographic and clinical questionnaires. We performed a series of linear regression analyses to determine whether a greater intolerance of uncertainty predicts greater cyberchondria (mediator) and whether cyberchondria predicts greater health anxiety. Although it is more appropriate to use the language of association (such as "whether cyberchondria is associated with health anxiety") in many observational studies, here, we opted to use the language of causation because this is the conventional language for studies testing statistical mediation.\n After controlling for potentially confounding variables including pain intensity, multiple pain conditions, and education, cyberchondria explained 33% of the variance of the effect of intolerance of uncertainty on health anxiety (95% CI, 6.98 to 114.72%; p < 0.001).\n Among orthopaedic patients who search the internet for medical information, a greater intolerance of uncertainty is associated with greater cyberchondria, which is associated with greater anxiety about health. Identifying patients with an intolerance of uncertainty and educating them about the negative role of compulsive searches for medical information may improve the success of orthopaedic treatment. Orthopaedic surgeons should also consider making referrals for cognitive behavioral therapy in these instances to increase the patient's tolerance of uncertainty, decrease internet searching habits, and reduce anxiety about health.\n Level III, prognostic study.\n\nFischerauer, Stefan Franz\n\n\n"
},
{
"text": "\n182910\nSpontaneous twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 249 cases.\n\nTollenaar, LSA\n\nSlaghekke, F\n\nLewi, L\n\nColmant, C\n\nLanna, M\n\nWeingertner, AS\n\nRyan, G\n\nArévalo, S\n\nKlaritsch, P\n\nTavares de Sousa, M\n\nKhalil, A\n\nPapanna, R\n\nGardener, GJ\n\nBevilacqua, E\n\nKostyukov, KV\n\nBahtiyar, MO\n\nKilby, MD\n\nTiblad, E\n\nOepkes, D\n\nLopriore, E\n\nBeiträge in Fachzeitschriften\nISI:000614552600018\n32730900.0\n10.1016/j.ajog.2020.07.041\nNone\nTwin anemia polycythemia sequence is a chronic form of unbalanced fetofetal transfusion through minuscule placental anastomoses in monochorionic twins, leading to anemia in the donor and polycythemia in the recipient. Owing to the low incidence of twin anemia polycythemia sequence, data on diagnosis, management, and outcome are limited.\n This study aimed to investigate the diagnosis, management, and outcome in a large international cohort of spontaneous twin anemia polycythemia sequence.\n Data from the international twin anemia polycythemia sequence registry, retrospectively collected between 2014 and 2019, were used for this study. A total of 17 fetal therapy centers contributed to the data collection. The primary outcomes were perinatal mortality and severe neonatal morbidity. Secondary outcomes included a risk factor analysis for perinatal mortality and severe neonatal morbidity.\n A total of 249 cases of spontaneous twin anemia polycythemia sequence were included in this study, 219 (88%) of which were diagnosed antenatally and 30 (12%) postnatally. Twin anemia polycythemia sequence was diagnosed antenatally at a median gestational age of 23.7 weeks (interquartile range, 9.7-28.8; range, 15.1-35.3). Antenatal management included laser surgery in 39% (86 of 219), expectant management in 23% (51 of 219), delivery in 16% (34 of 219), intrauterine transfusion (with partial exchange transfusion) in 12% (26 of 219), selective feticide in 8% (18 of 219), and termination of pregnancy in 1% (3 of 219) of cases. Perinatal mortality rate was 15% (72 of 493) for the total group, 22% (54 of 243) for donors, and 7% (18 of 242) for recipients (P<.001). Severe neonatal morbidity occurred in 33% (141 of 432) of twins with twin anemia polycythemia sequence and was similar for donors (32%; 63 of 196) and recipients (33%; 75 of 228) (P=.628). Independent risk factors for spontaneous perinatal mortality were donor status (odds ratio, 3.8; 95% confidence interval, 1.9-7.5; P<.001), antenatal