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Weiss MA, Herbst A, Schlegel J, Dannegger T, Evers M, Donges A, Nakajima M, Leitenstorfer A, Goennenwein STB, Nowak U, Kurihara T. Discovery of ultrafast spontaneous spin switching in an antiferromagnet by femtosecond noise correlation spectroscopy. Nat Commun 2023; 14:7651. [PMID: 38030606 PMCID: PMC10687256 DOI: 10.1038/s41467-023-43318-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023] Open
Abstract
Owing to their high magnon frequencies, antiferromagnets are key materials for future high-speed spintronics. Picosecond switching of antiferromagnetic spin systems has been viewed a milestone for decades and pursued only by using ultrafast external perturbations. Here, we show that picosecond spin switching occurs spontaneously due to thermal fluctuations in the antiferromagnetic orthoferrite Sm0.7Er0.3FeO3. By analysing the correlation between the pulse-to-pulse polarisation fluctuations of two femtosecond optical probes, we extract the autocorrelation of incoherent magnon fluctuations. We observe a strong enhancement of the magnon fluctuation amplitude and the coherence time around the critical temperature of the spin reorientation transition. The spectrum shows two distinct features, one corresponding to the quasi-ferromagnetic mode and another one which has not been previously reported in pump-probe experiments. Comparison to a stochastic spin dynamics simulation reveals this new mode as smoking gun of ultrafast spontaneous spin switching within the double-well anisotropy potential.
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Affiliation(s)
- M A Weiss
- Department of Physics, University of Konstanz, D-78457, Konstanz, Germany
| | - A Herbst
- Department of Physics, University of Konstanz, D-78457, Konstanz, Germany
| | - J Schlegel
- Department of Physics, University of Konstanz, D-78457, Konstanz, Germany
| | - T Dannegger
- Department of Physics, University of Konstanz, D-78457, Konstanz, Germany
| | - M Evers
- Department of Physics, University of Konstanz, D-78457, Konstanz, Germany
| | - A Donges
- Department of Physics, University of Konstanz, D-78457, Konstanz, Germany
| | - M Nakajima
- Institute of Laser Engineering, Osaka University, 565-0871, Osaka, Japan
| | - A Leitenstorfer
- Department of Physics, University of Konstanz, D-78457, Konstanz, Germany
| | - S T B Goennenwein
- Department of Physics, University of Konstanz, D-78457, Konstanz, Germany
| | - U Nowak
- Department of Physics, University of Konstanz, D-78457, Konstanz, Germany
| | - T Kurihara
- Department of Physics, University of Konstanz, D-78457, Konstanz, Germany.
- The Institute for Solid State Physics, The University of Tokyo, 277-8581, Kashiwa, Japan.
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van den Boom L, Auzanneau M, Woelfle J, Sindichakis M, Herbst A, Meraner D, Hake K, Klinkert C, Gohlke B, Holl RW. Use of Continuous Glucose Monitoring in Pump Therapy Sensor Augmented Pump or Automated Insulin Delivery in Different Age Groups (0.5 to <26 Years) With Type 1 Diabetes From 2018 to 2021: Analysis of the German/Austrian/Swiss/Luxemburg DPV Registry. J Diabetes Sci Technol 2023:19322968231156601. [PMID: 36840616 DOI: 10.1177/19322968231156601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
AIM Insulin pump, continuous glucose monitoring (CGM), and sensor augmented pump (SAP) technology have evolved continuously leading to the development of automated insulin delivery (AID) systems. Evaluation of the use of diabetes technologies in people with T1D from January 2018 to December 2021. METHODS A patient registry (Diabetes Prospective Follow-up Database [DPV]) was analyzed for use of SAP (insulin pump + CGM ≥90 days, no automated dose adjustment) and AID (HCL or LGS/PLGS). In total 46,043 people with T1D aged 0.5 to <26 years treated in 416 diabetes centers (Germany, Austria, Luxemburg, and Switzerland) were included and stratified into 4 groups A-D according to age. Additionally, TiR and HbA1c were analyzed. RESULTS From 2018 to 2021, there was a significant increase from 28.7% to 32.9% (sensor augmented pump [SAP]) and 3.5% to 16.6% (AID) across all age groups, with the most frequent use in group A (<7 years, 38.8%-40.2% and 10.3%-28.5%). A similar increase in SAP and AID use was observed in groups B (7 to <11 years) and C (11 to <16 years): B: +15.8 PP, C: +15.9 PP. HbA1c improved significantly in groups C and D (16 to <26 years) (both P < .01). Time in range (TiR) increased in all groups (A: +3 PP; B: +5 PP; C: +5 PP; D: +5 PP; P < 0.01 for each group). Insulin pumps (61.0% versus 53.4% male) and SAP (33.5% versus 28.9% male) are used more frequently in females. CONCLUSION In recent years, we found an increasing use of new diabetes technologies and an improvement in metabolic control (TiR) across all age groups.
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Affiliation(s)
- Louisa van den Boom
- Division of Pediatrics/Pediatric Diabetology, DRK Hospital, Kirchen, Germany
- Division of Pediatric Diabetology, Endocrinology, Metabolism and Obesity, Children's Hospital, University of Bonn, Bonn, Germany
| | - Marie Auzanneau
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Joachim Woelfle
- Children's and Adolescent's Hospital, University of Erlangen, Erlangen, Germany
| | | | - Antje Herbst
- Centre for Paediatrics, Medical Clinic Leverkusen, Leverkusen, Germany
| | - Dagmar Meraner
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Hake
- Children's Hospital, Müritzklinikum Waren, Waren, Germany
| | | | - Bettina Gohlke
- Division of Pediatric Diabetology, Endocrinology, Metabolism and Obesity, Children's Hospital, University of Bonn, Bonn, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany
- German Center for Diabetes Research, Neuherberg, Germany
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Herbst A, Orso F, Camartini V, Virciglio S, D‘Errico G, Salucci C, Verga F, Fattirolli F, Marchionni N, Di Bari M, Ungar A, Baldasseroni S. P239 TOLERABILITY OF SACUBITRIL/VALSARTAN TREATMENT IN OLDER PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION: PRELIMINARY DATA FROM THE REAL–WORLD AGING–HF REGISTRY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Although older patients with heart failure (HF) with reduced ejection fraction enrolled in PARADIGM–HF showed a good tolerance to sacubitril/valsartan (Sa/Va), more real–word data are needed to define their tolerability in this population. Aim: To describe the Sa/Va tolerability and titration in older HFrEF patients followed by our HF outpatient.
Methods
HFrEF patients aged ≥65 years and treated with Sa/Va from November 2016 to June 2021 were enrolled, assessing Sa/Va tolerability at six months and its clinical and hemodynamic effects.
Results
We enrolled 101 patients with a mean age of 78 years (⁓20% female). The aetiology was ischemic in 59% of cases while the mean ejection fraction was 31%. Sa/Va was prescribed at the starting dose (24/26mg) and intermediate dose (49/51mg) in 91% and 9% of cases, respectively. After six months, 9 of the 100 patients still alive had discontinued treatment with Sa/Va (4 for symptomatic hypotension, 3 for suspected allergic reaction and 2 for worsening renal function). Of the 91 patients still on therapy, only 17 had reached the target dose (97/103mg) while 28 were at the intermediate dose (Figure 1). Symptomatic hypotension (62%), hyperkalaemia (15%) and worsening of renal function (4%) were the main causes of maintaining Sa/Va therapy at the starting dose; note, in 15% of cases a specific cause of non–titration was not identified. Comparing HF treatment between starting dose vs higher–dose patients, after six months in low–dose patients there was a slight improvement in mineralcorticosteroid receptor antagonist (MRA) prescription and in combination therapy (Sa/Va, beta–blocker and MRA) while in patients at higher–doses there was a significant decrease (Figure 2). In patients still receiving Sa/Va, significant clinical improvement was observed while renal function, K+ levels and systolic blood pressure remained stable (Figure 3).
Conclusions
After six months of treatment, Sa/Va was well tolerated in most of our older patients and used in combination with a beta–blocker and an MRA in a high percentage of cases, although a reduction in MRA prescription is observed in patients taking higher dosages of Sa/Va. In addition, there was a marked improvement in the clinical variables.
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Verga F, Orso F, Herbst A, Camartini V, Virciglio S, D‘Errico G, Salucci C, Di Bari M, Marchionni N, Ungar A, Fattirolli F, Baldasseroni S. P252 PROTOCOL FOR TELEHEALTH MANAGEMENT AND STRATIFICATION RISK OF ELDERLY PATIENTS WITH CHRONIC HEART FAILURE DURING THE COVID–19 PANDEMIC: A MID–TERM PROGNOSTIC EVALUTATION BY TELEHFCOVID–19 SCORE. Eur Heart J Suppl 2022. [PMCID: PMC9383990 DOI: 10.1093/eurheartj/suac012.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The Coronavirus Disease (COVID–19) pandemic and its consequences has forced physicians to develop telematic methods in order to follow up patients with cronic diseases, such as heart failure (HF). Objectives To evaluate TeleHFCovid–19 score as a mid–term (six months) prognostic score in terms of prediction of hospitalitazion and cardiovascular mortality in patients with chronic HF during Covid–19 pandemic. Methods During COVID–19 pandemic (from March 2020 to May 2020), we were forced to cancel nearly all follow–up checks in our HF outpatient clinic. We hence standardized a telephone follow–up by developing a questionnaire (Fig. 1) from which we then obtained a score, later called the “TeleHFCovid–19 score” (0–29). This score stratified patients in three risk score groups: green (0–3), yellow (4–8), and red (≥9), for which the next telefonic evaluation was planned after 4, 2 and 1 weeks, respectively. Results 146 patients were enrolled: 112 were classified as green, 21 as yellow and 13 as red. Mean age was 81 years, females were 40%. Approximately one third had EF < 40%. At six months, compared to red (69.2%) and yellow patients (33.3%), green patients (8.9%) presented a significantly lower rate of the composite outcome of cardiovascular death and/or HF hospitalization, (p < 0.001, Fig 2). Multivariate analysis showed that high levels of creatinine (OR 5.960, 95% CI 1.627–21.837, p = 0.007), dyspnea at rest or for basic activities (OR 2.469, 95% CI 1.216–5.013, p = 0.012) and a high loop–diuretic dosage (OR 6.224, 95% CI 1.504–25.753, p = 0.012) were indipendently associated with the outcome. Moreover, ROC analysis showed a high sensibility and specificity for our score at six months (AUC =0.789, 95% CI 0.682–0.896, p < 0.001), with a score < 4.5 (very close to the green group cut–off) that identified lower–risk subjects (Fig 3). Conclusions The TeleHFCovid–19 score was able to correctly identify patients with good outcomes at six months. Furthermore, it has the ability to stratify the adverse event risk and this could represent a useful tool to appropriately schedule the reevaluation timing of these patients and to identify those who may need urgent hospital evaluation.
