1
|
Boxhammer E, Dienhart C, Kletzer J, Ramsauer S, Kopp K, Prinz E, Wintersteller W, Blessberger H, Hammerer M, Steinwender C, Lichtenauer M, Hoppe UC. Elevated systolic pulmonary artery pressure is a substantial predictor of increased mortality after transcatheter aortic valve replacement in males, not in females. Clin Res Cardiol 2024; 113:138-155. [PMID: 37750991 PMCID: PMC10808322 DOI: 10.1007/s00392-023-02307-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND While pulmonary hypertension (PH) in patients with severe aortic valve stenosis (AS) is associated with increased mortality after transcatheter aortic valve replacement (TAVR), there is limited data on gender differences in the effects on long-term survival. OBJECTIVE The aim of this retrospective, multicenter study was to investigate the prognostic impact of pre-interventional PH on survival of TAVR patients with respect to gender. METHODS 303 patients undergoing TAVR underwent echocardiography to detect PH prior to TAVR via measurement of systolic pulmonary artery pressure (sPAP). Different cut-off values were set for the presence of PH. The primary endpoint was all-cause mortality at 1, 3 and 5 years. RESULTS Kaplan-Meier analysis by gender showed that only males exhibited significant increased mortality at elevated sPAP values during the entire follow-up period of 5 years (sPAP ≥ 40 mmHg: p ≤ 0.001 and sPAP ≥ 50 mmHg: p ≤ 0.001 in 1- to 5-year survival), whereas high sPAP values had no effect on survival in females. In Cox regression analysis based on the selected sPAP thresholds, male gender was an independent risk factor for long-term mortality after TAVR in all time courses. CONCLUSION Male gender was an isolated risk factor for premature death after TAVR in patients with echocardiographic evidence of PH and severe AS. This could mean that, the indication for TAVR should be discussed more critically in men with severe AS and an elevated sPAP, while in females, PH should not be an exclusion criterion for TAVR.
Collapse
Affiliation(s)
- Elke Boxhammer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Christiane Dienhart
- Department of Internal Medicine I, Division of Gastroenterology, Hepathology, Nephrology, Metabolism and Diabetology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Joseph Kletzer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Susanne Ramsauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Kristen Kopp
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Erika Prinz
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Wilfried Wintersteller
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
| | - Matthias Hammerer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| |
Collapse
|
2
|
Brandt M, Prinz E, Hammerer M, Strohmer B, Motloch L, Nairz O, Hoppe U. TCT-247 Superior Radiation Protection With a Ceiling-Suspended Protection System in Emergency PCI for Acute Myocardial Infarction—Data From the OSCAR Registry. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.290] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
3
|
Rezar R, Paar V, Seelmaier C, Pretsch I, Schwaiger P, Kopp K, Kaufmann R, Felder TK, Prinz E, Gemes G, Pistulli R, Hoppe UC, Wernly B, Lichtenauer M. Soluble suppression of tumorigenicity 2 as outcome predictor after cardiopulmonary resuscitation: an observational prospective study. Sci Rep 2021; 11:21756. [PMID: 34741120 PMCID: PMC8571342 DOI: 10.1038/s41598-021-01389-x] [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] [Received: 05/12/2021] [Accepted: 10/27/2021] [Indexed: 11/09/2022] Open
Abstract
Prognostication after cardiopulmonary resuscitation (CPR) is complex. Novel biomarkers like soluble suppression of tumorigenicity 2 (sST2) may provide an objective approach. A total of 106 post-CPR patients were included in this single-center observational prospective study. Serum sST2 levels were obtained 24 h after admission. Individuals were assigned to two groups: patients below and above the overall cohort’s median sST2 concentration. Primary outcome was a combined endpoint at 6 months (death or Cerebral Performance Category > 2); secondary endpoint 30-day mortality. A uni- and multivariate logistic regression analysis were conducted. Elevated sST2-levels were associated with an increased risk for the primary outcome (OR 1.011, 95% CI 1.004–1.019, p = 0.004), yet no patients with poor neurological outcome were observed at 6 months. The optimal empirical cut-off for sST2 was 46.15 ng/ml (sensitivity 81%, specificity 53%, AUC 0.69). Levels above the median (> 53.42 ng/ml) were associated with higher odds for both endpoints (death or CPC > 2 after 6 months: 21% vs. 49%, OR 3.59, 95% CI 1.53–8.45, p = 0.003; death after 30 days: 17% vs. 43.3%, OR 3.75, 95% CI 1.52–9.21, p = 0.003). A positive correlation of serum sST2 after CPR with mortality at 30 days and 6 months after cardiac arrest could be demonstrated.
Collapse
Affiliation(s)
- Richard Rezar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria.
| | - Vera Paar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Clemens Seelmaier
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Ingrid Pretsch
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Philipp Schwaiger
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Kristen Kopp
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Reinhard Kaufmann
- Department of Radiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Thomas K Felder
- Department of Laboratory Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Erika Prinz
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Geza Gemes
- Department of Anaesthesiology and Intensive Care Medicine, Krankenhaus Der Barmherzigen Brüder Graz, Graz, Austria
| | - Rudin Pistulli
- Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Münster, Germany
| | - Uta C Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria.,Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria.,Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| |
Collapse
|
4
|
Brandt M, Prinz E, Schernthaner C, Kraus J, Wintersteller W, Hammerer M, Strohmer B, Lichtenauer M, Motloch L, Hoppe U, Nairz O. TCT-154 Advanced Radiation Protection in PCI and Diagnostic Procedures With a Ceiling-Suspended Radiation Protection System—Data From the OSCAR Registry. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
5
|
Weihs V, Pogran E, Kunschitz E, Weihs W, Prinz E, Eichenberg C, Fiegl J, Friedrich O, Huber K. Psychocardiological assessment in the acute phase of the takotsubo syndrome : Somatic and depressive disorders, resilience and illness perception. Wien Klin Wochenschr 2021; 134:269-275. [PMID: 34671830 PMCID: PMC9023402 DOI: 10.1007/s00508-021-01957-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/18/2021] [Indexed: 12/02/2022]
Abstract
Objective To analyze the psychocardiological profile and the clinical characteristics in the acute phase of takotsubo syndrome (TTS). Methods Prospective multicenter cohort study of TTS patients evaluating the clinical characteristics as well as the prevalence of somatic, depressive, panic, stress and anxiety disorders. Assessment of illness perception and resilience in the acute phase of the syndrome. Results All 27 evaluated TTS patients were female with a mean age of 68 years (±11.4 years). The apical type of TTS was found in 60% of patients, followed by the combined type of TTS in 30% of patients. Main clinical symptom leading to hospital admission was chest pain in nearly 80% of patients. An ST-segment elevation mimicking acute myocardial infarction was found in 44% of patients and T wave inversion in 26% of patients. An endogenous (emotional) stress event was found in 17 patients (63.0%), an exogenous (physical) stress event in 5 patients (18.5%) and a combined stress event in 2 patients (7.4%). In 11.1% of patients (n = 3) no stress event could be found. Moderate to high levels of illness threatening were found in 48% of patients and low to moderate resilience scores were found in 40% of patients. Somatic disorders were found in half of the patients (56%) followed by depressive disorders in 26% of patients. Conclusion Moderate to low resilience scores and moderate to high levels of illness threatening can be seen in the acute phase of TTS, reflecting the severity of the experience as an adverse life event. Patients suffering from TTS present in the acute phase with a high prevalence of somatic disorders and relatively high prevalence of depressive disorders.