twin anemia polycythemia sequence stage (odds ratio, 6.3; 95% confidence interval, 1.4-27.8; P=.016 [stage 2]; odds ratio, 9.6; 95% confidence interval, 2.1-45.5; P=.005 [stage 3]; odds ratio, 20.9; 95% confidence interval, 3.0-146.4; P=.002 [stage 4]), and gestational age at birth (odds ratio, 0.8; 95% confidence interval, 0.7-0.9; P=.001). Independent risk factors for severe neonatal morbidity were antenatal twin anemia polycythemia sequence stage 4 (odds ratio, 7.9; 95% confidence interval, 1.4-43.3; P=.018) and gestational age at birth (odds ratio, 1.7; 95% confidence interval, 1.5-2.1, P<.001).\n Spontaneous twin anemia polycythemia sequence can develop at any time in pregnancy from the beginning of the second trimester to the end of the third trimester. Management for twin anemia polycythemia sequence varies considerably, with laser surgery being the most frequent intervention. Perinatal mortality and severe neonatal morbidity were high, the former especially so in the donor twins.\n Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.\n\nGreimel, Patrick\n\nKlaritsch, Philipp\n\n\n"
},
{
"text": "\n112057\nHeart rate and functional impairment are predictors of outcome in heart failure patients in the real world. Data from the Austrian Heart Failure registry.\n\nFruhwald, FM\n\nUlmer, H\n\nPacher, R\n\nPölzl, G\n\nDornaus, C\n\nWieser, M\n\nEbner, C\n\nReiter, S\n\nKaltenbach, L\n\nAltenberger, J\n\nArbeitsgruppe Herzinsuffizienz der Österreichischen Kardiologischen Gesellschaft\n\nBeiträge in Fachzeitschriften\nISI:000292267800009\n21614457.0\n10.1007/s00508-011-1591-6\nNone\nPURPOSE: Elevated heart rate (70 beats per minute-bpm or more) is a predictor of impaired prognosis in patients with ischemic heart failure. The Austrian Working Group on Heart Failure has established a registry in May 2006 for all patients referred to dedicated heart failure clinics with a planned follow-up after 12 ± 3 months. Here we report an analysis of the prognostic impact of elevated heart rate at referral in a well-defined cohort of heart failure patients. METHODS: Between May 2006 and October 2009 1904 patients have been documented in the Austrian Heart Failure Registry. One thousand threehundred and sixty three patients (72%) had sinus rhythm at referral. Kaplan-Meier and Cox proportional hazards regression analyses were used to compare overall and cardiovascular mortality between high (70 bpm or more) and low heart-rate groups. Patients who were lost-to-follow-up (n = 166) were censored at the time of last contact. RESULTS: At baseline in 793 patients (58%) heart rate has been elevated (70 bpm or more) while in 562 patients it has been below 70 bpm, in 8 patients no baseline heart rate has been recorded. Groups were equally balanced regarding age, gender and cardiovascular risk factors with the exception of smokers (more active smokers in the high heart-rate group: 23 vs 14%; p = 0.001) and valvular cause of heart failure (more frequent in the high heart-rate group: 3% vs 1%; p = 0.012). Patients in the high heart-rate group had significantly higher median NT-pro-BNP (1470 pg/ml, IQR 499-4188 pg/ml) compared to patients in the low heart-rate group (784 pg/ml, IQR 314-2162 pg/ml; p < 0.001). NYHA functional classes III and IV have been more frequent in the high heart-rate group than in the low heart-rate group (32% and 22%, respectively; p < 0.001) while reduced left ventricular ejection fraction (39% or less) has been more frequent in the high heart-rate group than in the low heart-rate group (71% and 61%, respectively; p < 0.001). In the high heart-rate group treatment with beta-blockers has been less frequent than in the low heart rate group (76% and 86%, respectively; p < 0.01) while dosage of beta-blocker therapy has been comparable in both groups. Of the 75 patients who died within 3.5 years 38 deaths had a cardiovascular cause. Cox proportional hazards analysis revealed that high NYHA functional class (III and IV) and elevated heart rate (70 bpm or more) were the best predictors of overall mortality while cardiovascular mortality could best be predicted by NYHA functional classes III and IV. CONCLUSION: Higher NYHA-functional classes and elevated heart rate are predictors of adverse outcome in chronic heart failure patients.\n\nFruhwald, Friedrich\n\n\n"