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D‘Errico G, Herbst A, Orso F, Baldasseroni S, Fattirolli F, Virciglio S, Camartini V, Di Bari M, Marchionni N, Ungar A, Salucci C, Verga F. P250 PROTOCOL FOR TELEHEALTH EVALUATION AND FOLLOW–UP OF PATIENTS WITH CHRONIC HEART FAILURE DURING THE COVID–19 PANDEMIC. Eur Heart J Suppl 2022. [PMCID: PMC9384072 DOI: 10.1093/eurheartj/suac012.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background After the lockdown imposed by the COVID19 pandemic, physicians had to limite ambulatory visits to exceptional cases to reduce interpersonal contact. We structured a telephone follow–up developing a standardized 23 item questionnaire to administrate to our HF outpatient clinic and from whom we obtained the Covid–19–HFscore. Methods The patients were identified by a numeric code, date of birth and gender. The questionnaire was designed for rapid administration during telephone interview (on average 6 minutes) and was administered directly by physicians to patients and/or to their caregiver. It was built to reproduce our usual clinical evaluation. Results As shown in Figure 1, we investigated seven domains: 1) social and functional condition 2) mood 3) adherence to pharmacological and non–pharmacological recommendations (blood pressure, heart rate, weight monitoring and fluid intake control) 4) clinical and hemodynamic status 5) recording of laboratory tests 6) current pharmacological treatment 7) recent evaluation by family physician or need to contact emergency services followed or not by hospitalisation. General and pharmacological recommendations as well as the following telephone contact were finally recorded. To determine the timing of the next telephonic evaluation, we decided to weight questions regarding clinical and hemodynamic status, adherence to pharmacological and non–pharmacological recommendations, therapeutic changes and need for hospitalisation by scoring the answers (from 1 to 3) to build a score. The sum of individual scores represented the novel TeleHFCovid19–score, ranging from 0 to 29. Based on such score, three groups of patients were identified by arbitrary cut–off levels: the green (score <4), the yellow (score 4–8) and the red (score ≥9) group, for which next telephonic evaluation was planned respectively after four, two and one week respectively. Alternatively, the red group could receive recommendation for urgent hospital evaluation. Conclusion During this emergency situation this questionnaire could be a useful clinical tool to help physicians maintaining a regular FU of their patients and identifying patients at greatest risk of imminent instability. Furthermore, this instrument could also represent a useful resource in the management of low–risk HF patients.
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Affiliation(s)
- G D‘Errico
- AMBULATORIO SCOMPENSO CARDIACO AOU CAREGGI, FIRENZE; RIABILITAZIONE CARDIOLOGICA AOU CAREGGI, FIRENZE; AOU CAREGGI UTIG–GERIATRIA, FIRENZE; AOU CAREGGI DIPARTIMENTO CARDIO–TORACO–VASCOLARE, FIRENZE
| | - A Herbst
- AMBULATORIO SCOMPENSO CARDIACO AOU CAREGGI, FIRENZE; RIABILITAZIONE CARDIOLOGICA AOU CAREGGI, FIRENZE; AOU CAREGGI UTIG–GERIATRIA, FIRENZE; AOU CAREGGI DIPARTIMENTO CARDIO–TORACO–VASCOLARE, FIRENZE
| | - F Orso
- AMBULATORIO SCOMPENSO CARDIACO AOU CAREGGI, FIRENZE; RIABILITAZIONE CARDIOLOGICA AOU CAREGGI, FIRENZE; AOU CAREGGI UTIG–GERIATRIA, FIRENZE; AOU CAREGGI DIPARTIMENTO CARDIO–TORACO–VASCOLARE, FIRENZE
| | - S Baldasseroni
- AMBULATORIO SCOMPENSO CARDIACO AOU CAREGGI, FIRENZE; RIABILITAZIONE CARDIOLOGICA AOU CAREGGI, FIRENZE; AOU CAREGGI UTIG–GERIATRIA, FIRENZE; AOU CAREGGI DIPARTIMENTO CARDIO–TORACO–VASCOLARE, FIRENZE
| | - F Fattirolli
- AMBULATORIO SCOMPENSO CARDIACO AOU CAREGGI, FIRENZE; RIABILITAZIONE CARDIOLOGICA AOU CAREGGI, FIRENZE; AOU CAREGGI UTIG–GERIATRIA, FIRENZE; AOU CAREGGI DIPARTIMENTO CARDIO–TORACO–VASCOLARE, FIRENZE
| | - S Virciglio
- AMBULATORIO SCOMPENSO CARDIACO AOU CAREGGI, FIRENZE; RIABILITAZIONE CARDIOLOGICA AOU CAREGGI, FIRENZE; AOU CAREGGI UTIG–GERIATRIA, FIRENZE; AOU CAREGGI DIPARTIMENTO CARDIO–TORACO–VASCOLARE, FIRENZE
| | - V Camartini
- AMBULATORIO SCOMPENSO CARDIACO AOU CAREGGI, FIRENZE; RIABILITAZIONE CARDIOLOGICA AOU CAREGGI, FIRENZE; AOU CAREGGI UTIG–GERIATRIA, FIRENZE; AOU CAREGGI DIPARTIMENTO CARDIO–TORACO–VASCOLARE, FIRENZE
| | - M Di Bari
- AMBULATORIO SCOMPENSO CARDIACO AOU CAREGGI, FIRENZE; RIABILITAZIONE CARDIOLOGICA AOU CAREGGI, FIRENZE; AOU CAREGGI UTIG–GERIATRIA, FIRENZE; AOU CAREGGI DIPARTIMENTO CARDIO–TORACO–VASCOLARE, FIRENZE
| | - N Marchionni
- AMBULATORIO SCOMPENSO CARDIACO AOU CAREGGI, FIRENZE; RIABILITAZIONE CARDIOLOGICA AOU CAREGGI, FIRENZE; AOU CAREGGI UTIG–GERIATRIA, FIRENZE; AOU CAREGGI DIPARTIMENTO CARDIO–TORACO–VASCOLARE, FIRENZE
| | - A Ungar
- AMBULATORIO SCOMPENSO CARDIACO AOU CAREGGI, FIRENZE; RIABILITAZIONE CARDIOLOGICA AOU CAREGGI, FIRENZE; AOU CAREGGI UTIG–GERIATRIA, FIRENZE; AOU CAREGGI DIPARTIMENTO CARDIO–TORACO–VASCOLARE, FIRENZE
| | - C Salucci
- AMBULATORIO SCOMPENSO CARDIACO AOU CAREGGI, FIRENZE; RIABILITAZIONE CARDIOLOGICA AOU CAREGGI, FIRENZE; AOU CAREGGI UTIG–GERIATRIA, FIRENZE; AOU CAREGGI DIPARTIMENTO CARDIO–TORACO–VASCOLARE, FIRENZE
| | - F Verga
- AMBULATORIO SCOMPENSO CARDIACO AOU CAREGGI, FIRENZE; RIABILITAZIONE CARDIOLOGICA AOU CAREGGI, FIRENZE; AOU CAREGGI UTIG–GERIATRIA, FIRENZE; AOU CAREGGI DIPARTIMENTO CARDIO–TORACO–VASCOLARE, FIRENZE
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Virciglio S, Orso F, Herbst A, Camartini V, Girardi E, Ghiara C, Perfetti G, Pratesi A, Di Bari M, Ungar A, Fattirolli F, Marchionni N, Baldasseroni S. P253 INDEPENDENT PREDICTORS OF 1–YEAR MORTALITY IN OLDEST OLD PATIENTS MANAGED BY A GERIATRIC–CARDIOLOGY HF UNIT OF AOU CAREGGI. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
A multidisciplinary heart team and continuum care approach seems to be the most appropriate clinical strategy in order to reduce mortality, functional decline and disability of frail and clinical complex oldest old patients affected by heart failure (HF). We analysed the independent predictors of 1 year–total mortality in our cohort of oldest old HF patients.
Methods
All patients aged > 85 years referred to our Heart Failure Unit of a Tertiary teaching hospital were consecutively enrolled in the study and were evaluated at first visit with a comprehensive assessment recording cardiological, geriatric and bio–humoral variables. Then we assessed with a multivariable Cox regression analysis the independent predictors of 1–year all–cause mortality.
Results
87 patients were enrolled (mean age 89 ± 2.7 years, range 86–96 years); 48.9% were females, 57.9% were in NYHA class III or IV, 43.2% had HFpEF, 36.4% had an ischemic aethiology, 69.3% had a history of atrial fibrillation, 19.3% were living alone, the mean number of prescribed drugs was 8.8 ± 2.2, EVEREST congestion score was 5.2 ± 2.6, mean NT–proBNP was 8187 ± 11170 pg/ml. In the year after enrolment, 25 patients (34.1%) had more than one HF hospitalisation and 17 patients (19%) died. Among all clinical variables, living alone, having had one or more HF hospitalisation and HF–type (HFpEF, HFmrEF, HFrEF), EVEREST congestion score, trans–tricuspid gradient and tricuspid annular plane systolic excursion were significantly (p < 0.05) associated with 1–year mortality. At multivariable Cox–regression model only living alone (HR 3.34; 95% CI: 1.16–9.64) and EVEREST congestion score (HR 1.24; 95% CI: 1.04–1.46) resulted significantly associated with 1–year mortality. In the Figure we report the Kaplan–Meier curves according to the EVEREST congestion score (dichotomized according to a median value of 4) and living alone (yes vs not).
Conclusions
In a cohort of HF oldest old patients tightly managed in a dedicated cardiologic and geriatric Heart Failure Unit, 1–year all–cause mortality was independently predicted by a clinical score of congestion and by living alone status.