Collapse
Affiliation(s)
- Valerie Weihs
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring, Vienna, Austria.
| | - Edita Pogran
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring, Vienna, Austria
| | - Evelyn Kunschitz
- II. Medical Department for Cardiology, Takotsubo-Ambulanz, Hanusch Hospital, Vienna, Austria
- Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, II. Medical Department for Cardiology, Hanusch Hospital, Vienna, Austria
| | - Wolfgang Weihs
- Department of Cardiology, Hospital Graz II, Graz, Austria
| | - Erika Prinz
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Christiane Eichenberg
- Institute for Psychosomatic, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Jutta Fiegl
- Faculty of Psychotherapy Science, Sigmund Freud University, Vienna, Austria
| | - Oliver Friedrich
- Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, II. Medical Department for Cardiology, Hanusch Hospital, Vienna, Austria
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring, Vienna, Austria
- Medical Faculty, Sigmund Freud University, Vienna, Austria
| |
Collapse
|
6
|
Brandt MC, Prinz E, Wintersteller W, Schernthaner C, Hammerer M, Kraus J, Danmayr F, Strohmer B, Pretsch I, Lichtenauer M, Motloch LJ, Hoppe UC, Nairz O. Effective reduction of scatter radiation for operator and assistant during coronary procedures with a suspended radiation protection system in a per-procedure live-dosimetry analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2098] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Interventional cardiologists (IC) are exposed to the highest doses of radiation compared to all other medical specialties. Although head and eyes are exposed to a significant dose of scatter radiation (SCR), precise per-procedure data is sparse. Recently, the EU guidelines for maximum eye lens SCR doses have been reduced from 150 mSv to 20 mSv per year. A ceiling suspended operator radiation protection system has shown additional benefits for SCR protection in radiologic interventional procedures.
Purpose
To study the impact of the ZG system on IC and sterile assistant (SA) SCR exposure when used in addition to the current standard of X-ray protection (SXP) in unselected all-comers cardiologic procedures.
Methods
IC and SA were equipped with Unfors RaySafe i3 live-dosimeters at prespecified locations. 181 consecutive cardiac procedures were recorded, in which either both IC and SA were using SXP (lead apron, thyroid shield) or the IC was using the ZG system and the SA was wearing SXP. In all procedures a suspended lead shield, patient lead cover and an adjustable lead side-shield were present. Diagnostic angiographies (DA) and interventions (PCI) were grouped separately. Within both groups, the IC's and SA's SCR doses were compared.
Results
SCR doses were recorded in 100 DA and 81 PCI procedures. Compared to SXP, the use of the ZG device reduced the average SCR doses per procedure of the IC recorded at the left lateral head from 5.18±1.11 μSv to 0.60±0.07 μSv in DA (−88%; n=49/49, p<0.0001) and from 19.64±3.36 μSv to 1.05±0.28 μSv for PCI (−95%; n=54/23, p=0.0006). The IC's average frontal dose at eye level was reduced from 1.38±0.33 μSv to 0.36±0.04 μSv in DA (−74%; n=50/50, p=0.0033) and from 3.33±0.53 μSv to 0.88±0.20 μSv in PCI (−74%; n=55/25, p=0.0031). Consistently, the dose recorded immediately under the IC's left shoulder were reduced from 34.14±7.79 μSv to 1.59±0.32 μSv in DA (−95%; n=39/40, p=0.0001) and from 71.77±10.77 μSv to 3.95±0.83 μSv in PCI (−94%; n=44/23, p=0.0001). Furthermore, when the IC used the ZG system, the average SCR dose recorded at the SA's head was reduced from 4.32±0.98 μSv to 2.11±0.28 μSv in DA (−51%, n=45/49, p=0.027) and from 18.55±2.69 μSv to 6.93±1.93 μSv in PCI (−63%, n=54/24, p=0.0078). With the exception of the IC frontal dose, all SCR dose effects remained significant after correction for total radiation time (μSv/s) and dose-area product (μSv/Gy·cm2). Procedure duration, contrast use and patient radiation dose were not affected by ZG use.
Conclusions
In a representative all-comers cohort of cardiac procedures, the ZG X-ray protection system demonstrated an impressive potential for SCR reduction in critical anatomical areas - even in a state-of-the-art cath-lab inventory with multiple SCR reduction measures already in place. Remarkably, the protective effect also included the sterile assistant at the table wearing SXP.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- M C Brandt
- Paracelsus Medical University, Clinic II of Internal Medicine, Salzburg, Austria
| | - E Prinz
- Paracelsus Medical University, Clinic II of Internal Medicine, Salzburg, Austria
| | - W Wintersteller
- Paracelsus Medical University, Clinic II of Internal Medicine, Salzburg, Austria
| | - C Schernthaner
- Paracelsus Medical University, Clinic II of Internal Medicine, Salzburg, Austria
| | - M Hammerer
- Paracelsus Medical University, Clinic II of Internal Medicine, Salzburg, Austria
| | - J Kraus
- Paracelsus Medical University, Clinic II of Internal Medicine, Salzburg, Austria
| | - F Danmayr
- Paracelsus Medical University, Clinic II of Internal Medicine, Salzburg, Austria
| | - B Strohmer
- Paracelsus Medical University, Clinic II of Internal Medicine, Salzburg, Austria
| | - I Pretsch
- Paracelsus Medical University, Clinic II of Internal Medicine, Salzburg, Austria
| | - M Lichtenauer
- Paracelsus Medical University, Clinic II of Internal Medicine, Salzburg, Austria
| | - L J Motloch
- Paracelsus Medical University, Clinic II of Internal Medicine, Salzburg, Austria
| | - U C Hoppe
- Paracelsus Medical University, Clinic II of Internal Medicine, Salzburg, Austria
| | - O Nairz
- Paracelsus Medical University, Radiation Safety Office, Salzburg, Austria
| |
Collapse
|
7
|
Lloyd-Hughes J, Oppeneer PM, Pereira Dos Santos T, Schleife A, Meng S, Sentef MA, Ruggenthaler M, Rubio A, Radu I, Murnane M, Shi X, Kapteyn H, Stadtmüller B, Dani KM, da Jornada FH, Prinz E, Aeschlimann M, Milot RL, Burdanova M, Boland J, Cocker T, Hegmann F. The 2021 ultrafast spectroscopic probes of condensed matter roadmap. J Phys Condens Matter 2021; 33:353001. [PMID: 33951618 DOI: 10.1088/1361-648x/abfe21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
In the 60 years since the invention of the laser, the scientific community has developed numerous fields of research based on these bright, coherent light sources, including the areas of imaging, spectroscopy, materials processing and communications. Ultrafast spectroscopy and imaging techniques are at the forefront of research into the light-matter interaction at the shortest times accessible to experiments, ranging from a few attoseconds to nanoseconds. Light pulses provide a crucial probe of the dynamical motion of charges, spins, and atoms on picosecond, femtosecond, and down to attosecond timescales, none of which are accessible even with the fastest electronic devices. Furthermore, strong light pulses can drive materials into unusual phases, with exotic properties. In this roadmap we describe the current state-of-the-art in experimental and theoretical studies of condensed matter using ultrafast probes. In each contribution, the authors also use their extensive knowledge to highlight challenges and predict future trends.