},
{
"text": "\n63574\nFinal report of the early vs. late infantile strabismus surgery study (ELISSS), a controlled, prospective, multicenter study.\n\nSimonsz, HJ\n\nKolling, GH\n\nUnnebrink, K\n\nBeiträge in Fachzeitschriften\nNone\n16361188.0\n10.1080/09273970500416594\nNone\nBACKGROUND: The optimal age for surgery for infantile esotropia is controversial. Proponents of early surgery believe that further loss of binocular vision can be prevented by early surgery, a minority believes that binocular vision can even be restored by early surgery. The ELISSS compared early with late surgery in a prospective, controlled, non-randomized, multicenter trial. METHODS: Fifty-eight clinics recruited children aged 6-18 months for the study. Each clinic operated all eligible children either 'early', i.e. at age 6-24 months, or 'late', i.e. at age 32-60 months. At baseline the angle of strabismus, refraction, degree of amblyopia and limitation of abduction were assessed. Intermediate examinations took place every six months. Children were evaluated at age six in the presence of independent observers. Primary endpoints were (i) level of binocular vision, (ii) manifest angle of strabismus at distance and (iii) remaining amblyopia. Secondary endpoints were number of operations, vertical strabismus, angle at near and the influence of surgical technique. RESULTS: A total of 231 children were recruited for early and 301 for late surgery. Age at entry examination was 11.1 months (SD 3.7 months) in the early group and 10.9 (SD 3.7) months in the late group. Refraction, amblyopia and limitation of abduction were distributed equally in the early and late groups, but the angle of strabismus was slightly larger in the early group. Dropout-rates were 26.0% in the early and 22.3% in the late group. At age six, 13.5% of the early vs. 3.9% of the late group recognized the Titmus Housefly; 3.0% of the early and 3.9% of the late group had stereopsis beyond Titmus Housefly. No significant difference was found for angle of strabismus. 35.1% of the early group and 34.8% of the late group did not have an angle between 0 degrees and 10 degrees , the thresholds set for re-operation. For ratio of the visual acuities (remaining amblyopia) there was a small but significant advantage for the early group. There was hardly any correlation between the baseline parameters and the primary endpoints. Children scheduled for early surgery had first been operated at 20 (SD 8.4) months, but 8.2% had not been operated at age six. Children scheduled for late surgery had been operated at 49.1 (SD 12.7) months, but 20.1% had not been operated at age six. The number of operations per child was 1.18 (SD 0.67) in the early and 0.99 (SD 0.64) in the late group. Age at recruitment, age that strabismus reportedly had started and refraction at entry examination were similar among operated and non-operated children. Only the angle of strabismus at entry predicted, to some extent, whether a child had been operated at age six. DISCUSSION: Children operated early had better gross stereopsis at age six as compared to children operated late. They had been operated more frequently, however, and a substantial number of children in both groups had not been operated at all.\n\nLangmann, Andrea\n\n\n"
},
{