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Affiliation(s)
- S Virciglio
- AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, AMBULATORIO SCOMPENSO CARDIACO, UTIG, FIRENZE; OSPEDALE DI EMPOLI, GERIATRIA, EMPOLI; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, UTIG, FIRENZE; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO CARDIOTORACOVASCOLARE, RIABILITAZIONE CARDIOLOGICA, FIRENZE; AZIENDA OSPEDALIERA
| | - F Orso
- AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, AMBULATORIO SCOMPENSO CARDIACO, UTIG, FIRENZE; OSPEDALE DI EMPOLI, GERIATRIA, EMPOLI; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, UTIG, FIRENZE; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO CARDIOTORACOVASCOLARE, RIABILITAZIONE CARDIOLOGICA, FIRENZE; AZIENDA OSPEDALIERA
| | - A Herbst
- AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, AMBULATORIO SCOMPENSO CARDIACO, UTIG, FIRENZE; OSPEDALE DI EMPOLI, GERIATRIA, EMPOLI; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, UTIG, FIRENZE; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO CARDIOTORACOVASCOLARE, RIABILITAZIONE CARDIOLOGICA, FIRENZE; AZIENDA OSPEDALIERA
| | - V Camartini
- AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, AMBULATORIO SCOMPENSO CARDIACO, UTIG, FIRENZE; OSPEDALE DI EMPOLI, GERIATRIA, EMPOLI; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, UTIG, FIRENZE; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO CARDIOTORACOVASCOLARE, RIABILITAZIONE CARDIOLOGICA, FIRENZE; AZIENDA OSPEDALIERA
| | - E Girardi
- AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, AMBULATORIO SCOMPENSO CARDIACO, UTIG, FIRENZE; OSPEDALE DI EMPOLI, GERIATRIA, EMPOLI; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, UTIG, FIRENZE; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO CARDIOTORACOVASCOLARE, RIABILITAZIONE CARDIOLOGICA, FIRENZE; AZIENDA OSPEDALIERA
| | - C Ghiara
- AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, AMBULATORIO SCOMPENSO CARDIACO, UTIG, FIRENZE; OSPEDALE DI EMPOLI, GERIATRIA, EMPOLI; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, UTIG, FIRENZE; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO CARDIOTORACOVASCOLARE, RIABILITAZIONE CARDIOLOGICA, FIRENZE; AZIENDA OSPEDALIERA
| | - G Perfetti
- AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, AMBULATORIO SCOMPENSO CARDIACO, UTIG, FIRENZE; OSPEDALE DI EMPOLI, GERIATRIA, EMPOLI; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, UTIG, FIRENZE; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO CARDIOTORACOVASCOLARE, RIABILITAZIONE CARDIOLOGICA, FIRENZE; AZIENDA OSPEDALIERA
| | - A Pratesi
- AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, AMBULATORIO SCOMPENSO CARDIACO, UTIG, FIRENZE; OSPEDALE DI EMPOLI, GERIATRIA, EMPOLI; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, UTIG, FIRENZE; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO CARDIOTORACOVASCOLARE, RIABILITAZIONE CARDIOLOGICA, FIRENZE; AZIENDA OSPEDALIERA
| | - M Di Bari
- AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, AMBULATORIO SCOMPENSO CARDIACO, UTIG, FIRENZE; OSPEDALE DI EMPOLI, GERIATRIA, EMPOLI; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, UTIG, FIRENZE; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO CARDIOTORACOVASCOLARE, RIABILITAZIONE CARDIOLOGICA, FIRENZE; AZIENDA OSPEDALIERA
| | - A Ungar
- AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, AMBULATORIO SCOMPENSO CARDIACO, UTIG, FIRENZE; OSPEDALE DI EMPOLI, GERIATRIA, EMPOLI; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, UTIG, FIRENZE; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO CARDIOTORACOVASCOLARE, RIABILITAZIONE CARDIOLOGICA, FIRENZE; AZIENDA OSPEDALIERA
| | - F Fattirolli
- AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, AMBULATORIO SCOMPENSO CARDIACO, UTIG, FIRENZE; OSPEDALE DI EMPOLI, GERIATRIA, EMPOLI; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, UTIG, FIRENZE; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO CARDIOTORACOVASCOLARE, RIABILITAZIONE CARDIOLOGICA, FIRENZE; AZIENDA OSPEDALIERA
| | - N Marchionni
- AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, AMBULATORIO SCOMPENSO CARDIACO, UTIG, FIRENZE; OSPEDALE DI EMPOLI, GERIATRIA, EMPOLI; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, UTIG, FIRENZE; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO CARDIOTORACOVASCOLARE, RIABILITAZIONE CARDIOLOGICA, FIRENZE; AZIENDA OSPEDALIERA
| | - S Baldasseroni
- AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, AMBULATORIO SCOMPENSO CARDIACO, UTIG, FIRENZE; OSPEDALE DI EMPOLI, GERIATRIA, EMPOLI; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO DI GERIATRIA, UTIG, FIRENZE; AZIENDA OSPEDALIERA UNIVERSITARIA CAREGGI (AOUC), DIPARTIMENTO CARDIOTORACOVASCOLARE, RIABILITAZIONE CARDIOLOGICA, FIRENZE; AZIENDA OSPEDALIERA
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7
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Salucci C, Girardi E, Orso F, Herbst A, Migliorini M, Ghiara C, Virciglio S, Camartini V, Tognelli S, Fortini G, Di Bari M, Baldasseroni S, Ungar A, Marchionni N, Fattirolli F. P248 THE SCORE TELEHFCOVID19, ONE MONTH FOLLOW UP : A TELEHEALTH APPROACH TO MANAGE ELDERLY PATIENTS WITH CHRONIC HEART FAILURE DURING COVID–19 PANDEMIC. Eur Heart J Suppl 2022. [PMCID: PMC9384048 DOI: 10.1093/eurheartj/suac012.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Due to the total lockdown during COVID–19 pandemic, clinicians were forced to organize telephone visits or tele–monitoring. We developed a standardized multiparametric questionnaire, suitable for telephone administration to older heart failure (HF) patients and/or their caregivers. Purpose To compare clinical characteristics of the three groups (green, yellow, red) of patients classified by baseline TeleHFCovid19–Score and evaluate its ability to predict one–month in elderly patients with chronic HF. Methods The TeleHFCovid–19 score was obtained from a multiparametric questionnaire administered, from April 2020, during televisits to patients (or caregivers), which were divided in progressively increasing risk groups: green (0–3), yellow (4–8) and red (≥9). The primary study outcome was a composite of death from cardiovascular causes and/or hospitalization for HF, which individually were secondary outcomes. Results We enrolled 146 patients. Mean age was 81±9 years, females were 40%. In all the study population there was a high prevalence of self–reported adherence to guidelines–recommended drug treatments and behavioural measures, as well as a broad intake of diuretic therapy. Patients in green group had lower use of high dose loop diuretic (p < 0.001) or thiazide–like diuretic and had reported less frequently dyspnoea at rest or for basic activities, new/worsening extremities oedema or weight increase (all p < 0.001). Through scheduled phone contacts we were able to improve the overall clinical status of our patients even over a short (1 month) follow–up.The primary composite outcome of CV death and/or HF hospitalisation occurred in 8.2%, with a significantly lower prevalence in the green than in the yellow and red groups, and when analysing separately, we found that death for CV causes occurred more frequently in the red group than in the other two, while HF hospitalisations were significantly less frequent in the green group than in the red or yellow. ROC analysis confirmed the high sensibility and specificity of our score (AUC=0.883, 95% CI 0.806–0.959) with a score <4.5 (very close to green group cut–off) that identified lower–risk subjects (p < 0.001).
Conclusions The TeleHFCovid19–Score score was able to correctly recognize a low risk, green group. Therefore, the score could be used to identify low risk patients which could be followed remotely, reserving a tighter on–site clinical follow–up to higher events risk patients.
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Affiliation(s)
- C Salucci
- AOU CAREGGI, FIRENZE; AOU CAREGGI, FIRENZE
| | - E Girardi
- AOU CAREGGI, FIRENZE; AOU CAREGGI, FIRENZE
| | - F Orso
- AOU CAREGGI, FIRENZE; AOU CAREGGI, FIRENZE
| | - A Herbst
- AOU CAREGGI, FIRENZE; AOU CAREGGI, FIRENZE
| | | | - C Ghiara
- AOU CAREGGI, FIRENZE; AOU CAREGGI, FIRENZE
| | | | | | - S Tognelli
- AOU CAREGGI, FIRENZE; AOU CAREGGI, FIRENZE
| | - G Fortini
- AOU CAREGGI, FIRENZE; AOU CAREGGI, FIRENZE
| | - M Di Bari
- AOU CAREGGI, FIRENZE; AOU CAREGGI, FIRENZE
| | | | - A Ungar
- AOU CAREGGI, FIRENZE; AOU CAREGGI, FIRENZE
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8
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Camartini V, Orso F, Herbst A, Virciglio S, Salucci C, Verga F, D‘Errico G, Di Bari M, Ungar A, Fattirolli F, Marchionni N, Baldasseroni S. P260 PRELIMINARY EXPERIENCE OF REPEATED LEVOSIMENDAN INFUSIONS IN ELDERLY OUTPATIENTS WITH ADVANCED HEART FAILURE. Eur Heart J Suppl 2022. [PMCID: PMC9383975 DOI: 10.1093/eurheartj/suac012.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background The use of intermittent infusion of Levosimendan (L) demonstrated to be able to reduce hospitalisations and to improve functional capacity and quality of life in patients with advanced heart failure (HF). Purpose To describe our preliminary experience regarding L intermittent infusions in advanced HF older outpatients. Methods A maximum of three consecutive L infusions were carried out 14 days apart. The duration of each session was 8 hours. The starting infusion rate was 0.05 μg/Kg/min, titrated every 30/60‘ up to a maximum of 0.2 μg/Kg/min based on blood pressure, heart rate and arrhythmias recorded during telemetry. We evaluated patients by clinical, laboratory and echocardiographic controls at baseline and two weeks after the end of treatment. Results Since November 2020 we enrolled 17 patients with a mean age of 77 years; 12% were women. HF etiology was ischemic in 64% of cases and the mean ejection fraction was 30%. A total of 41 infusions were performed, the mean dose of L administered was 5.4 mg/infusion. Three patients did not complete the expected treatment, one due to an intercurrent COVID–19 infection and two because of social issues. In 28 sessions the maximum infusion rate was reached, while in 12 a lower rate; in one case drug infusion was suspended (Figure 1). The main complication observed was marked non–symptomatic hypotension, followed by the onset of atrial fibrillation or frequently ventricular extrasystole. As shown in Figure 2, at the end of the infusion cycles, there was an improvement of clinical and hemodynamic parameters. Moreover, at the end of the infusion cycles, we observed a reduction in the mean dose of loop diuretic prescribed and an increase in the prescription of disease–modify treatment, according to HF guidelines (Figure 3).
Conclusions In our preliminary experience repeated infusions of L appear to be well tolerated in older patients with advanced HF. Although there was an improvement in congestion parameters and targeted therapy for HF, more data will be needed in the future to confirm its safety and efficacy, also in terms of guidelines–directed medical therapy.
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9
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Iorizzo L, Carlsson Y, Johansson C, Berggren R, Herbst A, Wang M, Leiding M, Isberg P, Kristensen K, Wiberg-Itzel E, McGee T, Wiberg N. 35 Proposed cut-off for fetal scalp blood lactate in intrapartum fetal surveillance based on neonatal outcomes: A large prospective observational study. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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Piest B, Vollenkemper V, Böhm J, Herbst A, Rasel EM. Red- and blue-detuned magneto-optical trapping with liquid crystal variable retarders. Rev Sci Instrum 2022; 93:023202. [PMID: 35232144 DOI: 10.1063/5.0071619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
We exploit red- and blue-detuned magneto-optical trapping (MOT) of 87Rb benefitting from a simplified setup and a novel approach based on liquid crystal variable retarders (LCVR). To maintain the trapping forces when switching from a red- to a blue-detuned MOT, the handedness of the circular polarization of the cooling beams needs to be reversed. LCVRs allow fast polarization control and represent compact, simple, and cost-efficient components, which can easily be implemented in existing laser systems. This way, we achieve a blue-detuned type-II MOT for 8.7 × 108 atoms of 87Rb with sub-Doppler temperatures of 44 μK well below the temperatures reached in a conventional 87Rb type-I MOT. The phase space density is increased by more than two orders of magnitude compared to the standard red-detuned type-I MOT. The setup can readily be transferred to any other systems working with 87Rb.