Collapse
Affiliation(s)
- J Lloyd-Hughes
- Department of Physics, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom
| | - P M Oppeneer
- Department of Physics and Astronomy, Uppsala University, PO Box 516, S-75120 Uppsala, Sweden
| | - T Pereira Dos Santos
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, United States of America
| | - A Schleife
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, United States of America
- Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL 61801, United States of America
- National Center for Supercomputing Applications, University of Illinois at Urbana-Champaign, Urbana, IL 61801, United States of America
| | - S Meng
- Institute of Physics, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - M A Sentef
- Max Planck Institute for the Structure and Dynamics of Matter, Center for Free Electron Laser Science (CFEL), 22761 Hamburg, Germany
| | - M Ruggenthaler
- Max Planck Institute for the Structure and Dynamics of Matter, Center for Free Electron Laser Science (CFEL), 22761 Hamburg, Germany
| | - A Rubio
- Max Planck Institute for the Structure and Dynamics of Matter, Center for Free Electron Laser Science (CFEL), 22761 Hamburg, Germany
- Nano-Bio Spectroscopy Group and ETSF, Universidad del País Vasco UPV/EHU 20018 San Sebastián, Spain
- Center for Computational Quantum Physics (CCQ), The Flatiron Institute, 162 Fifth Avenue, New York, NY, 10010, United States of America
| | - I Radu
- Department of Physics, Freie Universität Berlin, Germany
- Max Born Institute, Berlin, Germany
| | - M Murnane
- JILA, University of Colorado and NIST, Boulder, CO, United States of America
| | - X Shi
- JILA, University of Colorado and NIST, Boulder, CO, United States of America
| | - H Kapteyn
- JILA, University of Colorado and NIST, Boulder, CO, United States of America
| | - B Stadtmüller
- Department of Physics and Research Center OPTIMAS, University of Kaiserslautern, 67663 Kaiserslautern, Germany
| | - K M Dani
- Femtosecond Spectroscopy Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Japan
| | - F H da Jornada
- Department of Materials Science and Engineering, Stanford University, Stanford, 94305, CA, United States of America
| | - E Prinz
- Department of Physics and Research Center OPTIMAS, University of Kaiserslautern, 67663 Kaiserslautern, Germany
| | - M Aeschlimann
- Department of Physics and Research Center OPTIMAS, University of Kaiserslautern, 67663 Kaiserslautern, Germany
| | - R L Milot
- Department of Physics, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom
| | - M Burdanova
- Department of Physics, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom
| | - J Boland
- Photon Science Institute, Department of Electrical and Electronic Engineering, University of Manchester, United Kingdom
| | - T Cocker
- Michigan State University, United States of America
| | | |
Collapse
|
8
|
Georg-Schaffner L, Prinz E. Corporate management boards’ information security orientation: an analysis of cybersecurity incidents in DAX 30 companies. J Manag Gov 2021. [DOI: 10.1007/s10997-021-09588-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
9
|
Lichtenauer M, Prinz E, Granitz C, Wernly B, Kopp K, Daburger A, Hoppe UC. Overview of Current International Recommendations for Echocardiography Exams During the Covid-19 Pandemic and Its Local Implementation in Austria. Front Cardiovasc Med 2021; 8:623076. [PMID: 33644131 PMCID: PMC7902516 DOI: 10.3389/fcvm.2021.623076] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
Since its first appearance in December 2019, the novel Coronavirus SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) has spread throughout the world at rapid pace causing the coronavirus disease 2019 (Covid-19). Originating in the Chinese province Hubei, more than 91.8 million people globally have now been infected with the coronavirus and more than 1.966.000 patients have died thus far from Covid-19 (as of January 13th 2021). The virus spreads primarily by droplet infection as well as via aerosols during close physical contact. Particularly in medical examinations with close physical contact between examiner and patient, like echocardiography, the risk of contracting the virus is increased. Therefore, the use of personal protective equipment is recommended for the protection of patients and medical personnel alike. In this article, the current recommendations of international professional associations on the use of personal protective equipment and their local implementation are presented.
Collapse
Affiliation(s)
- Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Erika Prinz
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Christina Granitz
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Bernhard Wernly
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Kristen Kopp
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Apollonia Daburger
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| |
Collapse
|
10
|
Peillex M, Marchandot B, Matsushita K, Prinz E, Hess S, Reydel Dedieu A, Carmona A, Heger J, Trimaille A, Petit-Eisenmann H, Trinh A, Jesel L, Ohlmann P, Morel O. Acute kidney injury and Acute kidney recovery following TAVR: Conflicting results with regards to earlier studies. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.164] [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]
|
11
|
Lichtenauer M, Prinz E, Granitz C, Wernly B, Daburger A, Hoppe UC. [Echocardiographic examinations in times of the COVID-19 pandemic : International recommendations and implementation]. Herz 2020; 45:715-718. [PMID: 33064159 PMCID: PMC7562754 DOI: 10.1007/s00059-020-04992-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 10/27/2022]
Abstract
Since its first appearance in December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world at a rapid pace causing the coronavirus disease 2019 (COVID-19). Originating from the Chinese province Hubei, more than 29.4 million people globally have now been confirmed to have contracted the coronavirus and more than 930,000 patients have died so far from COVID-19 (situation as of 15 September 2020). The virus is mainly spread during close contact by small droplets and aerosols. During the close contact in medical examinations, such as echocardiography, the risk of contracting the virus is increased. Therefore, the use of personal protective equipment is recommended for the protection of patients and medical personnel alike. This article summarizes the current recommendations of international societies and describes the local implementation in Austria.
