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Böhning K, Busch M, Rave-Fränk M, Dühmke E. Effect of Tamoxifen and Estrogen Treatment on the Radiosensitivity of MCF-7 Breast Cancer Cells. Oncol Res Treat 2009. [DOI: 10.1159/000218846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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252
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Schneider H, Busch I, Busch M, Jentsch H, Häfer M. Effect of Operator-specific Handling on Tooth-composite Interface and Microleakage Formation. Oper Dent 2009; 34:200-10. [DOI: 10.2341/08-66] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Clinical Relevance
After calibration of the restoration procedure, three operators experienced differences in tooth-composite interface morphology and microleakage formation. These differences reflect technique-sensitivity of the etch-and-rinse adhesive. The lowest microleakage on dentin was related to an enhanced interface integrity. After additional application of an adhesive component, sealing of the enamel and dentin was partially enhanced, but microleakage formation did not decrease. These results are helpful in the comparative evaluation of other bonding systems.
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Nugent CT, Dockter J, Bernardin F, Hecht R, Smith D, Delwart E, Pilcher C, Richman D, Busch M, Giachetti C. Detection of HIV-1 in alternative specimen types using the APTIMA HIV-1 RNA Qualitative Assay. J Virol Methods 2009; 159:10-4. [PMID: 19442838 DOI: 10.1016/j.jviromet.2009.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 02/04/2009] [Accepted: 02/12/2009] [Indexed: 11/24/2022]
Abstract
Peripheral blood mononuclear cells (PBMCs), saliva, seminal plasma, and dried blood spots were evaluated as specimen types for the APTIMA HIV-1 RNA Qualitative Assay (APTIMA HIV-1 Assay), which employs a target capture step to recover HIV-1-specific sequences from complex specimen types. Analytical sensitivity studies were carried out using samples that were either diluted or eluted with a buffered detergent and spiked with different concentrations of HIV-1 ranging from 1 to 10,000 copies/mL. PBMC samples spiked with HIV-1 had comparable analytical sensitivity to HIV-1 spiked plasma with a 95% limit of detection of 13.1 and 17.2 copies/mL, respectively. Analytical sensitivity in seminal plasma specimens diluted 1:5 and saliva diluted 1:2 was comparable to HIV-1 spiked dilution buffer alone. Whole blood and dried blood spot specimens spiked with HIV-1 had equivalent reactivity at 250 copies/spot (5000 copies/mL). However, the 95% limit of detection values were significantly different (293.7 copies/mL for whole blood and 2384 copies/mL for dried blood spot specimens). No significant effect on analytical sensitivity was observed when one HIV-1 positive dried blood spot punch was pooled with up to 9 HIV-1 negative dried blood spot punches. Together, these studies demonstrate that the APTIMA HIV-1 RNA Qualitative Assay can be used to process a diverse array of specimen types with minimal impact on analytical sensitivity for most specimen types.
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Gerth J, Schleussner E, Kentouche K, Busch M, Seifert M, Wolf G. Pregnancy-associated thrombotic thrombocytopenic purpura. Thromb Haemost 2009; 101:248-251. [PMID: 19190806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Thrombocytopenia during pregnancy is a common diagnostic and management problem. Several differential diagnosis must be considered including manifestations of thrombotic thrombocytopenic purpura (TTP). We report here on a case of a 21-year-old pregnant woman who presented initially severe thrombocytopenia (8 Gpt/l) in the 20(th)+1 week of gestation. The patient had an antibody against ADAMTS13, and enzyme activity was <5%. Immediate plasmapheresis treatment was initiated, followed by plasma infusions, and again plasmapheresis. A male neonate was delivered by caesarean section in the 32(nd )week of gestation. The child had an uncomplicated postnatal development. After delivery, the mother's platelet count and ADAMTS13 activity increased to normal values. This case shows interesting aspects of TTP in pregnancy and a close cooperation between obstetricians, nephrologists and pediatricians is necessary for a successful outcome of the pregnancy.