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Affiliation(s)
- B Piest
- Institut für Quantenoptik, Gottfried Wilhelm Leibniz Universität, Welfengarten 1, 30167 Hannover, Germany
| | - V Vollenkemper
- Institut für Quantenoptik, Gottfried Wilhelm Leibniz Universität, Welfengarten 1, 30167 Hannover, Germany
| | - J Böhm
- Institut für Quantenoptik, Gottfried Wilhelm Leibniz Universität, Welfengarten 1, 30167 Hannover, Germany
| | - A Herbst
- Institut für Quantenoptik, Gottfried Wilhelm Leibniz Universität, Welfengarten 1, 30167 Hannover, Germany
| | - E M Rasel
- Institut für Quantenoptik, Gottfried Wilhelm Leibniz Universität, Welfengarten 1, 30167 Hannover, Germany
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11
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Marigliano M, Eckert AJ, Guness PK, Herbst A, Smart CE, Witsch M, Maffeis C. Association of the use of diabetes technology with HbA1c and BMI-SDS in an international cohort of children and adolescents with type 1 diabetes: The SWEET project experience. Pediatr Diabetes 2021; 22:1120-1128. [PMID: 34716736 DOI: 10.1111/pedi.13274] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/18/2021] [Accepted: 08/25/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To examine the association between the use of diabetes technology (insulin pump [CSII], glucose sensor [CGM] or both) and metabolic control (HbA1c) as well as body adiposity (BMI-SDS) over-time in a cohort of children and adolescents with type 1 diabetes (T1D), that have never used these technologies before. SUBJECTS AND METHODS Four thousand six hundred forty three T1D patients (2-18 years, T1D ≥1 year, without celiac disease, no CSII and/or CGM before 2016) participating in the SWEET prospective multicenter diabetes registry, were enrolled. Data were collected at two points (2016; 2019). Metabolic control was assessed by glycated hemoglobin (HbA1c) and body adiposity by BMI-SDS (WHO). Patients were categorized by treatment modality (multiple daily injections [MDI] or CSII) and the use or not of CGM. Linear regression models, adjusted for age, gender, duration of diabetes and region, were applied to assess differences in HbA1c and BMI-SDS among patient groups. RESULTS The proportion of patients using MDI with CGM and CSII with CGM significantly increased from 2016 to 2019 (7.2%-25.7%, 7.8%-27.8% respectively; p < 0.001). Linear regression models showed a significantly lower HbA1c in groups that switched from MDI to CSII with or without CGM (p < 0.001), but a higher BMI-SDS (from MDI without CGM to CSII with CGM p < 0.05; from MDI without CGM to CSII without CGM p < 0.01). CONCLUSIONS Switching from MDI to CSII is significantly associated with improvement in glycemic control but increased BMI-SDS over-time. Diabetes technology may improve glucose control in youths with T1D although further strategies to prevent excess fat accumulation are needed.
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Affiliation(s)
- Marco Marigliano
- Regional Center for Pediatric Diabetes, University of Verona, University City Hospital, Verona, Italy
| | - Alexander J Eckert
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | | | - Antje Herbst
- Department of Pediatric and Adolescent Medicine, Hospital Leverkusen gGmbH, Leverkusen, Germany
| | - Carmel E Smart
- Department of Paediatric Endocrinology, John Hunter Children's Hospital, New Lambton Heights, Australia
| | - Michael Witsch
- Pediatric Diabetology, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Claudio Maffeis
- Regional Center for Pediatric Diabetes, University of Verona, University City Hospital, Verona, Italy
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12
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Lindegren L, Stuart A, Herbst A, Källén K. Stillbirth or neonatal death before 45 post-menstrual weeks in relation to gestational duration in pregnancies at 39 weeks of gestation or beyond: the impact of parity and body mass index. A national cohort study. BJOG 2021; 129:761-768. [PMID: 34637593 DOI: 10.1111/1471-0528.16964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 09/24/2021] [Accepted: 10/05/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the risk of stillbirth or neonatal death before 45 post-menstrual weeks in relation to gestational duration, stratified by body mass index (BMI) and parity. DESIGN Retrospective study. SETTING Data from the Swedish Medical Birth Register. POPULATION Singleton, cephalic births at between 39+0 and 42+2 weeks of gestation, 2005-2016 (n = 892 339). METHODS Relative risk ratios for mortality in relation to gestational duration were stratified by parity and BMI, and were adjusted for maternal age, smoking, country of birth and educational level. MAIN OUTCOME MEASURES Primary outcome: stillbirth or neonatal death before 45 post-menstrual weeks. Secondary outcome: stillbirth. RESULTS Among children of primiparous women, children born at 41+3 weeks of gestation, or later, were at increased risk of stillbirth or neonatal death before 45 post-menstrual weeks compared with children born between 39+0 and 40+2 weeks of gestation (aRR 1.29, 95% CI 1.10-1.52). For primiparous women with BMIs of <25, 25-29.9 and ≥ 30 kg/m2 , the corresponding aRRs were: 1.04 (95% CI 0.81-1.34), 1.25 (95% CI 0.94-1.66) and 1.52 (95% CI 1.10-2.10), respectively. No significant increase in risk with gestational age was detected for multiparous women, regardless of BMI class. Among primipara, the risk of stillbirth increased with gestational duration in all BMI classes, with the highest risk increase for BMI ≥ 30 kg/m2 , from 0.8/1000 at 40+3 -40+6 weeks of gestation to 4.0/1000 at 42+0 -42+2 weeks of gestation. CONCLUSIONS At 41+3 -42+2 weeks of gestation, pregnancy duration was associated with an increased risk for stillbirth or neonatal death before 45 post-menstrual weeks among primiparous women, especially among women who were obese. For multiparous women, no significant association between gestational duration and mortality was found. TWEETABLE ABSTRACT In term pregnancies the risk for stillbirth and neonatal death is affected by gestational age, parity and BMI.
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Affiliation(s)
- L Lindegren
- Department of Obstetrics and Gynaecology, Institution of Clinical Sciences, University of Lund, Lund, Sweden.,Helsingborg Hospital, Helsingborg, Sweden
| | - A Stuart
- Department of Obstetrics and Gynaecology, Institution of Clinical Sciences, University of Lund, Lund, Sweden.,Helsingborg Hospital, Helsingborg, Sweden
| | - A Herbst
- Department of Obstetrics and Gynaecology, Institution of Clinical Sciences, University of Lund, Lund, Sweden.,Skåne University Hospital, Lund, Sweden
| | - K Källén
- Department of Obstetrics and Gynaecology, Institution of Clinical Sciences, University of Lund, Lund, Sweden
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13
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Iorizzo L, Carlsson Y, Johansson C, Berggren R, Herbst A, Wang M, Leiding M, Isberg PE, Kristensen K, Wiberg-Itzel E, McGee T, Wiberg N. Proposed cutoff for fetal scalp blood lactate in intrapartum fetal surveillance based on neonatal outcomes: a large prospective observational study. BJOG 2021; 129:636-646. [PMID: 34555249 DOI: 10.1111/1471-0528.16924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Determination of lactate in fetal scalp blood (FBS) during labour has been recognised since the 1970s. The internationally accepted cutoff of >4.8 mmol/l indicating fetal acidosis is exclusive for the point-of-care device (POC) LactatePro™, which is no longer in production. The aim of this study was to establish a new cutoff for scalp lactate based on neonatal outcomes with the use of the StatstripLactate® /StatstripXpress® Lactate system, the only POC designed for hospital use. DESIGN Observational study. SETTING January 2016 to March 2020 labouring women with indication for FBS were prospectively included from seven Swedish and one Australian delivery unit. POPULATION Inclusion criteria: singleton pregnancy, vertex presentation, ≥35+0 weeks of gestation. METHOD Based on the optimal correlation between FBS lactate and cord pH/lactate, only cases with ≤25 minutes from FBS to delivery were included in the final calculations. MAIN OUTCOME MEASURES Metabolic acidosis in cord blood defined as pH <7.05 plus BDecf >10 mmol/l and/or lactate >10 mmol/l. RESULTS A total of 3334 women were enrolled of whom 799 were delivered within 25 minutes. The areas under the receiver operating characteristics curves (AUC) and corresponding optimal cutoff values were as follows; metabolic acidosis AUC 0.87 (95% CI 0.77-0.97), cutoff 5.7 mmol/l; pH <7.0 AUC 0.83 (95% CI 0.68-0.97), cutoff 4.6 mmol/l; pH <7.05 plus BDecf ≥12 mmol/l AUC 0.97 (95% CI 0.92-1), cutoff 5.8 mmol/l; Apgar score <7 at 5 minutes AUC 0.74 (95% CI 0.63-0.86), cutoff 5.2 mmol/l; and pH <7.10 plus composite neonatal outcome AUC 0.76 (95% CI 0.67-0.85), cutoff 4.8 mmol/l. CONCLUSION A scalp lactate level <5.2 mmol/l using the StatstripLactate® /StatstripXpress® system will safely rule out fetal metabolic acidosis. TWEETABLE ABSTRACT Scalp blood lactate <5.2 mmol/l using the StatstripLactate® /StatstripXpress system has an excellent ability to rule out fetal acidosis.
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Affiliation(s)
- L Iorizzo
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynaecology, Helsingborg Hospital, Helsingborg, Sweden
| | - Y Carlsson
- Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - C Johansson
- Department of Obstetrics and Gynaecology, Ystad lasarett, Ystad, Sweden
| | - R Berggren
- Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - A Herbst
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynaecology, Skåne University Hospital, Skåne, Sweden
| | - M Wang
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - M Leiding
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Skåne, Sweden
| | - P-E Isberg
- Department of Statistics, Lund University, Lund, Sweden
| | - K Kristensen
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynaecology, Gold Coast University Hospital, Gold Coast, Qld, Australia
| | - E Wiberg-Itzel
- Department of Obstetrics and Gynaecology, Söder Hospital, Stockholm, Sweden.,Institute of Karolinska, Stockholm, Sweden
| | - T McGee
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - N Wiberg
- Department of Obstetrics and Gynaecology, Ystad lasarett, Ystad, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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Prinz N, Konrad K, Brack C, Hahn E, Herbst A, Icks A, Grulich-Henn J, Jorch N, Kastendieck C, Mönkemöller K, Razum O, Steigleder-Schweiger C, Witsch M, Holl RW. Diabetes care in pediatric refugees from Africa or Middle East: experiences from Germany and Austria based on real-world data from the DPV registry. Eur J Endocrinol 2019; 181:31-38. [PMID: 31075760 DOI: 10.1530/eje-18-0898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/10/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE With increasing migration to Europe, diabetes diagnosis and treatment of refugees became challenging. To describe the current experience with pediatric refugees in Germany and Austria. DESIGN AND METHODS 43,137 patients (<21 years) with type 1 diabetes from the diabetes patient follow-up registry (DPV) were studied and divided by refugee status into patients born in Middle East (n = 365) or Africa (n = 175) and native patients (child and parents born in Germany/Austria; G/A: n = 42,597). Groups were compared using multivariable regression adjusted for age, sex and diabetes duration (SAS 9.4). In refugees the first year after arrival was studied, and for native children the most recent year of care. RESULTS After adjustment, HbA1c was highest in refugees (1. ME and 2. AFR vs 3. G/A: 72.3 ± 1.0 and 75.0 ± 1.4 vs 66.0 ± 0.1 mmol/mol, 1 vs 3: P < 0.001 and 2 vs 3: P < 0.001) and microalbuminuria (9.9 and 13.6 vs 6.5%, 1 vs 3: P = 0.039 and 2 vs 3: P = 0.002) was more prevalent. African children experienced severe hypoglycemia (17.8 ± 4.3 and 25.4 ± 8.7 vs 11.5 ± 0.3 per 100 patient years, 1 vs 3: P > 0.05 and 2 vs 3: P = 0.045) significantly more often, whereas hypoglycemia with coma (5.1 ± 1.1 and 4.1 ± 1.6 vs 2.6 ± 0.1 per 100 patient years, 1 vs 3: P = 0.006 and 2 vs 3: P > 0.05) and retinopathy (2.1 and n/a vs 0.2%, 1 vs 3: P < 0.001) were significantly more common in children from Middle East compared to natives. Insulin pumps were used in a markedly larger proportion of native patients (7.4 and 13.2 vs 43.0%, 1 vs 3: P < 0.001 and 2 vs 3: P < 0.001). CONCLUSIONS A relevant number of pediatric refugees with type 1 diabetes are treated in German/Austrian diabetes clinics. Refugee children, parents and caregivers are faced with several problems in diabetes therapy and outcome that should be addressed more intensively by pediatric diabetes teams.