Collapse
Affiliation(s)
- Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Österreich.
| | - Erika Prinz
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Österreich
| | - Christina Granitz
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Österreich
| | - Bernhard Wernly
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Österreich
| | - Apollonia Daburger
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Österreich
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Österreich
| |
Collapse
|
12
|
Lichtenauer M, Pichler T, Eder S, Mirna M, Magnes T, Wernly B, Paar V, Jung C, Prinz E, Seitelberger R, Hoppe UC. Carcinoid heart disease involving the left heart: a case report and biomarker analysis. ESC Heart Fail 2019; 6:222-227. [PMID: 30620449 PMCID: PMC6352891 DOI: 10.1002/ehf2.12396] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/15/2018] [Indexed: 01/30/2023] Open
Abstract
Herein, we report the case of a 67‐year‐old woman who was admitted to our hospital because of dyspnoea and oedema of the lower extremities. Transthoracic echocardiography revealed severe tricuspid and mitral regurgitation, and the leaflets of the tricuspid valve were found to be rigid and almost immobile. The plasma concentrations of serotonin and chromogranin A were elevated, and hence, suspicion for carcinoid heart disease was raised. In addition to the diagnostic workup and medical and surgical treatment, we analysed levels of novel cardiovascular biomarkers throughout the entire follow‐up by means of enzyme‐linked immunosorbent assay. A dopa positron emission tomography (DOPA‐PET) was conducted and showed a neoplasm in the terminal ileum. Tricuspid valve replacement, mitral valve repair, and a closure of the patent foramen ovale (PFO) were conducted. Two months later, hemicolectomy and liver segment resection were performed. The tumour was resected, and the diagnosis of a neuroendocrine tumour (NET) was confirmed. Throughout the follow‐up, we observed a decrease in the plasma levels of novel biomarkers [e.g. interleukin‐8 (IL‐8), soluble suppression of tumorigenicity‐2 (sST2), and heart‐type fatty acid‐binding protein (H‐FABP)] over the follow‐up period. In our case, carcinoid heart disease resulted in a severe tricuspid regurgitation as commonly seen in these patients. Moreover, a pre‐existent mitral regurgitation was likely aggravated by fibrotic remodelling, because a PFO has led to a right‐to‐left shunt and might have caused left heart involvement. As IL‐8 was associated with adverse outcomes in patients with NETs, and sST2 and H‐FABP were associated with adverse outcomes in patients with heart failure previously, these biomarkers could aid in the risk stratification of patients with NET.
Collapse
Affiliation(s)
- Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University, Muellner Hauptstrasse 48, A-5020, Salzburg, Austria
| | - Tristan Pichler
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University, Muellner Hauptstrasse 48, A-5020, Salzburg, Austria
| | - Sarah Eder
- Department of Internal Medicine, Oberndorf Hospital, Salzburg, Austria
| | - Moritz Mirna
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University, Muellner Hauptstrasse 48, A-5020, Salzburg, Austria
| | - Theresa Magnes
- Clinic of Internal Medicine III, Department of Oncology, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University, Muellner Hauptstrasse 48, A-5020, Salzburg, Austria
| | - Vera Paar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University, Muellner Hauptstrasse 48, A-5020, Salzburg, Austria
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Erika Prinz
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University, Muellner Hauptstrasse 48, A-5020, Salzburg, Austria
| | | | - Uta C Hoppe
- Department of Internal Medicine, Oberndorf Hospital, Salzburg, Austria
| |
Collapse
|
13
|
Mirna M, Wernly B, Eder S, Lichtenauer M, Prinz E, Wintersteller W, Jung C, Hoppe U, Hammerer M. Transcatheter aortic valve implantation without prior balloon valvuloplasty is associated with less pronounced markers of myocardial injury. J Cardiovasc Surg (Torino) 2018; 61:243-249. [PMID: 30303343 DOI: 10.23736/s0021-9509.18.10651-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Aortic valve stenosis is the most common valvulopathy in developed countries. Transcatheter aortic valve implantation (TAVI) is a therapeutic alternative in symptomatic patients at high or prohibitive perioperative risk. Predilatation by balloon aortic valvuloplasty (BAV) under rapid ventricular pacing (RVP) has been a routine part of TAVI. However, both RVP and BAV carry substantial risks and an increasing number of interventional centers are performing TAVI without predilatation (direct TAVI). A transient decrease of left ventricular function and elevated markers of myocardial injury after TAVI with predilatation were observed in previous studies. In this study, we investigated whether direct TAVI was associated with a similar increase in cardiac biomarkers and decrease in ejection fraction in a cohort of our patients. METHODS Consecutive patients undergoing TAVI without predilatation using a self-expanding system at a single center between April 2013 and December 2015 were followed up for one year and were retrospectively analyzed regarding mortality, safety and efficacy endpoints as well as common laboratory and echocardiographic parameters. RESULTS A total of 164 patients (83±6 years; 56% female) were included in the analysis. According to the Valve Academic Research Consortium 2 (VARC-2) criteria the technical success rate was 96.3% and 89.1% of patients remained free of a combined safety endpoint at 30 days. Mortality rates at 30 days and 1 year were 3.0% (N.=5) and 10.4% (N.=17), respectively. TAVI without predilatation was highly effective in lowering aortic valve peak velocity from 4.4±0.6 m/s before to 1.7±0.5 m/s (P<0.01), and mean pressure gradient across the valve from 48.7±15.1 mmHg to 8.3±4.5 mmHg (<0.05). Left ventricular function remained unaltered after the intervention (51±10% prior to TAVI and 51±9% post TAVI), whereas high sensitive troponin T (hs-TnT), a well-established marker for myocardial injury, increased significantly from 26 ng/L (interquartile range=18.00-44.00) to 119 ng/L (interquartile range=73.25-166.00, P<0.001) during this time. Notably, an increase in the plasma levels of hs-TnT >15 times the upper limit of normal was associated with mortality both one month and one year after TAVI. CONCLUSIONS TAVI without predilatation is feasible, safe and effective for aortic valve replacement in symptomatic patients with severe aortic stenosis who are at high perioperative risk. In contrast to a cohort of patients who underwent TAVI with predilatation previously published by another center, our patients did not suffer from transient impairment of left ventricular function. As a marker of myocardial injury, hs-TnT showed a less pronounced increase than reported previously. This might be a marker for a prognostic benefit as hs-TnT has been shown to be a strong predictor of outcome in patients undergoing TAVI. We conclude that direct TAVI is a less invasive option involving less myocardial stress.
