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Neumünster, Germany

Schuchert A.,Medical Clinic | Muto C.,Loreto Mare Hospital | Maounis T.,Onassis Cardiac Surgery Center | Frank R.,Hospital Pitie Salpetriere | And 3 more authors.
Clinical Cardiology | Year: 2013

Background Cardiac resynchronization therapy (CRT) is an established therapy for patients with chronic heart failure (CHF) and a broad QRS complex. Gender-related safety and efficacy data are necessary for informed patient decision-making for female patients with CHF. The aim of the study was to assess the effects of gender on the outcome of CRT in highly symptomatic heart failure patients. Hypothesis Gender may have an effect on the outcome of heart failure patients undergoing cardiac resynchronisation therapy. Methods The study analyzed the 2-year follow-up of 393 New York Heart Association (NYHA) class III/IV patients with a class I CRT indication enrolled in the Management of Atrial Fibrillation Suppression in AF-HF Comorbidity Therapy (MASCOT) study. Results In female patients (n = 82), compared with male patients (n = 311), CHF was more often due to dilated cardiomyopathy (74% vs 44%, respectively; P < 0.0001). Females also had a more impaired quality-of-life score and a smaller left ventricular end-diastolic diameter (LVEDD). Women were less likely than men to have received a CRT defibrillator (35% vs 61%, respectively; P < 0.0001). After 2 years, the devices had delivered more biventricular pacing in women than in men (96% ± 13% vs 94% ± 13%, respectively; P < 0.0004). Women had a greater reduction in LVEDD than did men (-8.2 mm ± 11.1 mm vs -1.1 mm ± 22.1 mm, respectively; P < 0.02). Both genders improved similarly in NYHA functional class. Women reported greater improvement than men in quality-of-life score (-21.1 ± 26.5 vs -16.2 ± 22.1, respectively; P < 0.0001). After adjustment for cardiovascular history, women had lower all-cause mortality (P = 0.0007), less cardiac death (P = 0.04), and fewer hospitalizations for worsening heart failure (P = 0.01). Conclusions Females exhibited a better response to CRT than did males. Because females have such impressive benefits from CRT, improved screening and advocacy for CRT implantation in women should be considered. © 2013 Wiley Periodicals, Inc. Source

Softeland E.,University of Bergen | Dimcevski G.,University of Bergen | Graversen C.,Aarhus University Hospital | Nedreb B.G.,Medical Clinic | And 2 more authors.
Experimental and Clinical Endocrinology and Diabetes | Year: 2011

Aims: Gastrointestinal symptoms such as pain, bloating, nausea and vomiting are more frequent in pre-diabetic states as well as established diabetes, compared to healthy individuals. The mechanisms behind these symptoms are multi-factorial and complex. Furthermore, the effect of isolated hyperinsulinaemia on visceral and peripheral sensory function is poorly understood. Thus, the current study aimed to evaluate effects of acute hyperinsulinaemia on sensory function in healthy adults. Methods: The sensitivity to electrical oesophageal and median nerve stimulation was assessed in 15 healthy volunteers together with recording of evoked brain potentials. All subjects were studied both fasting and using a euglycaemic hyperinsulinaemic clamp. Results: There was on average a 15% increased sensitivity to oesophageal electrical stimulation during hyperinsulinaemia compared to fasting state (P<0.05), but the sensation after median nerve stimulation remained stable (P=0.58). No significant changes in latencies and amplitudes of evoked brain potentials were observed after oesophageal or median nerve stimulation (all P>0.05). Conclusions: This study suggests that acute isolated hyperinsulinaemia increases visceral sensitivity, but does not influence the somatic sensory function. The lack of changes in the evoked brain potentials may indicate that hyperinsulinaemia affects the visceral sensory system at a peripheral level. Our result suggests distinct functions of insulin in the various parts of the nervous system, and yields further clues to the significance of insulin as a satiety signal. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York. Source

Leebmann J.,Medical Clinic | Roeseler E.,Center for Nephrology | Julius U.,University Hospital | Heigl F.,MVZ Kempten Allgaeu | And 8 more authors.
Circulation | Year: 2013