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MESH Headings
- ADAM Proteins/immunology
- ADAMTS13 Protein
- Autoantibodies/blood
- Blood Component Transfusion
- Cesarean Section
- Female
- Gestational Age
- Humans
- Infant, Newborn
- Live Birth
- Male
- Patient Care Team
- Plasmapheresis
- Platelet Count
- Pregnancy
- Pregnancy Complications, Hematologic/diagnosis
- Pregnancy Complications, Hematologic/immunology
- Pregnancy Complications, Hematologic/therapy
- Purpura, Thrombotic Thrombocytopenic/diagnosis
- Purpura, Thrombotic Thrombocytopenic/immunology
- Purpura, Thrombotic Thrombocytopenic/therapy
- Ultrasonography, Doppler, Color
- Ultrasonography, Prenatal/methods
- Young Adult
- von Willebrand Factor/metabolism
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Schüller A, Busch M, Wethekam S, Winter H. Fast atom diffraction from superstructures on a Fe110 surface. PHYSICAL REVIEW LETTERS 2009; 102:017602. [PMID: 19257241 DOI: 10.1103/physrevlett.102.017602] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Indexed: 05/27/2023]
Abstract
Fast atoms with energies from 500 eV up to several keV are grazingly scattered from a Fe(110) surface covered with defined superstructures of sulfur or oxygen atoms. For scattering along low index azimuthal directions, we observe defined diffraction patterns in the angular distributions for scattered projectiles. From the analysis of those patterns, we derive the widths of low indexed axial channels and the corrugation of the interaction potential across these channels. This allows us to estimate the positions of adsorbed atoms on the Fe(110) surface. By demonstration, for adsorbate induced superstructures on a metal surface, we show that fast atom diffraction, first observed for insulators, can be applied to studies on surface structures for a wide range of materials.
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Wolf G, Müller N, Busch M, Eidner G, Kloos C, Hunger-Battefeld W, Müller UA. Diabetic foot syndrome and renal function in type 1 and 2 diabetes mellitus show close association. Nephrol Dial Transplant 2009; 24:1896-901. [PMID: 19131351 DOI: 10.1093/ndt/gfn724] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Diabetic nephropathy and diabetic foot syndrome (DFS) are two major complications of diabetes. Surprisingly, little is known of a potential relationship between renal function and the development of DFS in patients with preterminal renal insufficiency. A retrospective cohort study at a single tertiary university centre caring for a large collective of patients with type 1 and 2 diabetes was performed. Patients and methods. All patients with type 1 or 2 diabetes from 1989 to 2007 on the electronic patient sheet who had standardized food examination, albuminuria and serum creatinine were analysed. A total number of 899 patients with type 1 and 4007 individuals with type 2 diabetes were studied. Estimated glomerular filtration rate (eGFR) was calculated according to the modified equation 7 MDRD formula. Patients were grouped into the chronic kidney disease (CKD) stages according to the eGFR and presence of albuminuria. DFS was classified according to Wagner as well as Armstrong stages. RESULTS Forty-six patients (5.1%) of 899 patients with type 1 diabetes have active or a history of DFS. Patients with type 1 diabetes and DSF had significantly higher serum creatinine levels, lower eGFR, higher systolic blood pressure and higher HbA1c levels compared to those without DFS. There was a significant negative correlation between eGFR and the presence of DFS in patients with type 1 diabetes (r = -0.155, P < 0.01). In type 1 diabetes patients, there was a significant negative correlation (Spearman test) between eGFR and Wagner stages (r = -0.218, P = 0.01) as well as Armstrong stages (r = -0.255, P = 0.01). Multiple logistic regression analysis revealed a significant association between the presence of DFS and eGFR (odds ratio 0.696 per 10 ml/min increase, 95% confidence interval 0.627-0.773, P < 0.001). A total of 532 type 2 patients from 4007 patients had DFS (13.7%). Compared with type 2 patients without DFS, those with DFS were significantly older (P < 0.005), exhibited a higher HbA1c, had a longer duration of diabetes (P < 0.005), higher serum creatinine levels (P < 0.005) and a lower eGFR (P < 0.005). There was a significant negative correlation between the Wagner stages and eGFR (r = -0.104, P < 0.01) as well as Armstrong stages and eGFR (r = -0.125, P < 0.01) in all patients with type 2 diabetes (Spearman test). Multiple logistic regression analysis revealed a significant association between the presence of DFS and eGFR (odds ratio 0.873 per 10 ml/min increase, 95% confidence interval 0.842-0.904, P < 0.001). There were also significant associations between DFS and duration of diabetes as well as diastolic blood pressure. In addition, the Jonckheere-Terpstra test confirmed the decrease of eGFR with increasing Wagner and Armstrong stages in patients with type 2 diabetes. Smoking was not associated with a higher prevalence of DFS in type 1 and 2 diabetic patients. CONCLUSION There was a strong association between the degree of renal function impairment and DFS in this observational study. Data show that diabetics with DFS undergo a higher incidence of amputation; thus, it should be recommended that diabetic patients with renal insufficiency should be regularly screened for the presence of DFS.