Collapse
Affiliation(s)
- Moritz Mirna
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Sarah Eder
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Erika Prinz
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Wilfried Wintersteller
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Faculty of Medicine, University of Duesseldorf, Duesseldorf, Germany
| | - Uta Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Matthias Hammerer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria -
| |
Collapse
|
14
|
Affiliation(s)
- Lynne Hinterbuchner
- Department of Cardiology, Paracelsus Medical University, Salzburger Landeskliniken, Salzburg, Austria
| | - Bernhard Strohmer
- Department of Cardiology, Paracelsus Medical University, Salzburger Landeskliniken, Salzburg, Austria
| | - Matthias Hammerer
- Department of Cardiology, Paracelsus Medical University, Salzburger Landeskliniken, Salzburg, Austria
| | - Erika Prinz
- Department of Cardiology, Paracelsus Medical University, Salzburger Landeskliniken, Salzburg, Austria
| | - Uta C Hoppe
- Department of Cardiology, Paracelsus Medical University, Salzburger Landeskliniken, Salzburg, Austria
| | - Christiana Schernthaner
- Department of Cardiology, Paracelsus Medical University, Salzburger Landeskliniken, Salzburg, Austria
| |
Collapse
|
15
|
Passow D, Prinz E, Maaß C, Wedler K, Bordel U, Schläfke D. Legalbewährung und Konsumverhalten bei Probanden der forensischen Nachsorge nach Unterbringung in einer Entziehungsanstalt (§ 64 StGB). Suchttherapie 2015. [DOI: 10.1055/s-0041-107758] [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: 10/22/2022]
Affiliation(s)
- D. Passow
- Klinik für Forensische Psychiatrie – Universitätsmedizin Rostock
| | - E. Prinz
- Klinik für Forensische Psychiatrie – Universitätsmedizin Rostock
| | - C. Maaß
- Klinik für Forensische Psychiatrie – Universitätsmedizin Rostock
| | - K. Wedler
- Klinik für Forensische Psychiatrie – Universitätsmedizin Rostock
| | - U. Bordel
- Klinik für Forensische Psychiatrie – Universitätsmedizin Rostock
| | - D. Schläfke
- Klinik für Forensische Psychiatrie – Universitätsmedizin Rostock
| |
Collapse
|
16
|
Krummel T, Garstka A, Thiery A, Prinz E, Chantrel F, Kribs M, Klein A, Hannedouche T. Vascularite rénale à ANCA : l’association d’échanges plasmatiques et de bolus de méthylprednisolone semble bénéfique dans les formes sévères. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.343] [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]
|
17
|
Prinz E, Rosner V, Kessler R, Moulin B. Évaluation du risque lithiasique associé à la mucoviscidose. Nephrol Ther 2013. [DOI: 10.1016/j.nephro.2013.07.014] [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: 10/26/2022]
|
18
|
Hofer-Dückelmann C, Prinz E, Beindl W, Berger K, Fellhofer G, Mutzenbach J, Schuler J. Evaluation of a computerised physician order entry system. Eur J Hosp Pharm 2012. [DOI: 10.1136/ejhpharm-2012-000074.131] [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] Open
|
19
|
Hammerer M, Schuler J, Altenberger J, Kraus J, Prinz E, Matzinger M, Pichler M, Heigert M. Rehospitalization rates after transcatheter aortic valve implantation. Wien Klin Wochenschr 2011; 124:45-52. [DOI: 10.1007/s00508-011-0075-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 08/25/2011] [Indexed: 01/19/2023]
|
20
|
Schuler J, Dückelmann C, Beindl W, Prinz E, Michalski T, Pichler M. Polypharmacy and inappropriate prescribing in elderly internal-medicine patients in Austria. Wien Klin Wochenschr 2009; 120:733-41. [PMID: 19122984 DOI: 10.1007/s00508-008-1089-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 09/01/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of the study was to assess the prevalence of polypharmacy and inappropriate drug use in elderly internal-medicine patients in one Austrian center and to define the impact of these and other identified predictors on the occurrence of adverse drug events. METHODS All patients>or=75 years admitted to selected internal wards of a university hospital were included in a monocentric prospective cohort study over a period of three months. The pre-admission medication of the patients was analyzed with respect to appropriateness by a multidisciplinary team consisting of pharmacists and physicians trained in internal medicine. The medication was evaluated for the occurrence of adverse drug events. RESULTS A total of 543 patients were analyzed (median age 82 years; 60.2% female). The mean number of drugs taken was 7.5+/-3.8, with women taking significantly more drugs than men (7.8 vs. 6.8, P=0.013). Overall, 58.4% of the patients fulfilled the given criteria for polypharmacy (>6 drugs). The following factors were associated with polypharmacy: female sex, need for nursing care, high number of discharge diagnoses and high Charlson comorbidity score. Unnecessary drugs were found prescribed in 36.3% of all patients, drugs to avoid (Beers criteria) in 30.1%, duplication in 7.6%, wrong dosage in 23.4% and possible drug-drug interactions in 65.8%. Adverse drug events were identified in 17.8% of the patients (97/543), among whom the adverse drug event was the reason for hospital admission in 56.7% of the cases and a drug-drug interaction was involved in 18.7%. Risk factors for adverse drug events were female sex, polymorbidity, renal dysfunction and inappropriate prescribing. CONCLUSION Polypharmacy, inappropriate prescribing and adverse drug events were highly prevalent in a cohort of elderly internal-medicine patients in Austria. To improve drug safety in this high-risk population, appropriate prescribing might be more important than simply reducing the number of prescribed drugs.
Collapse
Affiliation(s)
- Jochen Schuler
- Department of Cardiology and Internal Intensive Care, Salzburger Landeskliniken, Paracelsus Private Medical University Salzburg, Austria.
| | | | | | | | | | | |
Collapse
|
21
|
Pleyer L, Went P, Russ G, Prinz E, Faber V, Röwert HJ, Karlbauer R, Greil R. Massive infiltration of bone marrow in colon carcinoma after treatment with activated protein C. Wien Klin Wochenschr 2007; 119:254-8. [PMID: 17492354 DOI: 10.1007/s00508-007-0774-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Accepted: 12/07/2006] [Indexed: 11/26/2022]
Abstract
We present an unusual case of localized colorectal carcinoma complicated by sepsis which was treated with activated protein C (APC). Shortly after treatment the patient developed symptomatic metastases to the bone marrow (BM). Destruction of bones by colorectal cancer (CRC) is rare, although BM micrometastases are frequently observed. However, overt symptomatic BM metastasis is an exotic rarity. APC interacts with molecules and modulates pathways that are unquestionably involved in tumorigenesis and formation of metastases. Therefore a possible contributory role of the anti-inflammatory and immunomodulatory therapy in the rapid evolution of the disease cannot be excluded. Questions concerning the relevance and contribution of sepsis, treatment with APC, exquisitely high levels of non-thrombosis-associated D-dimer and CA19-9 to this highly uncommon course of disease are discussed. The lesson learned from this case is that APC may have contributed to the massive invasion of BM by colonic cancer cells in our patient and that APC should therefore be used with extreme restraint in patients with potentially curable cancer.