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Affiliation(s)
- Nicole Prinz
- Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich Neuherberg, Germany
| | - Katja Konrad
- Department of Pediatric and Adolescent Medicine, University of Cologne, Cologne, Germany
- Department of Pediatric and Adolescent Medicine, Elisabeth-Hospital Essen, Essen, Germany
| | | | - Eva Hahn
- Department of Pediatrics and Adolescent Medicine, Protestant Hospital Oberhausen, Oberhausen, Germany
| | - Antje Herbst
- Department of Pediatric and Adolescent Medicine, Hospital Leverkusen gGmbH, Leverkusen, Germany
| | - Andrea Icks
- German Center for Diabetes Research (DZD), Munich Neuherberg, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Norbert Jorch
- Department of Pediatrics, Protestant Hospital Bielefeld gGmbH, Bielefeld, Germany
| | | | - Kirsten Mönkemöller
- Department of Pediatrics, Pediatric Hospital Amsterdamer Straße, Cologne, Germany
| | - Oliver Razum
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Claudia Steigleder-Schweiger
- Department of Pediatrics, University Hospital of Pediatrics, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Witsch
- Department of Pediatric and Adolescent Medicine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich Neuherberg, Germany
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Pacaud D, Hermann JM, Karges B, Rosenbauer J, Danne T, Dürr R, Herbst A, Lindauer S, Müther S, Pötzsch S, Raile K, Witsch M, Holl RW. Risk of recurrent severe hypoglycemia remains associated with a past history of severe hypoglycemia up to 4 years: Results from a large prospective contemporary pediatric cohort of the DPV initiative. Pediatr Diabetes 2018; 19:493-500. [PMID: 29218766 DOI: 10.1111/pedi.12610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/17/2017] [Accepted: 10/18/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES In a contemporary cohort of youth with type 1 diabetes, we examined the interval between episodes of severe hypoglycemia (SH) as a risk factor for recurrent SH or hypoglycemic coma (HC). METHODS This was a large longitudinal observational study. Using the DPV Diabetes Prospective follow-up data, we analyzed frequency and timing of recurrent SH (defined as requiring assistance from another person) and HC (loss of consciousness or seizures) in 14 177 youths with type 1 diabetes aged <20 years and at least 5 years of follow-up. RESULTS Among 14 177 patients with type 1 diabetes, 72% (90%) had no, 14% (6.8%) had 1 and 14% (3.2%) >1 SH (HC). SH or HC in the last year of observation was highest with SH in the previous year (odds ratio [OR] 4.7 [CI 4.0-5.5]/4.6 [CI 3.6-6.0]), but remained elevated even 4 years after an episode (OR 2.0 [CI 1.6-2.7]/2.2 [CI 1.5-3.1]). The proportion of patients who experienced SH or HC during the last year of observation was highest with SH/HC recorded during the previous year (23% for SH and 13% for HC) and lowest in those with no event (4.6% for SH and 2% for HC) in the initial 4 years of observation. CONCLUSIONS Even 4 years after an episode of SH/HC, risk for SH/HC remains higher compared to children who never experienced SH/HC. Clinicians should continue to regularly track hypoglycemia history at every visit, adjust diabetes education and therapy in order to avoid recurrences.
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Affiliation(s)
- D Pacaud
- Department of Pediatrics, University of Calgary, Calgary, Canada.,Department of Pediatric Diabetes and Endocrinology, Alberta Children's Hospital, Calgary, Canada.,Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - J M Hermann
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich, Germany
| | - B Karges
- Division of Endocrinology and Diabetes, Medical Faculty, German Center for Diabetes Research (DZD), RWTH Aachen University, Aachen, Germany
| | - J Rosenbauer
- German Center for Diabetes Research (DZD), Munich, Germany.,German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - T Danne
- Diabetes Centre for Children and Adolescents, Children's and Youth Hospital "AUF DER BULT", Hannover, Germany
| | - R Dürr
- Department of Children and Adolescent Medicine, Rems-Murr-Clinics, Winnenden, Germany
| | - A Herbst
- Center for Paediatrics, Medical Clinic Leverkusen, Leverkusen, Germany
| | - S Lindauer
- Department for Children and Adolescent Medicine, Hospital Barmherzige Schwestern Linz, Linz, Austria
| | - S Müther
- Diabetes Center for Children and Adolescent, DRK Clinics Berlin Westend, Berlin, Germany
| | - S Pötzsch
- Department for Children and Adolescent Medicine, Helios Vogtland Clinic Plauen, Plauen, Germany
| | - K Raile
- Department of Pediatric Endocrinology and Diabetes, Charité Berlin, Berlin, Germany
| | - M Witsch
- Centre Hospitalier de Luxembourg, Clinique Pediatrie, Luxembourg, Luxembourg
| | - R W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich, Germany
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Herbst A. Ausbildung von Flüchtlingssozialarbeiter_innen hinsichtlich gesundheitlicher Themen. Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1578819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Herbst A. Sharing Public Health Data Generated in the gLobal South—Is it Possible? An INDEPTH Network experience. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv097.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Bohn B, Herbst A, Pfeifer M, Krakow D, Zimny S, Kopp F, Melmer A, Steinacker JM, Holl RW. Impact of Physical Activity on Glycemic Control and Prevalence of Cardiovascular Risk Factors in Adults With Type 1 Diabetes: A Cross-sectional Multicenter Study of 18,028 Patients. Diabetes Care 2015; 38:1536-43. [PMID: 26015557 DOI: 10.2337/dc15-0030] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/29/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Physical activity (PA) can improve cardiovascular risk in the general population and in patients with type 2 diabetes. Studies also indicate an HbA(1c)-lowering effect in patients with type 2 diabetes. Since reports in patients with type 1 diabetes are scarce, this analysis aimed to investigate whether there is an association between PA and glycemic control or cardiovascular risk in subjects with type 1 diabetes. RESEARCH DESIGN AND METHODS A total of 18,028 adults (≥18 to <80 years of age) from Germany and Austria with type 1 diabetes from the Diabetes-Patienten-Verlaufsdokumentation (DPV) database were included. Patients were stratified according to their self-reported frequency of PA (PA0, inactive; PA1, one to two times per week; PA2, more than two times per week). Multivariable regression models were applied for glycemic control, diabetes-related comorbidities, and cardiovascular risk factors. Data were adjusted for sex, age, and diabetes duration. P values for trend were given. SAS 9.4 was used for statistical analysis. RESULTS An inverse association between PA and HbA(1c), diabetic ketoacidosis, BMI, dyslipidemia (all P < 0.0001), and hypertension (P = 0.0150), as well as between PA and retinopathy or microalbuminuria (both P < 0.0001), was present. Severe hypoglycemia (assistance required) did not differ in PA groups (P = 0.8989), whereas severe hypoglycemia with coma was inversely associated with PA (P < 0.0001). CONCLUSIONS PA seemed to be beneficial with respect to glycemic control, diabetes-related comorbidities, and cardiovascular risk factors without an increase of adverse events. Hence, our data underscore the recommendation for subjects with type 1 diabetes to perform regular PA.
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Affiliation(s)
- Barbara Bohn
- Institute of Epidemiology and Medical Biometry, ZIBMT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
| | - Antje Herbst
- Centre for Paediatrics, Medical Clinic Leverkusen, Leverkusen, Germany
| | | | | | - Stefan Zimny
- Center for Internal Medicine, Endocrinology and Diabetology, Schwerin Hospital, Schwerin, Germany
| | - Florian Kopp
- Diabetes Center, Augsburg Clinical Center, Augsburg, Germany
| | - Andreas Melmer
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
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Herbst A, Kapellen T, Schober E, Graf C, Meissner T, Holl RW. Impact of regular physical activity on blood glucose control and cardiovascular risk factors in adolescents with type 2 diabetes mellitus--a multicenter study of 578 patients from 225 centres. Pediatr Diabetes 2015; 16:204-10. [PMID: 24888254 DOI: 10.1111/pedi.12144] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 03/06/2014] [Accepted: 03/06/2014] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Regular physical activity (RPA) is a major therapeutic recommendation in children and adolescents with type 2 diabetes mellitus (T2DM). We evaluated the association between frequency of RPA and metabolic control, cardiovascular risk factors, and treatment regimes. METHODS The Pediatric Quality Initiative (DPV), including data from 225 centers in Germany and Austria, provided anonymous data of 578 patients (10-20 yr; mean 15.7 ± 2.1 yr; 61.9% girls) with T2DM. Patients were grouped by the frequency of their self-reported RPA per week: RPA 0, none; RPA 1, 1-2×/wk; RPA 2, >2×/wk. RESULTS The frequency of RPA ranged from 0 to 9×/wk (mean 1.1×/wk ±1.5). 55.7% of the patients reported no RPA (58.1% of the girls). Hemoglobin A1c (HbA1c) differed significantly among RPA groups (p < 0.002), being approximately 0.8 percentage points lower in RPA 2 compared to RPA 0. Body mass index (BMI-SDS) was higher in the groups with less frequent RPA (p < 0.00001). Multiple regression analysis revealed a negative association between RPA and HbA1c (p < 0.0001) and between RPA and BMI-SDS (p < 0.01). The association between RPA and high density lipoprotein (HDL)-cholesterol was positive (p < 0.05), while there was no association to total cholesterol, low density lipoprotein (LDL)-cholesterol or triglycerides. Approximately 80% of the patients received pharmacological treatment (oral antidiabetic drugs and/or insulin) without differences between RPA groups. CONCLUSION More than half of the adolescents with T2DM did not perform RPA. Increasing physical activity was associated with a lower HbA1c, a lower BMI-SDS, a higher HDL-cholesterol, but not with a difference in treatment regime. These results suggest that regular exercise is a justified therapeutic recommendation for children and adolescents with T2DM.
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Affiliation(s)
- A Herbst
- Department of Pediatrics, Hospital of Leverkusen, Leverkusen 51375, Germany
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Olsen TR, Mattix B, Casco M, Herbst A, Williams C, Tarasidis A, Simionescu D, Visconti RP, Alexis F. Manipulation of cellular spheroid composition and the effects on vascular tissue fusion. Acta Biomater 2015; 13:188-98. [PMID: 25463485 DOI: 10.1016/j.actbio.2014.11.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 11/02/2014] [Accepted: 11/13/2014] [Indexed: 01/02/2023]
Abstract
Cellular spheroids were investigated as tissue-engineered building blocks that can be fused to form functional tissue constructs. While spheroids can be assembled using passive contacts for the fusion of complex tissues, physical forces can be used to promote active contacts to improve tissue homogeneity and accelerate tissue fusion. Understanding the mechanisms affecting the fusion of spheroids is critical to fabricating tissues. Here, manipulation of the spheroid composition was used to accelerate the fusion process mediated by magnetic forces. The Janus structure of magnetic cellular spheroids spatially controls iron oxide magnetic nanoparticles (MNPs) to form two distinct domains: cells and extracellular MNPs. Studies were performed to evaluate the influence of extracellular matrix (ECM) content and cell number on the fusion of Janus magnetic cellular spheroids (JMCSs). Results showed that the integration of iron oxide MNPs into spheroids increased the production of collagen over time when compared to spheroids without MNPs. The results also showed that ring tissues composed of JMCSs with high ECM concentrations and high cell numbers fused together, but exhibited less contraction when compared to their lower concentration counterparts. Results from spheroid fusion in capillary tubes showed that low ECM concentrations and high cell numbers experienced more fusion and cellular intermixing over time when compared to their higher counterparts. These findings indicate that cell-cell and cell-matrix interactions play an important role in regulating fusion, and this understanding sets the rationale of spheroid composition to fabricate larger and more complex tissue-engineered constructs.