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Busch M. Good outcome in noncoronary out-of-hospital cardiac arrest treated with mild induced hypothermia. Crit Care 2009. [PMCID: PMC4083958 DOI: 10.1186/cc7236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Busch M, Søreide E. Good outcome in octogenarians after ventricular fibrillation out-of-hospital cardiac arrest. Crit Care 2009. [PMCID: PMC4083952 DOI: 10.1186/cc7230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ott U, Busch M, Steiner T, Wolf G. Anemia After Renal Transplantation: An Underestimated Problem. Transplant Proc 2008; 40:3481-4. [PMID: 19100418 DOI: 10.1016/j.transproceed.2008.07.139] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 07/07/2008] [Indexed: 11/16/2022]
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Sanchez LC, Busch M. Population traits of the burrowing toad Rhinella fernandezae (Gallardo, 1957) (Anura, Bufonidae). BRAZ J BIOL 2008; 68:137-40. [PMID: 18470388 DOI: 10.1590/s1519-69842008000100019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Accepted: 02/05/2007] [Indexed: 11/22/2022] Open
Abstract
Size distribution, sex ratio and use of burrows of the burrowing toad Rhinella fernandezae were studied in Buenos Aires province, Argentina. Two sites separated by approximately 300 m were studied: one was a road next to a swamp, and the other a garden of a country house located further from the swamp. We identified toad burrows, and individuals were sexed, measured and given an individual mark. Burrows were examined in subsequent months after the first sampling to assess the presence of toads. We found significant differences in the size distribution between areas, being the proportion of juveniles greater at the site next to the swamp where the reproduction of the species was observed. This result may suggest that the site located near to the swamp functions as a source habitat of individuals that migrate to the other site, where recruitment would be very scarce. Sex proportion of adults did not differ from 1:1 in neither the total population nor in each site, suggesting that there was not differential mortality by sex. Some toads changed burrows throughout the study period, but there were not differences in the frequency of change between adults and juveniles.
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Ott U, Busch M, Steiner T, Schubert J, Wolf G. Renal retransplantation: a retrospective monocentric study. Transplant Proc 2008; 40:1345-8. [PMID: 18589102 DOI: 10.1016/j.transproceed.2008.01.068] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 01/16/2008] [Indexed: 12/13/2022]
Abstract
Approximately 10% to 20% of all annual renal transplantations are retransplantations and up to 20% of patients on waiting lists need a repeat kidney because of previous graft failure. The immunological risk is much greater among retransplanted patients than first-time kidney recipients. It is likely that retransplantation will become even more prevalent in the future. However, clinical studies or retrospective data are rare in this patient population. We retrospectively investigated 50 recipients after second or third renal transplantations in our center since 2001. Immunosuppression was performed with corticosteroids, mycophenolate mofetil (MMF), tacrolimus, and induction therapy with either thymoglobulin (2.5 mg/kg body weight; n = 27) or 20 mg basiliximab on days 0 and 4 (n = 22) after renal transplantation; 1 patient was treated with antithymoglobulin Fresenius after combined liver-kidney transplantation. Acute rejection occurred in 12 recipients (44.4%) after thymoglobulin and in 7 recipients (31.8%) after basiliximab induction therapy (P < .05). In 4 (14.8%) thymoglobulin- and 5 (22.7%) basiliximab-treated recipients, vascular rejections were observed (P = NS). Patients with basiliximab treatment showed improved renal function at 1 year after transplantation: serum creatinine 134.3 mumol/L versus 199.6 mumol/L in the thymoglobulin group (P < .05). Over the observation period the renal function remained stable or improved in both groups if rejection treatment was successful. However, allograft failure was higher in the basiliximab-treated group, namely, 18.1% versus 14.8% in thymoglobulin-treated patients, but the difference did not reach statistical significance. In 3 (11.1%) thymoglobulin- and 4 (18.2%) basiliximab-treated patients cytomegalovirus (CMV) infections complicated the follow-up (P = NS). In the follow-up period of 5 years, no malignant diseases were seen in either group. Three basiliximab-treated recipients died in the first year due to sepsis or cardiovascular complications. Two thymoglobulin-treated patients developed BK virus nephropathy in the follow-up period. In conclusion, we observed a high immunological risk and rejection risk among retransplanted kidney recipients in our center. Particularly, severe vascular rejections with a harmful long-term impact on allograft function were observed in this population. Induction treatment seems to be successful to reduce risk and achieve better results. Single-shot thymoglobulin may be preferable to reduce severe vascular rejection and prevent allograft failure than basiliximab with the same infection rate.