Collapse
Affiliation(s)
- Lisa Pleyer
- IIIrd Medical Department (Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases), Private Medical Paracelsus University Salzburg, Salzburg, Austria
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Nepstad D, Schwartzman S, Bamberger B, Santilli M, Ray D, Schlesinger P, Lefebvre P, Alencar A, Prinz E, Fiske G, Rolla A. Inhibition of Amazon deforestation and fire by parks and indigenous lands. Conserv Biol 2006; 20:65-73. [PMID: 16909660 DOI: 10.1111/j.1523-1739.2006.00351.x] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Conservation scientists generally agree that many types of protected areas will be needed to protect tropical forests. But little is known of the comparative performance of inhabited and uninhabited reserves in slowing the most extreme form of forest disturbance: conversion to agriculture. We used satellite-based maps of land cover and fire occurrence in the Brazilian Amazon to compare the performance of large (> 10,000 ha) uninhabited (parks) and inhabited (indigenous lands, extractive reserves, and national forests) reserves. Reserves significantly reduced both deforestation and fire. Deforestation was 1.7 (extractive reserves) to 20 (parks) times higher along the outside versus the inside of the reserve perimeters and fire occurrence was 4 (indigenous lands) to 9 (national forests) times higher. No strong difference in the inhibition of deforestation (p = 0. 11) or fire (p = 0.34) was found between parks and indigenous lands. However, uninhabited reserves tended to be located away from areas of high deforestation and burning rates. In contrast, indigenous lands were often created in response to frontier expansion, and many prevented deforestation completely despite high rates of deforestation along their boundaries. The inhibitory effect of indigenous lands on deforestation was strong after centuries of contact with the national society and was not correlated with indigenous population density. Indigenous lands occupy one-fifth of the Brazilian Amazon-five times the area under protection in parks--and are currently the most important barrier to Amazon deforestation. As the protected-area network expands from 36% to 41% of the Brazilian Amazon over the coming years, the greatest challenge will be successful reserve implementation in high-risk areas of frontier expansion as indigenous lands are strengthened. This success will depend on a broad base of political support.
Collapse
Affiliation(s)
- D Nepstad
- The Woods Hole Research Center, P.O. Box 296, 13 Church Street, Woods Hole, MA 02543, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
Microvessel density reportedly is increased in various hematologic disorders including acute lymphatic and myeloid leukemias. In these patients the bone marrow microvessel density (BM-MVD) appears to be associated with an unfavorable prognosis. In the present study, we have retrospectively analyzed the BM-MVD (at diagnosis) in 31 patients with acute myeloid leukemia (AML) (median age: 38 years; range: 21-53 years; f:m-ratio: 1:1,4) who underwent conventional chemotherapy and consecutive allogeneic bone marrow transplantation (BMT). The median BM-MVD at diagnosis was 30/mm2 (range: 17-48/mm2) and thus was significantly higher compared to controls (n = 9; BM-MVD: median 7/mm2, range 2-11/mm2; P < 0.05). In patients who failed to achieve a complete remission (CR) in response to induction chemotherapy, the BM-MVD was significantly higher (median: 41.5/mm2) at diagnosis than in patients who entered CR (median: 28.5/mm2, P < 0.05). In addition, patients with high BM-MVD ( > 30 mm2) had a significantly shorter overall survival compared to patients with a lower BM-MVD ( < 30 mm2, P < 0.05). Moreover, patients with a high BM-MVD ( > 30 mm2) were found to have a significantly higher risk of relapse (P < 0.05). In 4 patients in whom a continuous complete remission was documented after BMT, the BM-MVD levels were analyzed at diagnosis as well as between day + 80 and day + 100 after BMT. In all 4 patients, the BM-MVD was found to decrease in response to BMT until day 100 (P < 0.05). Together, our data suggest that the BM-MVD could be a prognostic parameter concerning survival in patients with AML undergoing allogeneic BMT.
Collapse
|
24
|
Laufens G, Poltz W, Prinz E, Reimann G, Schmiegelt F. Alternierende Laufband-Vojta-Laufband-Therapie bei stark gehbehinderten Patienten mit multipler Sklerose. Phys Rehab Kur Med 2004. [DOI: 10.1055/s-2003-814921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
25
|
Rabitsch W, Prinz E, Ackermann J, Wöhrer S, Kaufmann H, Seidl S, Keil F, Kalhs P, Greinix H, Gisslinger H, Leitner G, Drach J. Long-term follow up of patients with multiple myeloma after high-dose chemotherapy and allogeneic stem cell transplantation. Eur J Haematol 2003; 72:26-31. [PMID: 14962259 DOI: 10.1046/j.0902-4441.2004.00178.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 11/20/2022]
Abstract
OBJECTIVES Allogeneic transplantation may offer a curative approach to multiple myeloma (MM). We retrospectively analyzed the outcome of patients with multiple myeloma undergoing allogeneic stem cell transplantation in the context of beta(2) microglobulin and chromosome 13q. METHODS All 13 patients with MM, who were referred to our center for allogeneic stem cell transplantation, were evaluated. Median age of patients was 38 yr, eight patients had chemo-sensitive disease, and median time between diagnosis of MM and transplantation was 15 months. Engraftment, acute and chronic graft vs. host disease, response to treatment, disease-free survival, and overall survival were evaluated according to standard criteria. RESULTS There was one transplant-related death. Among 12 evaluable patients, seven patients (58%) achieved a complete remission (CR), and four patients (33%) achieved a partial remission. Acute graft vs. host disease occurred in 46% of patients, and chronic graft vs. host disease in 42% of available patients. After a median follow-up of 69.5 months (range, 5-128) nine patients (70%) are still alive, and six of them have remained progression free. Among five patients with low beta(2) microglobulin and normal chromosome 13q, four patients achieved a CR, with CR duration >5 yr in three of them. Among seven patients with elevated ss(2) microglobulin and/or deletion of chromosome 13q, only three CR were observed, with two patients still in CR on days +920 and +161, respectively. CONCLUSIONS Allogeneic stem cell transplantation in patients with MM results in promising rates of CR, but durable remissions are predominantly seen in patients with favorable prognostic parameters.
Collapse
Affiliation(s)
- Werner Rabitsch
- Bone Marrow Transplantation Unit, Department of Medicine I, University Hospital Vienna, Austria
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Rabitsch W, Knöbl P, Prinz E, Keil F, Greinix H, Kalhs P, Worel N, Jansen M, Hörl WH, Derfler K. Prolonged red cell aplasia after major ABO-incompatible allogeneic hematopoietic stem cell transplantation: removal of persisting isohemagglutinins with Ig-Therasorb® immunoadsorption. Bone Marrow Transplant 2003; 32:1015-9. [PMID: 14595389 DOI: 10.1038/sj.bmt.1704264] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [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: 11/08/2022]
Abstract
Delayed donor red cell engraftment and prolonged red cell aplasia (PRCA) are well-recognized complications of major ABO-incompatible myeloablative and non-myeloablative hematopoietic stem cell transplantation (HSCT). There is an intense debate about the impact on outcome, severity of hemolysis, association with graft-versus-host disease and survival after blood group-incompatible stem cell transplantation. Therefore, therapeutic strategies should be considered to avoid these possible complications. We present five patients, who received allogeneic HSCT from human leukocyte antigen-identical donors for hematological malignancies, which were treated with Ig-Therasorb immunoadsorption (five treatments/week) to remove persisting incompatible isohemagglutinins. After a median of 17 treatments (range 9-25), all the patients became transfusion independent with the presentation of donor's blood group. No side effects occurred during treatment. Ig-Therasorb immunoadsorption seems to be a promising therapeutic method for rapid, efficient and safe elimination for persisting isohemagglutinins for patients with PRCA after allogeneic hematological stem cell transplantation.