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Affiliation(s)
- T R Olsen
- Department of Bioengineering, Clemson University, 301 Rhodes Research Center, Clemson, SC 29634, USA
| | - B Mattix
- Department of Bioengineering, Clemson University, 301 Rhodes Research Center, Clemson, SC 29634, USA
| | - M Casco
- Department of Bioengineering, Clemson University, 301 Rhodes Research Center, Clemson, SC 29634, USA
| | - A Herbst
- Department of Bioengineering, Clemson University, 301 Rhodes Research Center, Clemson, SC 29634, USA
| | - C Williams
- Department of Bioengineering, Clemson University, 301 Rhodes Research Center, Clemson, SC 29634, USA
| | - A Tarasidis
- Department of Bioengineering, Clemson University, 301 Rhodes Research Center, Clemson, SC 29634, USA
| | - D Simionescu
- Department of Bioengineering, Clemson University, 301 Rhodes Research Center, Clemson, SC 29634, USA.
| | - R P Visconti
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, 173 Ashley Avenue - BSB 601, Charleston, SC 29425, USA.
| | - F Alexis
- Department of Bioengineering, Clemson University, 301 Rhodes Research Center, Clemson, SC 29634, USA; Institute of Biological Interfaces of Engineering, Department of Bioengineering, Clemson University, 401-2 Rhodes Engineering Research Center, Clemson, SC 29634, USA.
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Hermann G, Herbst A, Schütt M, Kempe HP, Krakow D, Müller-Korbsch M, Holl RW. Association of physical activity with glycaemic control and cardiovascular risk profile in 65 666 people with type 2 diabetes from Germany and Austria. Diabet Med 2014; 31:905-12. [PMID: 24646320 DOI: 10.1111/dme.12438] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 12/18/2013] [Accepted: 03/10/2014] [Indexed: 11/27/2022]
Abstract
AIMS To provide representative data from routine diabetes care concerning the physical activity levels of people with type 2 diabetes, and to show the association of activity level with cardio-metabolic risk profile in a gender-specific analysis. METHODS The anonymized data from 65 666 subjects with type 2 diabetes, who have been receiving treatment in specialized diabetes institutions, were analysed using a large multi-centre database. The population was categorized as physically inactive (PA0), active 1-2 times per week (PA1), active >2 times per week (PA2), and then stratified by age (20-59 and 60-80 years). BMI, glycaemic control (measured by HbA(1c) levels), blood pressure, lipid profile and therapeutic regimen were adjusted for age, gender and diabetes duration. RESULTS Most subjects were inactive (PA0: 90%; PA1: 6%, PA2: 4%). BMI, HbA(1c) and lipid profiles were better in older subjects and hypertension rates were lower in younger subjects. In both age groups, BMI, HbA(1c) (both P < 0.0001) and triglycerides (P < 0.002) were lower in the most active group PA2 compared with the inactive group PA0. HDL was higher in elderly (P < 0.0001) and pulse pressure (P = 0.03) lower in younger most active subjects only. Insulin therapy was used more frequently by the physically inactive and by older people. CONCLUSIONS This survey indicates that glycaemic control and cardio-metabolic risk profiles in people with type 2 diabetes are positively related to physical activity. The effects of physical activity were beneficial in younger as well as in older people. The high number of inactive people with diabetes underlines the need to promote physical activity and sport.
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Affiliation(s)
- G Hermann
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
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Herbst A, Graf M, Yilmaz M. Gesundheitliche Prävention in Bildungseinrichtungen. Gesundheitswesen 2014. [DOI: 10.1055/s-0034-1371640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Doruchowski G, Balsari P, Marucco P, Herbst A, Wehmann HJ, Roettele M, Gil E, Codis S, Pauwelyn E. Decision support tools for environmentally safe use of pesticides. Commun Agric Appl Biol Sci 2013; 78:37-45. [PMID: 25145224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Prevention of environmental risk due to pesticide application is demanded by EU legislation regarding water and crop protection issues. The pesticide users are required to take responsibility for the environmental consequences of applications. Therefore they need to make responsible decisions at both strategic and tactical level. The first one is a long term decision on selection of equipment, and the other applies to decisions on use of equipment in actual meteorological and environmental situation at any time when treatment is needed. In order to assist the user to make proper decisions the decision support tools were developed in form of web-based applications: EOS - Environmentally Optimised Sprayer; DET--Drift Evaluation Tool. EOS performs evaluation of the sprayer in terms of its risk mitigation potential based on the technical solutions present on the sprayer and selected by the user. EOS has been designed as a stepwise structured questionnaire, divided in sections representing different sources of pollution, i.e. RISK AREAS (step 1): Inside contamination; outside contamination; Filling; Spray Loss (Drift); Remnants. Within each RISK AREA there were identified PROBLEMS (step 2) to be solved by different TECHNOLOGIES (step 3), evaluated in different ASPECTS (step 4) when the user selects TECHNICAL SOLUTION (step 5) used on the sprayer. The items of steps 1-4 were assigned weights (%) and the items of TECHNICAL SOLUTIONs were scored from 0 to 10 (10 = best in class). This stepwise approach and valuation of items allows for calculating the effective score of each individual TECHNICAL SOLUTION in terms of its risk mitigation potential. The sum of these individual scores related to the final score of environmentally optimised sprayer gives the evaluated sprayer's EOS index (%) expressing the environmental value of the sprayer. DET performs evaluation of drift risk in actual situation, and proposes measures to mitigate this risk, helping the operator to make better tactical decisions. It consists of three sections: (I) SPRAY APPLICATION SITE; (II) METEO and FIELD CONDITIONS; (III) DRIFT RISK MITIGATION. Within the sections (I) and (II) the user makes selection of options defining the distance between application site and sensitive areas, as well as weather and field/crop conditions. The selected items describe the actual and objective situation, for which DET calculates the Drift Risk Value [%] followed by appropriate recommendation. In section (III) the user can simulate and check the effect of drift mitigation measures by selecting one of the classified spray drift reduction technologies or key application parameters affecting risk of drift. Based on the user's selection the tool appropriately modifies the Drift Risk Value and gives the final recommendation. Simple and practical EOS and DET tools are meant to be used by pesticide users and advisors as they also have educative and awareness raising value.
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Mueller-Vogt U, Brawanski A, Proescholdt M, Riemenschneider M, Schebesch KM, Herbst A. WHO Grade III Anaplastic Meningioma Metastasizing to the Parotid Gland and the Lungs: Case Report and Review of the Literature. J Neurol Surg A Cent Eur Neurosurg 2012; 74:197-202. [DOI: 10.1055/s-0032-1313722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- U. Mueller-Vogt
- Department of Neurosurgery, University Medical Center Regensburg, Germany
| | - A. Brawanski
- Department of Neurosurgery, University Medical Center Regensburg, Germany
| | - M. Proescholdt
- Department of Neurosurgery, University Medical Center Regensburg, Germany
| | - M. Riemenschneider
- Department of Neuropathology, University Medical Center Regensburg, Germany
| | - K.-M. Schebesch
- Department of Neurosurgery, University Medical Center Regensburg, Germany
| | - A. Herbst
- Department of Neurosurgery, University Medical Center Regensburg, Germany
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Schmidt F, Kapellen T, Wiegand S, Herbst A, Wolf J, Fröhlich-Reiterer E, Rabl W, Rohrer T, Holl R. Diabetes Mellitus in Children and Adolescents with Genetic Syndromes. Exp Clin Endocrinol Diabetes 2012; 120:579-85. [DOI: 10.1055/s-0032-1306330] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- F. Schmidt
- Department of Paediatrics, University of Halle-Wittenberg, Halle, Germany
| | - T. Kapellen
- Department of Paediatrics, University of Leipzig, Leipzig, Germany
| | - S. Wiegand
- Institute of Experimental Paediatric Endocrinology; Charité, Universitätsmedizin Berlin, Germany
| | - A. Herbst
- Department of Paediatrics, Hospital of Leverkusen, Leverkusen, Germany
| | - J. Wolf
- Department of Paediatrics, St. Vincenz-Hospital, Paderborn, Germany
| | | | - W. Rabl
- Department of Paediatrics, Technical University of Munich, Munich, Germany
| | - T. Rohrer
- Department of Paediatrics and Neonatology, Saarland University Hospital, Homburg/Saar, Germany
| | - R. Holl
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
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Herbst A, Mueller-Vogt U, Brawanski A, Proescholdt M, Riemenschneider M, Schebesch KM. WHO Grade III Anaplastic Meningioma Metastasizing to the Parotid Gland and the Lungs: Case Report and Review of the Literature. Cent Eur Neurosurg 2011; 72:1. [PMID: 22187412 DOI: 10.1055/s-0031-1280838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- A Herbst
- Department of Neurosurgery, University Medical Center Regensburg, Germany
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Herbst A, Diethelm K, Cheng G, Alexy U, Icks A, Buyken AE. Direction of associations between added sugar intake in early childhood and body mass index at age 7 years may depend on intake levels. J Nutr 2011; 141:1348-54. [PMID: 21562234 DOI: 10.3945/jn.110.137000] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Dietary factors, especially during early childhood, have been discussed as potentially critical for the development of childhood overweight. This study evaluated associations between added sugar intake during early childhood and BMI and body fat at age 7 y. Analysis was based on data from 216 participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study. Life-course plots were constructed to evaluate the association between added sugar intake at different ages (0.5, 1, 1.5, and 2 y) and BMI SD score (BMI-SDS) and % body fat (%BF) at age 7 y. Multivariable analyses were performed for the periods identified as critical for later BMI and body fat. Added sugar intake at age 1 y and the change in intake levels during the second year of life emerged as potentially critical. At age 1 y, a higher total added sugar intake was related to a lower BMI-SDS at age 7 y [adjusted β ± SE: -0.116 ± 0.057 BMI-SDS/percent energy (%En) added sugar; P = 0.04]. Conversely, an increase in total added sugar in the second year of life (Δ%En between age 1 and 2 y) tended to be associated with a higher BMI-SDS (adjusted β ± SE: 0.074 ± 0.043 BMI-SDS/Δ%En added sugar; P = 0.09). No associations were observed with %BF. In conclusion, added sugar intake at low intake levels during early childhood does not appear to be critical for BMI and body fat at age 7 y. However, detrimental effects on BMI development may emerge when added sugar intakes are increased to higher levels.