"text": "\n182588\nFunctional Outcome of Intravenous Thrombolysis in Patients With Lacunar Infarcts in the WAKE-UP Trial.\n\nBarow, E\n\nBoutitie, F\n\nCheng, B\n\nCho, TH\n\nEbinger, M\n\nEndres, M\n\nFiebach, JB\n\nFiehler, J\n\nFord, I\n\nGalinovic, I\n\nNickel, A\n\nPuig, J\n\nRoy, P\n\nWouters, A\n\nMagnus, T\n\nThijs, V\n\nLemmens, R\n\nMuir, KW\n\nNighoghossian, N\n\nPedraza, S\n\nSimonsen, CZ\n\nGerloff, C\n\nThomalla, G\n\nWAKE-UP Investigators\n\nBeiträge in Fachzeitschriften\nISI:000474834200006\n30907934.0\n10.1001/jamaneurol.2019.0351\nPMC6563546\nThe rationale for intravenous thrombolysis in patients with lacunar infarcts is debated, since it is hypothesized that the microvascular occlusion underlying lacunar infarcts might not be susceptible to pharmacological reperfusion treatment.\n To study the efficacy and safety of intravenous thrombolysis among patients with lacunar infarcts.\n This exploratory secondary post hoc analysis of the WAKE-UP trial included patients who were screened and enrolled between September 2012 and June 2017 (with final follow-up in September 2017). The WAKE-UP trial was a multicenter, double-blind, placebo-controlled randomized clinical trial to study the efficacy and safety of intravenous thrombolysis with alteplase in patients with an acute stroke of unknown onset time, guided by magnetic resonance imaging. All 503 patients randomized in the WAKE-UP trial were reviewed for lacunar infarcts. Diagnosis of lacunar infarcts was based on magnetic resonance imaging and made by consensus of 2 independent investigators blinded to clinical information.\n The primary efficacy variable was favorable outcome defined by a score of 0 to 1 on the modified Rankin Scale at 90 days after stroke, adjusted for age and severity of symptoms.\n Of the 503 patients randomized in the WAKE-UP trial, 108 patients (including 74 men [68.5%]) had imaging-defined lacunar infarcts, whereas 395 patients (including 251 men [63.5%]) had nonlacunar infarcts. Patients with lacunar infarcts were younger than patients with nonlacunar infarcts (mean age [SD], 63 [12] years vs 66 [12] years; P = .003). Of patients with lacunar infarcts, 55 (50.9%) were assigned to treatment with alteplase and 53 (49.1%) to receive placebo. Treatment with alteplase was associated with higher odds of favorable outcome, with no heterogeneity of treatment outcome between lacunar and nonlacunar stroke subtypes. In patients with lacunar strokes, a favorable outcome was observed in 31 of 53 patients (59%) in the alteplase group compared with 24 of 52 patients (46%) in the placebo group (adjusted odds ratio [aOR], 1.67 [95% CI, 0.77-3.64]). There was 1 death and 1 symptomatic intracranial hemorrhage according to Safe Implementation of Thrombolysis in Stroke-Monitoring Study criteria in the alteplase group, while no death and no symptomatic intracranial hemorrhage occurred in the placebo group. The distribution of the modified Rankin Scale scores 90 days after stroke also showed a nonsignificant shift toward better outcomes in patients with lacunar infarcts treated with alteplase, with an adjusted common odds ratio of 1.94 (95% CI, 0.95-3.93).\n While the WAKE-UP trial was not powered to demonstrate the efficacy of treatment in subgroups of patients, the results indicate that the association of intravenous alteplase with functional outcome does not differ in patients with imaging-defined lacunar infarcts compared with those experiencing other stroke subtypes.\n\nFandler-Höfler, Simon\n\nFazekas, Franz\n\nGattringer, Thomas\n\nPichler, Alexander\n\n\n"
},
{
"text": "\n174173\nEvaluation of Low-Dose, Low-Frequency Oral Psoralen-UV-A Treatment With or Without Maintenance on Early-Stage Mycosis Fungoides: A Randomized Clinical Trial.\n\nVieyra-Garcia, P\n\nFink-Puches, R\n\nPorkert, S\n\nLang, R\n\nPöchlauer, S\n\nRatzinger, G\n\nTanew, A\n\nSelhofer, S\n\nPaul-Gunther, S\n\nHofer, A\n\nGruber-Wackernagel, A\n\nLegat, F\n\nPatra, V\n\nQuehenberger, F\n\nCerroni, L\n\nClark, R\n\nWolf, P\n\nBeiträge in Fachzeitschriften\nISI:000467501100005\n30892603.0\n10.1001/jamadermatol.2018.5905\nPMC6506892\nPsoralen-UV-A (PUVA) photochemotherapy is standard first-line treatment for skin-limited, early-stage mycosis fungoides capable of producing high initial complete response (CR) rates. However, much remains unknown about PUVA's therapeutic mechanisms, optimal duration and frequency of treatment, dose escalation, or use as maintenance therapy.