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Busch M, Gerth J, Ott U, Schip A, Haufe CC, Gröne HJ, Wolf G. [Treatment of idiopathic membranous nephropathy. Is the anti-CD20 antibody rituximab a reasonable option?]. ACTA ACUST UNITED AC 2008; 103:519-24. [PMID: 18604487 DOI: 10.1007/s00063-008-1077-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 06/06/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND Membranous nephropathy (MN) is characterized by proteinuria and other symptoms of the nephrotic syndrome. In many cases, the etiology is unknown. Whether and how to treat MN is still a controversial question. Despite the use of corticosteroids and alkylating agents, up to 40% of patients still progress to end-stage renal failure. CASE REPORT A 40-year-old male patient with biopsy-proven idiopathic MN was initially treated with prednisolone and chlorambucil because of a proteinuria of 22 g/d. Treatment with cyclosporine was started because the nephrotic syndrome failed to improve. Proteinuria was reduced to a minimum of 4 g/d. Cyclosporine was stopped after 17 months leading to a fast relapse. Therapy with an ACE inhibitor and AT(1) receptor antagonist and retreatment with cyclosporine improved proteinuria. Cyclosporine was terminated after a total of 24 months. 5 months later, relapse occurred with a high proteinuria of 34 g/d. The monoclonal anti-CD20 antibody rituximab (375 mg/m(2)) was given four times every 4 weeks. 4 weeks and 4 months after the end of treatment, proteinuria decreased to 780 mg/d and <150 mg/d, but renal function remained impaired (creatinine clearance 65 ml/min, stage 2 according to K/DOQI). Now, remission of proteinuria (<150 mg/d) has been stable for almost 2 years. However, renal insufficiency progressed further (creatinine clearance 45 ml/min, stage 3 according to K/DOQI). CONCLUSION Rituximab offers the possibility for a targeted treatment of idiopathic MN. Based on the existing evidence and experience from this case, rituximab can be recommended as a new treatment option for MN, possibly before starting any treatment with cytotoxic agents and high-dose prednisolone carrying the risk of severe side effects. However, long-term results of this treatment are still lacking.
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Reesink HW, Engelfriet CP, Henn G, Mayr WR, Delage G, Bernier F, Krusius T, Assal A, Gallian P, Corbi C, Morel P, David B, De Micco P, Murokawa H, Yugi H, Hino S, Tadokoro K, Flesland O, Brojer E, Letowska M, Olim G, Nascimento F, Gonçalves H, Castro L, Morais M, Stezinar SL, Alvarez M, Sauleda S, González R, Niederhauser C, Stolz M, Allain JP, Owusu-Ofori S, Eglin R, Stramer S, Busch M, Strong DM, Epstein J, Biswas R. Occult hepatitis B infection in blood donors. Vox Sang 2008; 94:153-66. [PMID: 18205672 DOI: 10.1111/j.1423-0410.2008.01017.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Busch M, Franke S, Wolf G, Rohde RD, Stein G. Serum Levels of the Advanced Glycation End Products N ε-Carboxymethyllysine and Pentosidine Are Not Influenced by Treatment with the Angiotensin Receptor II Type 1 Blocker Irbesartan in Patients with Type 2 Diabetic Nephropathy and Hypertension. ACTA ACUST UNITED AC 2008; 108:c291-7. [DOI: 10.1159/000127838] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 02/04/2008] [Indexed: 11/19/2022]
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Musich D, Busch M. Die Betreuung von Patienten mit Klasse-III-Dysgnathie und noch nicht abgeschlossenem Wachstum. INFORMATIONEN AUS ORTHODONTIE UND KIEFERORTHOPAEDIE 2008. [DOI: 10.1055/s-2008-1004758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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267
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Busch M, Kordass B. Optical stereo matching for digitizing edentulous jaws. INTERNATIONAL JOURNAL OF COMPUTERIZED DENTISTRY 2008; 11:159-167. [PMID: 19216308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
So far, CAD/CAM technology has not yet made any noteworthy inroads into removable dentures. One of the possible reasons for this may be the lack of a tried-and-tested and economically acceptable scanner technology. Our motivation for developing our own 3D digitization method was therefore to develop a really low-cost scanner under exclusive use of standard industrial components. The method presented here for spatial acquisition of edentulous jaws is based on the evaluation of the optical structure inherent in jaw impressions themselves. For this purpose, an optimized method of Dense Stereo Matching on three images (Fig 1), acquired from three different perspectives, is used.