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Affiliation(s)
- Antje Herbst
- Hospital of Leverkusen, Department of Pediatrics, 51375 Leverkusen, Germany
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Kolligs FT, Philipp AB, Nagel D, Spelsberg F, Herbst A, Stieber P. Clinical and prognostic relevance of methylation of circulating HLTF and HPP1 tumor DNA and CEA in serum of patients with colorectal carcinoma (CRC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Herbst A, Awa W, Meissner T, Dost A, Kapellen T, Holl RW. Einfluss von regelmäßigem Sport auf die Stoffwechseleinstellung und das kardiovaskuläre Risikoprofil bei Jugendlichen mit Diabetes mellitus Typ 2: Eine multizentrische Auswertung von 435 Patienten aus 153 Zentren. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Weitzel D, Pfeffer U, Dost A, Herbst A, Knerr I, Holl R, Herbstc A, Knerr I, Holl R. Initial insulin therapy in children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes 2010; 11:159-65. [PMID: 19708907 DOI: 10.1111/j.1399-5448.2009.00562.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of the study was to define parameters that influence the initial insulin dosage in young subjects with type 1 diabetes regarding the amount of daily insulin, the ratios of basal and prandial insulin, and the insulin/carbohydrate ratios. STUDY DESIGN We used a computer-based registry (with prospectively collected data) in Germany and Austria, a software for the management and data documentation of diabetic patients (DPV), to analyze the initial insulin therapy in 2247 children with newly diagnosed type 1 diabetes to identify factors that influence diabetes therapy within the first 10 d. RESULTS For both genders, glucosylated hemoglobin A1c (HbA1c), blood pH at diabetes onset, and pubertal status are the major factors determining the initial insulin dosage calculated as the amount of daily insulin per kilogram body weight (kg), the basal and prandial insulin dose per kilogram, and day and the insulin/carbohydrate ratios for meals. The frequency of hypoglycemia correlated with increasing quotient of applied to calculated insulin dosage. CONCLUSION The predictive factors of insulin requirement may exert beneficial effects on the assessment and adjustment of insulin therapy in young diabetic subjects at disease onset. On the basis of a multiple, linear regression, we suggest a formula to calculate the initial insulin therapy.
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Affiliation(s)
- Dieter Weitzel
- German Clinic for Diagnostic, Children's and Adolescent's Outpatient Centre, Wiesbaden, Germany
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Schebesch KM, Herbst A, Schoedel P, Rockmann F, Brawanski A. Extended extra- and intracerebral ulceration and brain abscess following self-mutilation in an auto-aggressive 51-year-old woman: case report. ACTA ACUST UNITED AC 2010; 71:43-5. [PMID: 20201127 DOI: 10.1055/s-0029-1214383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In neurosurgical practice, the operative treatment of deep or infected wounds caused by auto-mutilation is quite rare, especially in the neurocranium. We present an extraordinary case of an auto-aggressive 51-year-old female suffering from a deeply ulcerated wound on the right frontal skull with consecutive brain abscess, caused manually with needles and forceps over a period of 8 months. The clinical course is present ed together with a description of the conservative and surgical regimen and is illustrated with photographs and CT and MRI images.
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Affiliation(s)
- K M Schebesch
- Department of Neurosurgery, University of Regensburg, Regensburg, Germany.
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Dost A, Hofer S, Herbst A, Stachow R, Schober E, Müller UA, Holl RW. Factors contributing to terminal digital preference in 91,398 patients with diabetes mellitus in Germany and Austria: possible impact on therapeutic decisions. Diabet Med 2009; 26:947-8. [PMID: 19719719 DOI: 10.1111/j.1464-5491.2009.02783.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Amer-Wåhlin I, Källén K, Herbst A, Rydhstroem H, Sundström AK, Marsál K. Implementation of new medical techniques: Experience from the Swedish randomized controlled trial on fetal ECG during labor. J Matern Fetal Neonatal Med 2009; 18:93-100. [PMID: 16203593 DOI: 10.1080/14767050500233191] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In a large Swedish multicenter randomized controlled trial (RCT) on intra partum fetal monitoring with automatic analysis of fetal ECG waveform (STAN) in combination with cardiotocography (CTG) (4966 parturients, 300 obstetricians and midwives managing the patients), interim analysis revealed protocol violations. By a post hoc analysis of the results over time, factors affecting the acceptance of the new technique were analyzed. METHODS The rates of primary and secondary outcome measures (fetal outcome, operative deliveries) were compared in the two study groups (CTG + ST and CTG only). Changes over time were statistically evaluated using a test for homogeneity between the two periods. RESULTS After retraining, the CTG + ST group showed the lowest rates of operative delivery for fetal distress, fetal blood sampling and admissions to neonatal intensive care unit. Operative deliveries (p = 0.02) and the number of fetal blood sampling decreased significantly over time (p = 0.001). CONCLUSIONS Training and education probably predisposed the clinicians to a change and reinforced it when it occurred as a result of increased personal experience. The audit and feedback together with the influence of opinion leaders and inter-collegial interactions seem to have been of importance for the successively increasing acceptance of the new method during the RCT.
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Affiliation(s)
- I Amer-Wåhlin
- Department of Obstetrics and Gynecology, Lund University Hospital, Lund, Sweden.
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Melin M, Bonnevier A, Cardell M, Iorizzo Hogan L, Herbst A. Changes in the ST-interval segment of the fetal electrocardiogram in relation to acid-base status at birth. BJOG 2009. [DOI: 10.1111/j.1471-0528.2009.02180.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
DESIGN To study the association between mode of delivery and neonatal mortality in second twins. To study the association between caesarean delivery and mortality with minimum bias of the indication for the operation, we wanted to compare the outcome of second twins delivered by caesarean due to breech presentation of the sibling with vaginally delivered second twins in uncomplicated pregnancies. SETTING Sweden, 1980-2004. POPULATION Twins born during 1980-2004 were identified from the Swedish Medical Birth Registry. Twin pairs delivered by caesarean due to breech presentation of the first twin, and vaginally delivered twins with the first twin in cephalic presentation were included. Pregnancies with antepartum complications were excluded. METHODS Odds ratios and 95% CI were calculated using multiple logistic regression analyses, adjusting for year of birth, maternal age, parity and gestational age. MAIN OUTCOME MEASURES Neonatal mortality. RESULTS Compared with second-born twins delivered vaginally, second-born twins delivered by caesarean (for breech presentation of the sibling) had a lower risk of neonatal death (adjusted OR 0.40; 95% CI 0.19-0.83). The decreased risk after caesarean delivery was significant for births before 34 weeks (2.1 versus 9.0%; adjusted OR 0.40; 95% CI 0.17-0.95). After 34 weeks, neonatal mortality was low in both groups (0.1 and 0.2%, respectively), and the difference was not statistically significant (adjusted OR 0.42; 95% CI 0.10-1.79). CONCLUSIONS Neonatal mortality is lower for the second twin after caesarean delivery at birth before 34 weeks. At term, mortality is low irrespective of delivery mode.
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Affiliation(s)
- A Herbst
- Department of Obstetrics and Gynaecology, Clinical Sciences, Lund University, Lund, Sweden.
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Geldmacher H, Biller H, Herbst A, Urbanski K, Allison M, Buist AS, Hohlfeld JM, Welte T. [The prevalence of chronic obstructive pulmonary disease (COPD) in Germany. Results of the BOLD study]. Dtsch Med Wochenschr 2008; 133:2609-14. [PMID: 19052996 DOI: 10.1055/s-0028-1105858] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Chronic obstructive pulmonary disease (COPD) is one of the most common causes of chronic morbidity and mortality. The "Burden of Obstructive Lung Disease" (BOLD) initiative was established as an international study collecting data about the prevalence of COPD. The Medical University of Hanover took part in this study collecting data representative for Germany. METHODS 683 individuals aged = 40 years from the city and region of Hannover were included in the study. On the basis of standardized questionnaires data were collected on general health, physical and mental capability, smoking habits and occupational exposure to dust. All participants performed spirometry before and after inhalation of salbutamol. RESULTS The prevalence of COPD, GOLD (Global Health Initiative on Obstructive Lung Disease) severity stage = I, was 13.2% (GOLD stage I: 7.4%; GOLD stage II: 5.0%, GOLD stage III or IV: 0.8%). There was a marked increase of the prevalence of COPD depending on age and smoking habits. The percentage of active smokers in the sample was 20.6 %. Among younger participants the percentage of female smokers was noticeable higher than in older subjects. Although clinical symptoms of COPD, GOLD stage = III correlated with disease severity, only persons with COPD reported reduced physical capability. CONCLUSION COPD is a highly prevalent disease. With regard to the increasing life expectancy and the change of smoking habits of the population, a further increase of morbidity and mortality due to COPD must be expected, especially in women.
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Affiliation(s)
- H Geldmacher
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover.
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Melin M, Bonnevier A, Cardell M, Hogan L, Herbst A. Changes in the ST-interval segment of the fetal electrocardiogram in relation to acid-base status at birth. BJOG 2008; 115:1669-75. [DOI: 10.1111/j.1471-0528.2008.01949.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fröhlich-Reiterer EE, Hofer S, Kaspers S, Herbst A, Kordonouri O, Schwarz HP, Schober E, Grabert M, Holl RW. Screening frequency for celiac disease and autoimmune thyroiditis in children and adolescents with type 1 diabetes mellitus--data from a German/Austrian multicentre survey. Pediatr Diabetes 2008; 9:546-53. [PMID: 18713134 DOI: 10.1111/j.1399-5448.2008.00435.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Type 1 diabetes mellitus (T1DM) is associated with other autoimmune diseases such as celiac disease (CD) and Hashimoto thyroiditis. The aim of this study was to evaluate the screening frequency for CD and thyroid antibodies in a multicentre survey. METHODS The Diabetes Patienten Verlaufsdokumentationssystem (DPV) initiative is based on standardized, prospective, multicentre documentation in children and adolescents with diabetes. Data from 31,104 patients <18 yr of age (52% males, mean age 13.1 yr) with T1DM from 177 paediatric centres in Germany and Austria from 1995 until 2007 were analysed. RESULTS Of 31,104 patients, 16,994 patients (55%) were screened at least once for CD. In 1995, 44% of the patients were screened for CD compared with 68.6% in 2006. Annual screening for CD has also increased (11.9% in 1995 compared with 43.6% in 2006). Eleven per cent of the patients had positive antibodies for CD. Patients with positive antibodies were significantly younger at diabetes onset and had a significantly longer duration of diabetes (p < 0.001). Compared with screening for CD, screening for thyroid antibodies was performed more frequently (at least once in 62% of the patients). Fifteen per cent of the patients had positive thyroid antibodies. Screening for thyroid antibodies also increased from 62.6 to 72.9%, and annual screening frequency increased from 15.9 to 48.9%. CONCLUSION Screening for associated autoimmune diseases in children with T1DM has increased during the past decade. Eleven per cent of the patients had positive CD-specific antibodies, and 15% had positive thyroid antibodies. Screening for thyroid antibodies is performed more frequently than screening for CD.
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Ornö AK, Marsál K, Herbst A. Ultrasonographic anatomy of perineal structures during pregnancy and immediately following obstetric injury. Ultrasound Obstet Gynecol 2008; 32:527-534. [PMID: 18726927 DOI: 10.1002/uog.6122] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To assess perineal anatomy using ultrasound before and immediately after delivery. METHODS Structures in the perineum were studied by real-time two-dimensional transvaginal and endoanal ultrasound imaging using a combined linear and semicircular (up to 200 degrees sector) probe. We examined 45 nulliparous pregnant women and 44 primiparae immediately after delivery (40 with anal sphincter tears and four without sphincter injury). In each case a single longitudinal image was later assessed by two observers in order to evaluate interobserver agreement. RESULTS In pregnancy, the perineal membrane, puboperineal muscles, conjoined longitudinal muscle and central point were identified on real-time examination in 91%, 98%, 100% and 100% of cases, respectively. At offline evaluation of the longitudinal images obtained for each of the pregnant women, the percentage of cases in which each structure was identified by both observers ranged from 64% to 100%. In the women who were examined postpartum, all structures were identified by both observers in all four of the women without sphincter injury. In the women with sphincter tears, the perineal membrane, puboperineal muscles, conjoined longitudinal muscle and central point were found by ultrasound to be intact in 10%, 10%, 55% and 18%, respectively. The agreement between two observers regarding identification of intact structures in a single longitudinal image was good for perineal membrane (kappa index, 0.66), fair for puboperineal muscles (kappa index, 0.40), and poor for conjoined longitudinal muscle and central point (kappa index, 0.08 and 0.17, respectively). CONCLUSIONS Ultrasonography might be helpful in the evaluation of perineal anatomy and extent of perineal tears. However, the relatively poor agreement between the two observers evaluating single linear transvaginal images implies that both transverse and longitudinal projections are necessary to obtain relevant information. Further studies are needed regarding the importance of specific sonographically identified structures and their role in pelvic floor dysfunction after delivery.