\n To evaluate low-dose, low-frequency PUVA, and whether maintenance treatment extends disease-free remission in patients with mycosis fungoides.\n This prospective randomized clinical trial with defined PUVA dosing regimen was carried out in 5 centers (Graz, Vienna, Hietzing, Innsbruck, and Salzburg) across Austria. Patients with stage IA to IIA mycosis fungoides (n = 27) were enrolled in the study beginning March 13, 2013, with the last patient enrolled March 21, 2016. These patients were treated with oral 8-methoxypsoralen followed by UV-A exposure 2 times per week for 12 to 24 weeks until CR. Patients with CR were randomized to PUVA maintenance for 9 months (14 total exposures) or no maintenance. The study was conducted from April 27, 2012, to July 27, 2018. Data analysis of the primary end point was of the intention-to-treat population, and the secondary end point analysis was of the evaluable population.\n Efficacy of the PUVA regimen was determined by the rate of CR as defined by a modified severity-weighted assessment tool (mSWAT) score reduction to 0. Levels of proinflammatory molecules in serum and histologic features and percentage of clonal T cells in skin were assessed to search for biomarkers of clinical response.\n In 27 patients with mycosis fungoides, 19 (70%) were male with mean (range) age 61 (30-80) years. At baseline, patients with CR had a mean (range) mSWAT score of 18.6 (1-66) compared with 16.8 (3-46) in patients with partial response. The 12- to 24-week PUVA induction regimen reduced the mSWAT score in all patients and led to CR in 19 (70%) of 27 patients and a low mean cumulative UV-A dose of 78.5 J/cm2. The subsequent standardized 9-month PUVA maintenance phase prolonged median (range) disease-free remission from 4 (1-20) months to 15 (1-54) months (P = .02). High density of histologic infiltrate and high percentage of clonal TCR sequences in skin biopsy specimens at baseline were inversely associated with therapeutic response. No severe adverse effects were seen during the PUVA induction or maintenance phase.\n This proof-of-concept study identifies potential biomarkers for therapeutic response to PUVA in mycosis fungoides; it also demonstrates that low-dose, low-frequency PUVA appears to be highly effective, and maintenance treatment may extend disease-free remission.\n ClinicalTrials.gov identifier: NCT01686594.\n\nCerroni, Lorenzo\n\nFink-Puches, Regina\n\nGruber-Wackernagel, Alexandra\n\nHofer, Angelika\n\nLegat, Franz\n\nPatra, Vijaykumar\n\nQuehenberger, Franz\n\nVieyra Garcia, Pablo Augusto\n\nWolf, Peter\n\n\n"
},
{
"text": "\n176549\nGerman Mobile Apps in Rheumatology: Review and Analysis Using the Mobile Application Rating Scale (MARS).\n\nKnitza, J\n\nTascilar, K\n\nMessner, EM\n\nMeyer, M\n\nVossen, D\n\nPulla, A\n\nBosch, P\n\nKittler, J\n\nKleyer, A\n\nSewerin, P\n\nMucke, J\n\nHaase, I\n\nSimon, D\n\nKrusche, M\n\nBeiträge in Fachzeitschriften\nISI:000481506400001\n31381501.0\n10.2196/14991\nPMC6699116\nChronic rheumatic diseases need long-term treatment and professional supervision. Mobile apps promise to improve the lives of patients and physicians. In routine practice, however, rheumatology apps are largely unknown and little is known about their quality and safety.\n The aim of this study was to provide an overview of mobile rheumatology apps currently available in German app stores, evaluate app quality using the Mobile Application Rating Scale (MARS), and compile brief, ready-to-use descriptions for patients and rheumatologists.\n The German App Store and Google Play store were systematically searched to identify German rheumatology mobile apps for patient and physician use. MARS was used to independently assess app quality by 8 physicians, 4 using Android and 4 using iOS smartphones. Apps were randomly assigned so that 4 apps were rated by all raters and the remaining apps were rated by two Android and two iOS users. Furthermore, brief app descriptions including app developers, app categories, and features were compiled to inform potential users and developers.