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Busch M, Franke S, Stein G, Wolf G. Ist die Serumkonzentration von Pentosidin ein Prädiktor kardiovaskulärer Ereignisse bei Patienten mit Diabetes mellitus Typ 2 und Nephropathie? Dtsch Med Wochenschr 2007; 132:1810-4. [PMID: 17726651 DOI: 10.1055/s-2007-984971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Advanced glycation end-products (AGEs) are implicated in the pathogenesis of vascular damage of atherosclerosis, especially in diabetes and renal failure. Pentosidine, an AGE, is generated by glycation and oxidation reactions (glycoxidation product). METHODS 218 patients at high risk of cardiovascular events (from the "Irbesartan in Diabetic Nephropathy Trial" [IDNT] cohort) with type 2 diabetes and nephropathy (mean age 61 +/- 6,4 years, 68 female, 150 male) were followed for a mean of 2.2 years. The mean GFR at baseline was 47,9 +/- 16,0 ml/min (MDRD formula). Serum levels of pentosidine were measured by high-performance liquid chromatography. The relationship between pentosidine, traditional risk factors and cardiovascular events (CVE) was tested in Cox proportional hazards models. RESULTS The mean serum level of pentosidine at baseline was 148 +/- 113 pmol/ml, that of hemoglobin A (1c) (HbA (1c)) 8.6 +/- 1.7 %. During follow-up, 93 CVE occurred; a total of 50 patients died, 39 of cardiovascular causes. Final multivariate analysis showed low density lipoprotein (LDL) and duration of diabetes to be independent risk factors for a first cardiovascular event (including death from cardiovascular causes) (relative risk [RR] for the highest quartile compared with the lowest: LDL 3,041, confidence interval 1.616 - 5.724, P = 0.001; duration of diabetes: RR 2.629, CI 1.279 - 6.151, P = 0.011). CONCLUSION The serum level of pentosidine was not an independent risk factor for cardiovascular outcomes in the selected cohort. This suggests that traditional risk factors may play a more important role in causing cardiovascular events and that serum levels of AGEs are of low predictive value. Further investigations are necessary to assess whether tissue levels of AGEs are of greater relevance.
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Busch M, Haas S, Weigl M, Wirl C. Long term substitution treatment (maintenance treatment) of opioid dependent persons. GMS HEALTH TECHNOLOGY ASSESSMENT 2007; 3:Doc04. [PMID: 21289938 PMCID: PMC3011334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
HEALTH POLITICAL BACKGROUND Methadone substitution treatment in Germany is introduced in 1988 in the framework of a scientific pilot study in North Rhein Westphalia. Recent statistics show that by now a broad offer of substitution treatment exists. From 1 June 2002 to 31 December 2003 113,000 substitution treatments have been recorded as being started of which around 56,000 have been recorded as ongoing treatments by 1 December 2003. SCIENTIFIC BACKGROUND Substitution treatment (treatment of opioid-dependent persons using substitution substances) is one part of addiction treatment. Its goals are harm reduction and the stabilisation of opioid dependent persons. Integration of opioid-dependent persons in a treatment-setting, reduction of consumption of psychoactive substances, reduction of risk behaviour (primarily related to infectious diseases), decrease of mortality and improvements concerning the social, psychic and physic situation are seen as a success of substitution treatment as maintenance therapy. RESEARCH QUESTIONS The aim of this HTA report is to investigate which indicators can be used to evaluate the effectiveness of substitution treatment. Based on these indicators an evaluation of the medical, social and economical benefit of substitution treatment - also in relation to abstinence oriented treatment - is carried out. METHODS A systematic literature search was performed in 31 international databases which yielded 2451 articles with publication date between 1995 and February 2005. RESULTS After a twofold selection process 32 publications were included for assessment and 276 publications were used as background literature. Despite serious restrictions due to selection bias and dropout in most studies focusing on substitution treatment, reduction of consumption of illegal opioids, reduction of risk behaviour, criminal behaviour, mortality and incidence of HIV can be seen as an empirically proven success of substitution treatment. Concerning the improvement of life and health situation the results of the studies are contradictory. The results show that retention rate of substitution treatment is higher than retention rate of abstinence oriented treatment. Regarding economical aspects substitution treatment is efficient in avoiding secondary illnesses (infections) and decreasing criminality. From the perspective of medical ethics substitution treatment as well as medical prescription of heroin is in principle acceptable. DISCUSSION AND CONCLUSIONS Based on these results, it can be recommended that substitution treatment in principle should be made available for all opioid dependent persons. The decision whether substitution treatment or another treatment (e. g. abstinence oriented treatment) is more promising has to take into account the individual situation of the client. In addition a combination of substitution treatment and abstinence oriented treatment might be promising although there is a lack of studies about this approach. In any case the decision concerning a certain form of treatment should leave aside pseudo-moralic concerns and should be made on the base of established medical ethic principles - like the interest of the patient - taking into account the specific situation of the client.