Collapse
Affiliation(s)
- W Rabitsch
- Department of Medicine I, Bone Marrow Transplantation Unit, University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Rabitsch W, Knöbl P, Greinix H, Prinz E, Kalhs P, Hörl WH, Derfler K. Removal of persisting isohaemagglutinins with Ig-Therasorb(R) immunoadsorption after major ABO-incompatible non-myeloablative allogeneic haematopoietic stem cell transplantation. Nephrol Dial Transplant 2003; 18:2405-8. [PMID: 14551374 DOI: 10.1093/ndt/gfg364] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Major ABO-incompatibility can be associated with haemolysis, prolonged red cell aplasia (PRCA) and higher peri-transplant mortality resulting from organ toxicity after conventional and non-myeloablative allogeneic haematopoietic stem cell transplantation. Different therapeutic strategies have been developed to allow erythroid reconstitution in these patients. METHODS We present three patients, who developed PRCA after non-myeloablative allogeneic haematological stem cell transplantation for haematological malignancies. The patients were treated with Ig-Therasorb immunoadsorption (five treatments per week) to remove persisting incompatible isohaemagglutinins. RESULTS Two patients became transfusion independent after 12 and 14 treatments. In one patient, however, no reduction of the isohaemagglutinin titres could be observed after 25 treatments, probably due to persistence of his underlying disease. CONCLUSIONS Although Ig-Therasorb immunoadsorption was effective in only two patients, it seems to be a promising therapeutic option for patients with PRCA after allogeneic non-myeloablative haematological stem cell transplantation.
Collapse
Affiliation(s)
- Werner Rabitsch
- Department of Medicine I, Bone Marrow Transplantation Unit, University of Vienna, Vienna, Austria.
| | | | | | | | | | | | | |
Collapse
|
28
|
Worel N, Kalhs P, Keil F, Prinz E, Moser K, Schulenburg A, Mitterbauer M, Mannhalter C, Mayr WR, Schwarzinger I, Höcker P, Lechner K, Greinix HT. ABO mismatch increases transplant-related morbidity and mortality in patients given nonmyeloablative allogeneic HPC transplantation. Transfusion 2003; 43:1153-61. [PMID: 12869124 DOI: 10.1046/j.1537-2995.2003.00465.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [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: 01/28/2023]
Abstract
BACKGROUND ABO mismatch has not been thought to affect the outcome of patients undergoing myeloablative conditioning and allogeneic HPC transplantation. Data on transplant-related complications after ABO-mismatched transplantation after nonmyeloablative conditioning are limited. STUDY DESIGN AND METHODS Therefore, 40 patients were analyzed after nonmyeloablative conditioning with regard to ABO compatibility. Eleven received a minor and bidirectional and 8 a major ABO-mismatched graft. RESULTS Four patients had evidence of hemolysis during engraftment, being lethal in one, and three developed pure RBC aplasia. Six patients in the ABO-mismatched group developed thrombotic microangiopathy, and three of them died. ABO-identical and ABO-mismatched patients had a similar incidence of GVHD. Viral infections occurred in both groups in equal shares. Patients with an ABO-mismatch had to be rehospitalized until Day 100 for a median of 19 days versus 0 days in the identical group (p < 0.05). Overall survival was 60 and 57 percent in the ABO-identical and ABO-mismatch groups, respectively. The probability of transplant-related mortality was 0 versus 28 percent in the identical group compared to patients with an ABO mismatch (p < 0.05). The probability of relapse or progression was 76 versus 25 percent in the ABO-identical group compared to the ABO-mismatched group, respectively. CONCLUSION Significantly more patients with ABO mismatch showed transplant-associated complications and died as a result of transplant-related causes.
Collapse
Affiliation(s)
- Nina Worel
- Department for Blood Group Serology and Transfusion Medicine, University of Vienna, Vienna, Austria.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Keil F, Prinz E, Moser K, Mannhalter C, Kalhs P, Worel N, Rabitsch W, Schulenburg A, Mitterbauer M, Greinix H. Rapid establishment of long-term culture-initiating cells of donor origin after nonmyeloablative allogeneic hematopoietic stem-cell transplantation, and significant prognostic impact of donor T-cell chimerism on stable engraftment and progression-free survival. Transplantation 2003; 76:230-6. [PMID: 12865815 DOI: 10.1097/01.tp.0000071862.42835.76] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [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: 11/26/2022]
Abstract
BACKGROUND Nonmyeloablative allogeneic hematopoietic stem-cell transplantation (NST) allows establishment of donor hematopoiesis without eradication of recipient stem cells by chemoradiotherapy. Quantification of donor chimerism may predict graft failure and relapse. METHODS We quantified donor long-term culture-initiating cells (LTC-IC) in nine patients during the early phase after NST and lineage-specific donor cells of myeloid (CD33+, CD34+, granulocytes) and lymphoid lineage (CD3+, CD4+, CD8+, CD56+) in 38 patients with a median follow-up of 40 weeks after NST. Conditioning therapy consisted of fludarabine 90 mg/m2 followed by total body irradiation of 2 Gy. RESULTS Only rapid establishment of donor T-cell chimerism was essential for stable donor engraftment. Patients with less than 90% of donor T cells 4 weeks after NST had a significantly higher risk of relapse, graft rejection, or both (14 of 18 patients) than patients with donor T-cell chimerism of 90% and higher (3 of 20 patients). Although conditioning therapy was nonmyeloablative, a significant decrease of repopulating stem cells defined as LTC-IC was seen after 2 weeks followed by rapid recovery of LTC-IC to pretransplant values. Interestingly, all LTC-IC were from donor origin 2 and 4 weeks after NST, but rapid establishment of donor LTC-IC was not predictive for progression-free survival. CONCLUSIONS Rapid establishment of lymphoid but not myeloid donor chimerism is a prognostic factor for stable donor engraftment after NST. It seems that an immunologic shield of alloreactive donor T cells is essential for early hematopoietic progenitors.