\n In total, 128 and 63 apps were identified in the German Google Play and App Store, respectively. After removing duplicates and only including apps that were available in both stores, 28 apps remained. Sixteen apps met the inclusion criteria, which were (1) German language, (2) availability in both app stores, (3) targeting patients or physicians as users, and (4) clearly including rheumatology or rheumatic diseases as subject matter. Exclusion criteria were (1) congress apps and (2) company apps with advertisements. Nine apps addressed patients and 7 apps addressed physicians. No clinical studies to support the effectiveness and safety of apps could be found. Pharmaceutical companies were the main developers of two apps. Rheuma Auszeit was the only app mainly developed by a patient organization. This app had the highest overall MARS score (4.19/5). Three out of 9 patient apps featured validated questionnaires. The median overall MARS score was 3.85/5, ranging from 2.81/5 to 4.19/5. One patient-targeted and one physician-targeted app had MARS scores >4/5. No significant rater gender or platform (iOS/Android) differences could be observed. The overall correlation between app store ratings and MARS scores was low and inconsistent between platforms.\n To our knowledge, this is the first study that systematically identified and evaluated mobile apps in rheumatology for patients and physicians available in German app stores. We found a lack of supporting clinical studies, use of validated questionnaires, and involvement of academic developers. Overall app quality was heterogeneous. To create high-quality apps, closer cooperation led by patients and physicians is vital.\n ©Johannes Knitza, Koray Tascilar, Eva-Maria Messner, Marco Meyer, Diana Vossen, Almut Pulla, Philipp Bosch, Julia Kittler, Arnd Kleyer, Philipp Sewerin, Johanna Mucke, Isabell Haase, David Simon, Martin Krusche. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 05.08.2019.\n\nBosch, Philipp\n\n\n"
},
{
"text": "\n174586\nCerebral regional tissue Oxygen Saturation to Guide Oxygen Delivery in preterm neonates during immediate transition after birth (COSGOD III): an investigator-initiated, randomized, multi-center, multi-national, clinical trial on additional cerebral tissue oxygen saturation monitoring combined with defined treatment guidelines versus standard monitoring and treatment as usual in premature infants during immediate transition: study protocol for a randomized controlled trial.\n\nPichler, G\n\nBaumgartner, S\n\nBiermayr, M\n\nDempsey, E\n\nFuchs, H\n\nGoos, TG\n\nLista, G\n\nLorenz, L\n\nKarpinski, L\n\nMitra, S\n\nKornhauser-Cerar, L\n\nAvian, A\n\nUrlesberger, B\n\nSchmölzer, GM\n\nBeiträge in Fachzeitschriften\nISI:000462317000001\n30894226.0\n10.1186/s13063-019-3258-y\nPMC6427901\nTransition immediately after birth is a complex physiological process. The neonate has to establish sufficient ventilation to ensure significant changes from intra-uterine to extra-uterine circulation. If hypoxia or bradycardia or both occur, as commonly happens during immediate transition in preterm neonates, cerebral hypoxia-ischemia may cause perinatal brain injury. The primary objective of the COSGOD phase III trial is to investigate whether it is possible to increase survival without cerebral injury in preterm neonates of less than 32 weeks of gestation by targeting cerebral tissue oxygen saturation (crSO2) using specified clinical treatment guidelines during the immediate transition period after birth (the first 15 min) in addition to the routine monitoring of arterial oxygen saturation (SpO2) and heart rate (HR).