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Basel, Switzerland

De Munter J.P.J.M.,Amarna Therapeutics | Wolters E.C.,Universitatsspital
Journal of Neural Transmission | Year: 2013

Ischemic and traumatic insults of the central nervous system both result in definite chronic disability, only to some extent responsive to rehabilitation. Recently, the application of autologous stem cells (fresh bone marrow-derived mononuclear cells including mesenchymal and hematopoietic stem cells) was suggested to provide a strategy to further improve neurological recovery in these disorders. During the acute phase, stem cells act mainly by neuroprotection with prevention of apoptosis, whereas during the chronic situation they provide neurorestoration by transdifferentiation and/or the secretion of neurotrophic factors. To reach these goals, in the acute phase, stem cells (10 million mononuclear cells per kg body weight) might be best applied intravenously, as during the first 7 days after the lesion, the blood-brain barrier permits passage of cells from the blood into the brain or the spinal cord. In the more chronic situation, though, those cells might be applied best intrathecally by lumbar puncture. Based on the reported results so far, it seems justified to develop well-designed clinical double-blind trials in chronic spinal cord injury and ischemic stroke patients, as efficacy and safety concerns might not be answered by preclinical studies. © 2012 Springer-Verlag. Source

Bollini P.,Services for Medical Research Formed | Quack-Lotscher K.,Universitatsspital
Journal of Evaluation in Clinical Practice | Year: 2013

Rationale, aims and objectives No comprehensive measurement of quality of antenatal care is available. Late booking or low number of checks are often used as surrogate for poor quality, leaving uncertainty on the actual content of the care received. In order to fill this gap, we have reviewed two sets of clinical guidelines and developed corresponding indicators of quality. Method A group of clinicians and methodologists reviewed the National Institute for Clinical Excellency Clinical Guidelines on antenatal care, and the list of prenatal care interventions recommended by the Research and Development Group, both based on evidence of effectiveness of specific interventions. We identified single aspects in three domains: (1) services utilization; (2) screening; and (3) interventions. For each indicator, we defined: (1) eligibility, that is the characteristics of the women to whom the indicator applies; (2) standard, that is the situation when the target is met; and (3) moderators, that is all conditions which legitimately hamper the fulfilment of the standard. Results We developed four indicators of service utilization, 25 of screening and 17 of intervention. The respective eligibility, standard and moderators criteria were described for each indicator. While many indicators could be retrospectively evaluated from medical charts, quality of communication with provider, screening for sensible issues and counselling on behaviours to be avoided could only be obtained with a prospective data collection. Conclusions The indicators of quality of antenatal care, complemented by measures of social position, social support and immigrant/ethnic status, allow for a careful description of the gaps in quality of care for specific groups of women. © 2013 John Wiley & Sons Ltd. Source

The prevalence of a major depressive disorder in patients after myocardial infarction is 20%. Depression is a risk factor for incident coronary heart disease and poor prognosis after myocardial infarction. Poor lifestyle habits and adherence to cardiac therapy as well as metabolic and pathophysiologic changes may partially explain this link. The threatening experience of an acute coronary event and immune and inflammatory changes may be unique features contributing to incident depression after myocardial infarction. While psychotherapy, antidepressants, and physical exercise may alleviate depressive symptoms in patients with coronary heart disease, cardiac rehabilitation additionally reduces mortality risk. Attempts are being undertaken to identify the cardiotoxic characteristics of depression to develop even more effective therapies in the future. © 2014 Verlag Hans Huber, Hogrefe AG, Bern. Source

Component-resolved diagnosis of allergies allows disease-specific patterns of sensitization in some conditions such as allergic bronchopulmonary aspergillosis ABPA). By determination of IgE against important pollen allergens such as Bet v 1, Ole e 1 or Phl p1/Phl p 5, more precise guidance for allergen-specific immunotherapy may be achieved, as pollen extracts contain mostly these major allergens. Sensitizations against minor allergens such as profilins or polcalcins influence the outcome of IgE measurements against full allergen sources, but are often of limited clinical relevance. In food allergy, frequent cross reactivity between pollens such as birch pollen via Bet v 1/PR10 proteins can be identified. Sensitization against some storage proteins such as peanut (Ara h 2) or lipid transfer proteins of peach (Pru p 3) or hazelnut (Cor a 8) may indicate an increased risk of severe anaphylactic reactions. Exercise-induced anaphylaxis, unclear sensitizations against latex or double-positivity in insect allergy are other useful indications for component-resolved diagnosis. Microarray-based allergen chip diagnosis makes possible today the detection of IgE against more than 100 allergens in tiny amounts of serum and is very promising, but still needs evaluation and optimization in regard to allergen selection and sensitivity. © 2010 Springer-Verlag. Source

Transcatheter treatment of coronary artery disease (PCI) has transformed the purely diagnostic discipline cardiology into a semi-surgical specialty. The berth of the so-called interventional cardiology was the first PCI performed by Grüntzig in Zurich, Switzerland, on September 16, 1977. The patient was 38 years old and he is still in excellent health, 33 years later. Meanwhile, PCI has matured to the most important medical intervention worldwide considering its clinical and economical potential. It is estimated that globally 2-3 million PCIs are performed. In Austria over 20,000 PCIs are performed per year, in about 34 centers dispersed across the country. Today PCI numbers are 2-4 times larger than the numbers of the classical coronary artery by-pass operations, available since the 60ies. An increasingly early detection and invasive work-up of coronary artery disease favors PCI over by-pass surgery, which can be reserved to the advanced cases that have escaped early detection. In the 3 decades of its existence PCI has seen only one major change of paradigm, i. e., the introduction of the coronary stent in 1986. For the past 7 years, drug-eluting stents have gradually replaced conventional bare metal stents. They effectively contain the inner scaring after stent implantation and thereby reduce the need for reinterventions due to restenosis. Other techniques meant to replace or complement the balloon (laser, drills etc.), have come and gone. PCI sees itself squeezed between medical therapy for mild coronary artery disease and surgical therapy for advanced coronary artery disease. There is significant overlap to both sides and the debate about what best to do with these patients is ongoing. Source

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