Collapse
Affiliation(s)
- Felix Keil
- Department of Internal Medicine I, Bone Marrow Transplantation, University of Vienna, Austria.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Prinz E, Keil F, Kalhs P, Mitterbauer M, Rabitsch W, Rosenmayr A, Moser K, Schulenburg A, Lechner K, Greinix HT. Successful immunotherapy in early relapse of acute myeloid leukemia after nonmyeloablative allogeneic stem cell transplantation. Ann Hematol 2003; 82:295-8. [PMID: 12679886 DOI: 10.1007/s00277-003-0621-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2002] [Accepted: 01/10/2003] [Indexed: 10/25/2022]
Abstract
We report on a 35-year-old woman who underwent allogeneic stem cell transplantation (SCT) in second complete remission (CR) of acute myeloid leukemia (AML) after reduced-intensity conditioning with fludarabine and 2 Gy of total body irradiation. For graft-versus-host disease (GVHD) prophylaxis, cyclosporin A (CsA) and mycophenolate mofetil (MMF) were given. On day 27 after SCT complete hematological remission and donor chimerism was documented. However, in CD34(+) bone marrow cells 28% of recipient hematopoiesis persisted. On day +59 leukemic relapse occurred. After discontinuation of CsA and onset of GVHD, complete donor chimerism and hematological CR were achieved which has been maintained for 14 months.
Collapse
Affiliation(s)
- E Prinz
- Department of Medicine I, Bone Marrow Transplantation, University Hospital of Vienna, Vienna, Austria.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Mitterbauer M, Kalhs P, Keil F, Prinz E, Moser K, Mannhalter C, Mitterbauer G, Brugger S, Gisslinger H, Lechner K, Greinix HT. Continuous complete clinical and molecular remission in two patients with refractory lymphoid malignancies after autografting followed by allogeneic stem cell transplantation with reduced intensity conditioning. Br J Haematol 2002; 118:132-5. [PMID: 12100137 DOI: 10.1046/j.1365-2141.2002.03562.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 11/20/2022]
Abstract
We present a 60-year-old patient with primary refractory non-Hodgkin's lymphoma and a 58-year-old patient with multiple myeloma with relapse after first autologous stem cell transplantation (ASCT), who underwent ASCT followed by allogeneic stem cell transplantation (alloSCT) with reduced intensity conditioning consisting of fludarabine and a single dose of total body irradiation. For graft-versus-host disease prophylaxis cyclosporine and mycophenolate mofetyl were given. Complete donor chimaerism was observed on d 28 after SCT. Both patients achieved sustained complete haematological and molecular remission of the immunoglobulin kappa light chain (Igkappa) rearrangement and are alive and well 17 and 16 months after SCT respectively.
Collapse
Affiliation(s)
- Margit Mitterbauer
- Department of Medicine I, Bone Marrow Transplantation, University Hospital of Vienna, Vienna, Austria.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Keil F, Elahi F, Greinix HT, Fritsch G, Louda N, Petzer AL, Prinz E, Wagner T, Kalhs P, Lechner K, Geissler K. Ex vivo expansion of long-term culture initiating marrow cells by IL-10, SCF, and IL-3. Transfusion 2002; 42:581-7. [PMID: 12084166 DOI: 10.1046/j.1537-2995.2002.00102.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 11/20/2022]
Abstract
BACKGROUND Ex vivo expansion of progentior cells may shorten hematopoietic regeneration after myeloablative chemoradiotherapy, increase target cells for gene therapy, and improve purging of progenitor cell components. STUDY DESIGN AND METHODS Marrow cells were incubated for 1 week in suspension culture with and without IL-10, IL-3, and SCF. As long-term culture initiating cells (LTC-ICs) represent early hematopoietic progenitors in vitro, these cells were quantified at initiation and after a 1-week culture period in a limiting dilution assays. Additionally, immunophenotyping of cells before and after culture was performed. RESULTS In six experiments, marrow cells cultured for 1 week with IL-10, IL-3, and SCF showed a significant increase (almost doubling) in LTC-ICs as compared with marrow cells before expansion. Additionally, an increased proliferative capacity of LTC-ICs was achieved with a sevenfold increase of committed colony-forming cells and a 10-fold proliferation of high proliferative potential colony-forming cells. Immunophenotyping revealed a sevenfold increase of CD34+ CD45 RA- cells in IL-10-, IL-3-, SCF-stimulated suspension cultures. In unstimulated cultures, no LTC-ICs were maintained after 1 week. CONCLUSION Expansion of LTC-ICs by IL-10, IL-3, and SCF has not been shown so far. This in vitro model allows expansion of LTC-IC if compared with the input of progenitor cells without extensive progenitor cell manipulation. This should be an attractive model for in vitro purging, gene transfer, or expansion of progenitor cells to allow rapid engraftment after myeloablative chemotherapy.
Collapse
Affiliation(s)
- Felix Keil
- Department of Internal Medicine I, Bone Marrow Transplantation Unit, University of Vienna, Vienna, Austria
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Keil F, Prinz E, Kalhs P, Lechner K, Moser K, Schwarzinger I, Jäger U, Fonatsch C, Worel N, Mannhalter C, Rabitsch W, Loidolt H, Schulenburg A, Mitterbauer M, Höcker P, Greinix HT. Treatment of leukemic relapse after allogeneic stem cell transplantation with cytotoreductive chemotherapy and/or immunotherapy or second transplants. Leukemia 2001; 15:355-61. [PMID: 11237057 DOI: 10.1038/sj.leu.2402048] [Citation(s) in RCA: 18] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We analyzed toxicity and efficacy of chemotherapy (CT) or second stem cell transplantation (SCT) and/or immunotherapy defined as stop of immunosuppression (IS) or donor leukocyte infusion (DLI) in 47 patients relapsing with acute leukemia. Ten patients received no treatment and 14 patients were treated with CT only. In 12 patients IS was stopped and three of them received additional CT. Five patients received DLI after CT as consolidation and one patient as frontline therapy. Five patients received a second SCT. Median overall survival after relapse was 2 months for the untreated patients, 2 months for patients receiving CT only, 2 months in patients after cessation of IS, 17 months in DLI treated patients and three months in patients receiving a second SCT. Fourteen patients achieved remission after relapse. Two with CT (2, 2 months), three with SI (3, 19, 19+ months), six with DLI (3, 8, 9, 14, 20, 36 months) and three with second SCT (2, 4, 6 months). Conventional CT was able do re-establish donor hematopoiesis and patients achieving remission showed a significantly better survival than patients with refractory disease. Patients who were brought into remission by DLI or cessation of IS had a significantly better survival than patients who achieved remission with CT alone or a second SCT. We conclude that a selected group of patients achieving remission with regeneration of donor hematopoiesis following CT might benefit from immunotherapy as consolidation.
Collapse
Affiliation(s)
- F Keil
- Department of Medicine I, University of Vienna, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
|
35
|
|