\n COSGOD III is an investigator-initiated, randomized, multi-center, multi-national, phase III clinical trial. Inclusion criteria are neonates of less than 32 weeks of gestation, decision to provide full life support, and parental informed consent. Exclusion criteria are severe congenital malformations of brain, heart, lung, or prenatal cerebral injury or a combination of these. The premature infants will be randomly assigned to study or control groups. Both groups will have a near-infrared spectroscopy (NIRS) device (left frontal), pulse oximeter (right palm/wrist), and electrocardiogram placed immediately after birth. In the study group, the crSO2, SpO2, and HR readings are visible, and the infant will receive treatment in accordance with defined treatment guidelines. In the control group, only SpO2 and HR will be visible, and the infant will receive routine treatment. The intervention period will last for the first 15 min after birth during the immediate transition period and resuscitation. Thereafter, each neonate will be followed up for primary outcome to term date or discharge. The primary outcome is mortality or cerebral injury (or both) defined as any intra-ventricular bleeding or cystic periventricular leukomalacia (or both). Secondary outcomes are neonatal morbidities.\n crSO2 monitoring during immediate transition has been proven to be feasible and improve cerebral oxygenation during immediate transition. The additional monitoring of crSO2 with dedicated interventions may improve outcome of preterm neonates as evidenced by increased survival without cerebral injury.\n ClinicalTrials.gov Identifier: NCT03166722 . Registered March 5, 2017.\n\nAvian, Alexander\n\nPichler, Gerhard\n\nUrlesberger, Berndt\n\n\n"
},
{
"text": "\n3327\nRelationship between different subcutaneous adipose tissue layers, fat mass, and leptin in response to short-term energy restriction in obese girls.\n\nSudi, KM\n\nTafeit, E\n\nMöller, R\n\nReiterer, E\n\nGallistl, S\n\nBorkenstein, MH\n\nBeiträge in Fachzeitschriften\nISI:000089820900008\n11534071.0\n10.1002/1520-6300(200011/12)12:6<803::AID-AJHB8>3.0.CO;2-0\nNone\nThis study addresses whether the expected relationship of 15 specified subcutaneous adipose tissue layers (SAT layers) from 1-neck to 15-calf and body fat mass (FM) with leptin was influenced by a weight-loss program. In 30 obese girls (10 prepubertal, 15 pubertal, and 5 late/postpubertal) SAT layers were measured by means of the optical device Lipometer. Fat mass (FM) was estimated indirectly by means of bioelectrical impedance. Leptin and insulin were determined by means of radioimmunoassays. All measurements were performed before (pre) and after (post) 3 weeks of low-caloric diet and physical training. At the beginning of the study, there were significant correlations for all estimates of adiposity and leptin (0.67 to 0.79; P < 0.0001). Five SAT layers from the upper body and the trunk (0.48 to 0.67; P < 0.01) but none from the abdominal region and lower extremities were correlated with leptin. FM together with SAT layers 4-upper back and 8-lower abdomen (negative slope) explained 79% of the variation in pre leptin values (P < 0.0001). The weight-loss program significantly reduced leptin (P < 0.0001), insulin (P = 0.04), estimates of adiposity (P < 0.0001), and SAT layers 4-upper back (P = 0.0006), 11-front thigh, 13-rear thigh, and 14-inner thigh (P between <0.03 and <0.01). Although significant, the reductions in the four SAT layers were small. Estimated fat-free mass was significantly increased after three weeks (P < 0.05). Changes in SAT layers from the upper extremities and from the trunk were inversely correlated to the decrease in leptin (P between <0.05 and <0.001). Initial leptin was the best correlate of the decrease in leptin (adj. R(2) = 0.815; P < 0.0001). However, when only changes in adiposity and insulin were considered in the regression model, changes in insulin contributed to the fall in leptin (adj. R(2) = 0.23; P = 0.004). When changes in SAT layers were added to the model, changes in SAT layers 2-triceps and 10-hip (negative slopes) contributed to the decrease in leptin (adj. R(2) = 0.48; P < 0.0001). After weight loss, correlations between estimates of post adiposity and post leptin (0.40, P = 0.01 to 0.57, P = 0.0005) were lower compared with pre values. SAT layers 4-upper back and 3-biceps contributed independently to post leptin values (adj. R(2) = 0.50; P < 0.0001). It is suggested that fat mass and SAT layers from the upper body are the main determinants of leptin in obese girls before weight loss. The diet and sports intervention program reduced leptin independent of the reduction in adiposity. The distribution of subcutaneous fat might be a stable correlate of circulating leptin after a short-term reduction in energy intake. Am. J. Hum. Biol. 12:803-813, 2000. Copyright 2000 Wiley-Liss, Inc.