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Affiliation(s)
- A-K Ornö
- Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund, Sweden.
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Wiberg-Itzel E, Lipponer C, Norman M, Herbst A, Prebensen D, Hansson A, Bryngelsson AL, Christoffersson M, Sennström M, Wennerholm UB, Nordström L. Determination of pH or lactate in fetal scalp blood in management of intrapartum fetal distress: randomised controlled multicentre trial. BMJ 2008; 336:1284-7. [PMID: 18503103 PMCID: PMC2413392 DOI: 10.1136/bmj.39553.406991.25] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the effectiveness of pH analysis of fetal scalp blood compared with lactate analysis in identifying hypoxia in labour to prevent acidaemia at birth. DESIGN Randomised controlled multicentre trial. SETTING Labour wards. PARTICIPANTS Women with a singleton pregnancy, cephalic presentation, gestational age >or=34 weeks, and clinical indication for fetal scalp blood sampling. INTERVENTIONS Standard pH analysis (n=1496) or lactate analysis (n=1496) with an electrochemical microvolume (5 mul) test strip device. The cut-off levels for intervention were pH <7.21 and lactate >4.8 mmol/l, respectively. MAIN OUTCOME MEASURE Metabolic acidaemia (pH <7.05 and base deficit >12 mmol/l) or pH <7.00 in cord artery blood. RESULTS Metabolic acidaemia occurred in 3.2% in the lactate group and in 3.6% in the pH group (relative risk 0.91, 95% confidence interval 0.61 to 1.36). pH <7.00 occurred in 1.5% in the lactate group and in 1.8% in the pH group (0.84, 0.47 to 1.50). There was no significant difference in Apgar scores <7 at 5 minutes (1.15, 0.76 to 1.75) or operative deliveries for fetal distress (1.02, 0.93 to 1.11). CONCLUSION There were no significant differences in rate of acidaemia at birth after use of lactate analysis or pH analysis of fetal scalp blood samples to determine hypoxia during labour. TRIAL REGISTRATION ISRCT No 1606064.
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Affiliation(s)
- E Wiberg-Itzel
- Departments of Obstetrics and Gynaecology Söder Hospital, Stockholm
| | - C Lipponer
- Sahlgrenska University Hospital, East, Gothenburg
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- Karolinska University Hospital, Karolinska Institute, 171 76 Stockholm, Sweden
| | | | - L Nordström
- Karolinska University Hospital, Karolinska Institute, 171 76 Stockholm, Sweden
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Dannemann K, Hecker W, Haberland H, Herbst A, Galler A, Schäfer T, Brähler E, Kiess W, Kapellen TM. Use of complementary and alternative medicine in children with type 1 diabetes mellitus - prevalence, patterns of use, and costs. Pediatr Diabetes 2008; 9:228-35. [PMID: 18331412 DOI: 10.1111/j.1399-5448.2008.00377.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Complementary and alternative medicine (CAM) is increasingly used in adults and children. Studies on CAM in diabetes have mainly focused on the adult population and its use among children with type 1 diabetes has not been well characterized. OBJECTIVES This study determines prevalence, parental reasons and motivations, perceived effectiveness, costs, and communication of CAM use. Moreover, caregiver-related variables associated with the use of CAM were investigated. METHODS A self-completed anonymous questionnaire was administered to parents of children with type 1 diabetes in four pediatric diabetes centers in Germany (Leipzig, Berlin, Stuttgart, and Bonn). RESULTS Two hundred and twenty eight (65.9%) of 346 families completed the survey. Mean age of the diabetic patients was 11.9 +/- 3.8 yr. Forty two (18.4%) received one or more types of CAM, with the most common types being homeopathy (14.5%), vitamins and minerals (13.7%), modified diet (12.9%), aloe vera (7.3%), and cinnamon (5.6%). Users had a significantly higher family income and parental tertiary education (p < 0.05) and stated a significantly stronger interest in self-care (p < 0.01). Parents' motivations for using CAM were the hope for an improved well-being (92.1%), to try everything (77.8%), and assumption of fewer side effects (55.2%). Costs for the entire treatment varied between less than euro100 and up to euro5000, with mostly no reimbursement. CONCLUSIONS Use of CAM in children with type 1 diabetes is less common than that documented for adults. Parents using CAM do not question the need for insulin. When using CAM, improved well-being and quality of life are important considerations where CAM can have a role.
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Affiliation(s)
- Karen Dannemann
- Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
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Wiberg N, Källén K, Herbst A, Åberg A, Olofsson P. Lactate concentration in umbilical cord blood is gestational age-dependent: a population-based study of 17 867 newborns. BJOG 2008; 115:704-9. [DOI: 10.1111/j.1471-0528.2008.01707.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hitzschke B, Herbst A. Beobachtungen bei Miβbrauch von Methylpentinol. Eur Neurol 2008. [DOI: 10.1159/000127367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Schmidt F, Herbst A, Wolf J, Kapellen T, Hofer S, Rabl W, Holl RW. Diabetes mellitus im Rahmen von genetischen Syndromen im Kindes- und Jugendalter – eine DPV-Wiss-Analyse. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Raile K, Galler A, Hofer S, Herbst A, Dunstheimer D, Busch P, Holl RW. Diabetic nephropathy in 27,805 children, adolescents, and adults with type 1 diabetes: effect of diabetes duration, A1C, hypertension, dyslipidemia, diabetes onset, and sex. Diabetes Care 2007; 30:2523-8. [PMID: 17630266 DOI: 10.2337/dc07-0282] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To give an up-to-date profile of nephropathy and the involvement of risk factors in a large, prospective cohort of patients with type 1 diabetes and largely pediatric and adolescent onset of disease. RESEARCH DESIGN AND METHODS A total of 27,805 patients from the nationwide, prospective German Diabetes Documentation System survey were included in the present analysis. Inclusion criteria were at least two documented urine analyses with identical classification. Urine analyses, treatment regimens, diabetes complications, and risk factors were recorded prospectively. Baseline characteristics were age at diagnosis 9.94 years (median [interquartile range 5.8-14.3]), age at last visit 16.34 years (12.5-22.2), and follow-up time 2.5 years (0.43-5.3). Cumulative incidence of nephropathy was tested by Kaplan-Meier analysis and association with risk factors by logistic regression. RESULTS Nephropathy was classified as normal in 26,605, microalbuminuric in 919, macroalbuminuric in 78, and end-stage renal disease (ESRD) in 203 patients. After calculated diabetes duration of 40 years, 25.4% (95% CI 22.3-28.3) had microalbuminuria and 9.4% (8.3-11.4) had macroalbuminuria or ESRD. Risk factors for microalbuminuria were diabetes duration (odds ratio 1.033, P < 0.0001), A1C (1.13, P < 0.0001), LDL cholesterol (1.003, P < 0.0074), and blood pressure (1.008, P < 0.0074), while childhood diabetes onset (1.011, P < 0.0001) was protective. Male sex was associated with the development of macroalbuminuria. CONCLUSIONS Diabetes duration, A1C, dyslipidemia, blood pressure, and male sex were identified as risk factors for nephropathy. Therefore, besides the best possible metabolic control, early diagnosis and prompt treatment of dyslipidemia and hypertension is mandatory in patients with type 1 diabetes.
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Affiliation(s)
- Klemens Raile
- Department of Pediatric Endocrinology and Diabetes, Charité Children's Hospital, Augustenburger Platz 1, 13353 Berlin, Germany.
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Herbst A, Kordonouri O, Schwab KO, Schmidt F, Holl RW. Impact of physical activity on cardiovascular risk factors in children with type 1 diabetes: a multicenter study of 23,251 patients. Diabetes Care 2007; 30:2098-100. [PMID: 17468347 DOI: 10.2337/dc06-2636] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Antje Herbst
- Pediatrics, Hospital of Leverkusen, Am Gesundheitspark 11, 51375 Leverkusen, Germany.
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Abstract
Patients with type 1 diabetes require continuous substitution of exogenous insulin due to their disability to produce insulin themselves. The insulin dosage required is individual-specific and may change dramatically during the perioperative period. The patient may be endangered by metabolic decompensation including hypoglycaemia and diabetic ketoacidosis. Thus, perioperative management should include frequent blood glucose measurements and frequent adjustment of the insulin and glucose administration. When planning the operation, an individual treatment regime should be drawn up and be made available to the medical team. In order to facilitate the challenging perioperative management of these patients, this article presents the current recommendations for the perioperative management of children and adolescents with type 1 diabetes mellitus (i.e. of the International Society for Pediatric and Adolescent Diabetes, ISPAD).
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Affiliation(s)
- A Herbst
- Zentrum für Kinderheilkunde, Klinikum Leverkusen, Am Gesundheitspark 11, 51375 Leverkusen, Deutschland.
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Hilgard D, Johannsen C, Herbst A, Oeverink R, Mix M, Holl R. Entwicklung von Hospitalisierung und durchschnittlicher stationärer Verweildauer bei Kindern und Jugendlichen mit Diabetes mellitus Typ 1 in der Zeit von 1995 bis 2005. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-960655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dost A, Herbst A, Kintzel K, Haberland H, Roth CL, Gortner L, Holl RW. Shorter remission period in young versus older children with diabetes mellitus type 1. Exp Clin Endocrinol Diabetes 2007; 115:33-7. [PMID: 17286232 DOI: 10.1055/s-2007-948214] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The initial period of diabetes type 1 is of great importance, since early metabolic adjustment has profound impact on long term control. The majority of pediatric centers in Germany participate in a national quality initiative, providing longitudinal data for central analysis. PATIENTS 104543 anonymous data sets were obtained from 6123 pediatric patients under 18 years who were treated in 157 pediatric centers and monitored for 36 months at the same center starting from diagnosis. RESULTS Partial remission (insulin <0.5 U/kg/d and HbA1c < or = 7.0%) was present in 1992 children (32.5%) within the first 3 months after diagnosis. Remission phase lasted in average for 0.74 +/- 0.77 years and was significantly shorter in children below 10 years of age at onset of diabetes compared to the older patients. The remission period was significantly longer in boys, particularly in children under 10 years (p=0.0039). Multiple regression analysis showed a longer remission phase in children with pubertal diabetes onset. The children entering remission were younger, more often boys and had a lower initial HbA1c level. CONCLUSION These data from a large multicenter group of children with diabetes type 1 emphasize the influence of gender, pubertal stage and age at manifestation on the amount of insulin required, and therefore the clinical remission, during the first three years of the disease.
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Affiliation(s)
- A Dost
- Department of Pediatrics, University of Jena, Jena, Germany.
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