Background-Lipoprotein(a) (Lp(a)) hyperlipoproteinemia is a major risk factor for cardiovascular disease, which is not affected by treatment of other cardiovascular risk factors. This study sought to assess the effect of chronic lipoprotein apheresis (LA) on the incidence of cardiovascular events in patients with progressive cardiovascular disease receiving maximally tolerated lipid-lowering treatment. Methods and Results-In a prospective observational multicenter study, 170 patients were investigated who commenced LA because of Lp(a)-hyperlipoproteinemia and progressive cardiovascular disease. Patients were characterized regarding plasma lipid status, lipid-lowering drug treatment, and variants at the LPA gene locus. The incidence rates of cardiovascular events 2 years before (y-2 and y-1) and prospectively 2 years during LA treatment (y+1, y+2) were compared. The mean age of patients was 51 years at the first cardiovascular event and 57 years at the first LA. Before LA, mean lowdensity lipoprotein cholesterol and Lp(a) were 2.56±1.04 mmolL-1 (99.0±40.1 mgdL-1) and Lp(a) 3.74±1.63 μmolL-1 (104.9±45.7 mgdL-1), respectively. Mean annual rates for major adverse coronary events declined from 0.41 for 2 years before LA to 0.09 for 2 years during LA (P<0.0001). Event rates including all vascular beds declined from 0.61 to 0.16 (P<0.0001). Analysis of single years revealed increasing major adverse coronary event rates from 0.30 to 0.54 (P=0.001) for y-2 to y-1 before LA, decline to 0.14 from y-1 to y+1 (P<0.0001) and to 0.05 from y+1 to y+2 (P=0.014). Conclusions-In patients with Lp(a)-hyperlipoproteinemia, progressive cardiovascular disease, and maximally tolerated lipid-lowering medication, LA effectively lowered the incidence rate of cardiovascular events. © 2013 American Heart Association, Inc. Source

Kemmerling R.,University of Salzburg | Stintzing S.,Ludwig Maximilians University of Munich | Muhlmann J.,Medical Clinic | Dietze O.,University of Salzburg | Neureiter D.,University of Salzburg
Oncology Reports | Year: 2010

Primary testicular lymphomas display mostly aggressive diffuse large cell B-cell lymphomas, which could be further subclassified into germinal center B-cell-like and an activated B-cell phenotype via immunohistochemistry. A retrospective analysis of primary testicular lymphomas diagnosed at the Institute of Pathology, Salzburger Landeskliniken (SALK) between January 1997 and December 2008 was done. Immunohistochemical staining and complete clinical data evaluation was carried out and linked to overall survival time. We found 18 cases of primary testicular lymphoma diagnosed in elderly patients showing no side predilection and having an aggressive clinical behavior with short overall survival independent of treatment. The lymphomas could for the most be classified into diffuse large cell B-cell lymphomas [15/18 (83.3%)] showing a non-significant prevalence of activated B cell phenotype [9/15 (60%)] compared to the germinal centre phenotype [6/15 (40%)]. Two of the cases were mantle cell lymphomas consisting of the infrequent pleomorphic subtype. The survival analysis revealed no significant difference for any of the investigated antigens. Primary testicular lymphomas are for the most DLBCL, but subtype classification reveal molecular heterogeneity inside this lymphoma entity. A distinction between those subtypes is necessary because of different clinical behavior and treatment. Source

Atreya R.,Friedrich - Alexander - University, Erlangen - Nuremberg | Neumann H.,Friedrich - Alexander - University, Erlangen - Nuremberg | Neufert C.,Friedrich - Alexander - University, Erlangen - Nuremberg | Waldner M.J.,Friedrich - Alexander - University, Erlangen - Nuremberg | And 18 more authors.
Nature Medicine | Year: 2014

As antibodies to tumor necrosis factor (TNF) suppress immune responses in Crohn's disease by binding to membrane-bound TNF (mTNF), we created a fluorescent antibody for molecular mTNF imaging in this disease. Topical antibody administration in 25 patients with Crohn's disease led to detection of intestinal mTNF + immune cells during confocal laser endomicroscopy. Patients with high numbers of mTNF + cells showed significantly higher short-term response rates (92%) at week 12 upon subsequent anti-TNF therapy as compared to patients with low amounts of mTNF + cells (15%). This clinical response in the former patients was sustained over a follow-up period of 1 year and was associated with mucosal healing observed in follow-up endoscopy. These data indicate that molecular imaging with fluorescent antibodies has the potential to predict therapeutic responses to biological treatment and can be used for personalized medicine in Crohn's disease and autoimmune or inflammatory disorders. © 2014 Nature America, Inc. Source

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