\n\nBorkenstein, Helmuth Martin\n\nFröhlich-Reiterer, Elke\n\nGallistl, Siegfried\n\nTafeit, Erwin\n\n\n"
},
{
"text": "\n178355\nThe contribution of frailty, cognition, activity of daily life and comorbidities on outcome in acutely admitted patients over 80 years in European ICUs: the VIP2 study.\n\nGuidet, B\n\nde Lange, DW\n\nBoumendil, A\n\nLeaver, S\n\nWatson, X\n\nBoulanger, C\n\nSzczeklik, W\n\nArtigas, A\n\nMorandi, A\n\nAndersen, F\n\nZafeiridis, T\n\nJung, C\n\nMoreno, R\n\nWalther, S\n\nOeyen, S\n\nSchefold, JC\n\nCecconi, M\n\nMarsh, B\n\nJoannidis, M\n\nNalapko, Y\n\nElhadi, M\n\nFjølner, J\n\nFlaatten, H\n\nVIP2 study group\n\nBeiträge in Fachzeitschriften\nISI:000499414900002\n31784798.0\n10.1007/s00134-019-05853-1\nPMC7223711\nPremorbid conditions affect prognosis of acutely-ill aged patients. Several lines of evidence suggest geriatric syndromes need to be assessed but little is known on their relative effect on the 30-day survival after ICU admission. The primary aim of this study was to describe the prevalence of frailty, cognition decline and activity of daily life in addition to the presence of comorbidity and polypharmacy and to assess their influence on 30-day survival.\n Prospective cohort study with 242 ICUs from 22 countries. Patients 80 years or above acutely admitted over a six months period to an ICU between May 2018 and May 2019 were included. In addition to common patients' characteristics and disease severity, we collected information on specific geriatric syndromes as potential predictive factors for 30-day survival, frailty (Clinical Frailty scale) with a CFS > 4 defining frail patients, cognitive impairment (informant questionnaire on cognitive decline in the elderly (IQCODE) with IQCODE ≥ 3.5 defining cognitive decline, and disability (measured the activity of daily life with the Katz index) with ADL ≤ 4 defining disability. A Principal Component Analysis to identify co-linearity between geriatric syndromes was performed and from this a multivariable model was built with all geriatric information or only one: CFS, IQCODE or ADL. Akaike's information criterion across imputations was used to evaluate the goodness of fit of our models.\n We included 3920 patients with a median age of 84 years (IQR: 81-87), 53.3% males). 80% received at least one organ support. The median ICU length of stay was 3.88 days (IQR: 1.83-8). The ICU and 30-day survival were 72.5% and 61.2% respectively. The geriatric conditions were median (IQR): CFS: 4 (3-6); IQCODE: 3.19 (3-3.69); ADL: 6 (4-6); Comorbidity and Polypharmacy score (CPS): 10 (7-14). CFS, ADL and IQCODE were closely correlated. The multivariable analysis identified predictors of 1-month mortality (HR; 95% CI): Age (per 1 year increase): 1.02 (1.-1.03, p = 0.01), ICU admission diagnosis, sequential organ failure assessment score (SOFA) (per point): 1.15 (1.14-1.17, p < 0.0001) and CFS (per point): 1.1 (1.05-1.15, p < 0.001). CFS remained an independent factor after inclusion of life-sustaining treatment limitation in the model.\n We confirm that frailty assessment using the CFS is able to predict short-term mortality in elderly patients admitted to ICU. Other geriatric syndromes do not add improvement to the prediction model. Since CFS is easy to measure, it should be routinely collected for all elderly ICU patients in particular in connection to advance care plans, and should be used in decision making.\n\nEller, Philipp\n\n\n"
}
]
}