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Meier J.,Kepler University Hospital
Best Practice and Research: Clinical Anaesthesiology | Year: 2016

Despite impressive progress in surgical technique, aortic surgery is still associated with relatively high morbidity and mortality. One of the most important contributors to this phenomenon is the triad of bleeding, anemia, and transfusion. All three factors are known to influence the outcome of aortic surgery to a great extent. However, over the last few years a multidisciplinary, multimodal concept has been established, which enables the physician to avoid bleeding, anemia, and transfusion as much as possible. The concept of "patient blood management" combines several established measures with the potential to improve perioperative outcome. This chapter describes these measures with regard to aortic surgery and assesses their respective efficacy. © 2016 Elsevier Ltd. Source

Ebner T.,Kepler University Hospital | Montag M.,Ilabcomm GmbH
Reproductive BioMedicine Online | Year: 2015

Artificial oocyte activation using Ca2+ionophores or similar compounds is a widely applied technique in IVF laboratories. This is all the more interesting as most of the agents aiming for intracellular Ca2+ increase do not result in physiological Ca2+ oscillations but much rather cause a single Ca2+ transient. Two observations from mammals may explain why a rather non-physiological single Ca2+ peak caused by ionophores is sufficient to rescue cycles showing severe male factor infertility, deficient oocyte maturation, developmental problems in humans, or both. On the one hand, it has been shown that it is mainly the initial Ca2+ rise that drives further downstream events, in particular calcium/calmodulin-dependent protein kinase II (CaMKII) action, and on the other, it is possible that this enzyme remains active even in the absence of Ca2+. It therefore seems that mammalian oocytes can respond to a wide range of intracellular Ca2+ signals and have a surprisingly high degree of tolerance for changes in cytosolic Ca2+. As epigenetic consequences or differences in gene expression have not been studied to date, artificial oocyte activation has to be considered as experimental and should only be applied with a proper indication. © 2015 Reproductive Healthcare Ltd. Source

Pieringer H.,Kepler University Hospital | Pieringer H.,University of Salzburg | Danninger K.,Klinikum Wels Grieskirchen | Puchner R.,Freiung 19 | And 2 more authors.
Clinical Rheumatology | Year: 2016

While there is a lot of evidence published on the association of cardiovascular (CV) disease and rheumatoid arthritis (RA), little is known about urinary albumin excretion (UAE)—a marker of CV risk—in this particular high-risk population. Therefore, we investigated UAE in a large cross-sectional study. We used data from the US National Health and Nutrition Examination Survey (NHANES), including the years 2007–2012. Primary outcome was the proportion of patients with a urinary albumin-creatinine ratio (ACR) >30 mg/g. A total of 14,648 study participants (representing a population size of 174,663,008) with available ACR were included in the study (14,179 without RA and 469 with RA). In the RA group, the proportion of patients with an ACR >30 mg/g was 10.46 % (95 % CI 7.47–14.45 %) and in the non-RA group this proportion was 13.39 % (95 % CI 12.65–14.16 %; p = 0.09). There was a strong association between RA and DM (OR 5.84; 95 % CI 4.48–7.62). In the RA group, significantly more patients had a former CV event (OR 3.01; 95 % CI 2.28–3.97). Adjustments for DM, smoking status, former CV event, age, systolic blood pressure, and gender did not substantially alter the association between RA and ACR >30 mg/g (OR 0.82; 95 % CI 0.51–1.33). We did not find evidence for a difference in UAE in patients with or without RA, despite the fact that RA was associated with DM and, in addition, RA patients more often had a previous CV event. These findings may support the assumption that despite an increased CV risk, UAE does not play a major role in RA patients. © 2016 International League of Associations for Rheumatology (ILAR) Source

Mejza F.,Jagiellonian University | Lamprecht B.,Kepler University Hospital | Lamprecht B.,Johannes Kepler University | Nizankowska-Mogilnicka E.,Jagiellonian University | Undas A.,Jagiellonian University
Pneumonologia i Alergologia Polska | Year: 2015

Chronic obstructive pulmonary disease (COPD) affects approximately 10% of adults older than 40 years and is an important causes of disability and death in elderly subjects. A large proportion of COPD patients suffer from cardiovascular comorbidities. Thromboembolic events contribute considerably to morbidity and mortality in these subjects. This review summarizes the current evidence regarding the association of COPD with increased thromboembolic risk. We discuss multiple mechanisms potentially linking these conditions and available pharmacological interventions reducing the risk of thrombotic arterial and venous events with special attention paid to new oral anticoagulants. © 2015 PTChP. Source

Lamprecht B.,Kepler University Hospital | Lamprecht B.,Johannes Kepler University | Soriano J.B.,Autonomous University of Madrid | Studnicka M.,Paracelsus Medical University | And 14 more authors.
Chest | Year: 2015

Background: COPD ranks within the top three causes of mortality in the global burden of disease, yet it remains largely underdiagnosed. We assessed the underdiagnosis of COPD and its determinants in national and international surveys of general populations. Methods: We analyzed representative samples of adults aged ≥ 40 years randomly selected from well-defined administrative areas worldwide (44 sites from 27 countries). Postbronchodilator FEV 1 /FVC < lower limit of normal (LLN) was used to define chronic airflow limitation consistent with COPD. Undiagnosed COPD was considered when participants had postbronchodilator FEV 1 /FVC < LLN but were not given a diagnosis of COPD. Results: Among 30,874 participants with a mean age of 56 years, 55.8% were women, and 22.9% were current smokers. Population prevalence of (spirometrically defined) COPD ranged from 3.6% in Barranquilla, Colombia, to 19.0% in Cape Town, South Africa. Only 26.4% reported a previous lung function test, and only 5.0% reported a previous diagnosis of COPD, whereas 9.7% had a postbronchodilator FEV 1 /FVC < LLN. Overall, 81.4% of (spirometrically defined) COPD cases were undiagnosed, with the highest rate in Ile-Ife, Nigeria (98.3%) and the lowest rate in Lexington, Kentucky (50.0%). In multivariate analysis, a greater probability of underdiagnosis of COPD was associated with male sex, younger age, never and current smoking, lower education, no previous spirometry, and less severe airflow limitation. Conclusions: Even with substantial heterogeneity in COPD prevalence, COPD underdiagnosis is universally high. Because effective management strategies are available for COPD, spirometry can help in the diagnosis of COPD at a stage when treatment will lead to better outcomes and improved quality of life. © 2015 American College of Chest Physicians. Source

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