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Busch M, Custer B. Health outcomes research using large donor-recipient databases: a new frontier for assessing transfusion safety and contributing to public health. Vox Sang 2007; 91:282-4. [PMID: 17105602 DOI: 10.1111/j.1423-0410.2006.00847.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Vocks S, Busch M, Schulte D, Grönemeyer D, Herpertz S, Suchan B. Veränderungen der Hirnaktivität bei der Betrachtung des eigenen Körpers durch eine kognitiv-verhaltenstherapeutische Körperbildtherapie: Eine randomisiert-kontrollierte fMRT-Untersuchung. Psychother Psychosom Med Psychol 2007. [DOI: 10.1055/s-2007-970724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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272
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Busch M. Der epidemiologische Schlüsselindikator „Drogenbezogene Todesfälle und Mortalität von Drogenkonsumentinnen und Drogenkonsumenten” in der Europäischen Union und in Norwegen. SUCHTTHERAPIE 2006. [DOI: 10.1055/s-2006-927291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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273
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Busch M. Buchbesprechung: Supercritical Carbon Dioxide in Polymer Reaction Engineering. Von M. F. Kemmere, T. Meyer. CHEM-ING-TECH 2006. [DOI: 10.1002/cite.200690135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Busch M, Soreide E, Lossius HM, Lexow K, Dickstein K. Rapid implementation of therapeutic hypothermia in comatose out-of-hospital cardiac arrest survivors. Acta Anaesthesiol Scand 2006; 50:1277-83. [PMID: 17067329 DOI: 10.1111/j.1399-6576.2006.01147.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The implementation of therapeutic hypothermia (TH) into daily clinical practice appears to be slow. We present our experiences with rapid implementation of a simple protocol for TH in comatose out-of-hospital cardiac arrest (OHCA) survivors. METHODS From June 2002, we started cooling pre-hospitally with sport ice packs in the groin and over the neck. In the intensive care unit (ICU), we used ice-water soaked towels over the torso. All patients were endotracheally intubated, on mechanical ventilation and sedated and paralysed. The target temperature was 33 +/- 1 degrees C to be maintained for 12-24 h. We used simple inclusion criteria: (i) no response to verbal command during the ambulance transport independent of initial rhythm and cause of CA; (ii) age 18-80 years; and (iii) absence of cardiogenic shock (SBP < 90 mmHg despite vasopressors). We compared the first 27 comatose survivors with a presumed cardiac origin of their OHCA with 34 historic controls treated just before implementation. RESULTS TH was initiated in all 27 eligible patients. The target temperature was reached in 24 patients (89% success rate). ICU- and hospital- length of stay did not differ significantly before and after implementation of TH. Hypokalemia (P= 0.001) and insulin resistance (P= 0.025) were more common and seizures (P= 0.01) less frequently reported with the use of TH. The implementation of TH was associated with a higher hospital survival rate (16/27; 59% vs. 11/34; 32%, respectively; P< or = 0.05). Our results indicate a population-based need of approximately seven cooling patients per 100,000 person-years served. CONCLUSION Our simple, external cooling protocol can be implemented overnight in any system already treating post-resuscitation patients. It was well accepted, feasible and safe, but not optimal in terms of cooling rate. Neither safety concerns nor costs should be a barrier for implementation of TH.
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