Survival in systemic lupus erythematosus, 1995–2010. A prospective study in a Danish community

Objective

The objective of this paper is to investigate survival and causes of death in a Danish lupus population.

Methods

Two hundred and fifteen SLE patients (94% Caucasians) were followed prospectively for up to 16 years. Thirty-eight patients died. Survival rate and causes of death were analysed.

Results

Overall standardized mortality ratio (SMR) was 2.2. Peak values were recorded for patients aged 20–29 (SMR 21.1). Cumulated survival rates at one, five, 10 and 15 years were 98.6%, 93.6%, 86.5% and 73.0%, respectively. The most common causes of death were cardiovascular events (32%), respiratory system disease (16%) and malignancies (13%). Deaths due to infections and active SLE were rare and predominated within the first seven years after diagnosis and before age 40, while cardiovascular deaths prevailed after 20 years’ follow-up.

Conclusion

This study shows that despite progress in lupus management, including direct access to specialized hospital care and increased use of hydroxychloroquine, mortality in lupus patients is still increased. Main causes of death were active disease and infections among the young and newly diagnosed, while cardiovascular deaths prevailed in longstanding disease.

Long-term outcome after heart transplantation predicted by quantitative myocardial blush grade in coronary angiography

The purpose of our study was to investigate whether the quantification of myocardial blush grade (MBG) during surveillance coronary angiography can predict long-term outcome after heart transplantation (HT). In 105 HT recipients who underwent cardiac catheterization, cardiac allograft vasculopathy (CAV) was assessed visually using the ISHLT grading scale (prospective cohort study). MBG was quantified by dividing the plateau of contrast agent gray-level intensity (G(max)) by the time-to-peak intensity (T(max)). In a subgroup (n = 72), myocardial perfusion index by cardiac magnetic resonance imaging (CMR) was assessed. During a mean follow-up duration of 2.7 (standard deviation [SD] 1.0) years, 26 patients experienced cardiac events, including 7 with cardiac death and 19 who underwent coronary revascularization. G(max)/T(max) was related to CAV by ISHLT criteria and to subsequent cardiac events. By univariate analysis, patient age, organ age, CAV, MBG and myocardial perfusion index by CMR were all predictive for cardiac events. Multivariable analysis demonstrated that G(max)/T(max) provided the most robust prediction of cardiac death (hazard ratio [HR] = 0.2, 95% confidence interval [CI] = 0.06-0.64, p < 0.01) and cardiac events (HR = 0.52, 95% CI = 0.32-0.84, p < 0.01), beyond clinical parameters and the presence of CAV. G(max)/T(max) is a valuable surrogate parameter of microvascular integrity, which is associated with cardiac death and revascularization procedures after HT.

Femtosecond Yb:CaGdAlO4 thin-disk oscillator

A mode-locked thin-disk laser based on Yb:CALGO is demonstrated for the first time. At an average output power of 28 W we obtained pulses with a duration of 300 fs and a pulse energy of 1.3 μJ. 197 fs pulses with 0.9 μJ of energy were achieved at an average output power of 20 W. The shortest pulse duration measured in our experiments was 135 fs with a spectrum centered at 1043 nm. The experiments also revealed a very broad tunability from 1032 to 1046 nm with sub-200 fs pulses.

Monitoring in cardiovascular disease patients by nonlinear biomedical signal processing

Due to recent advances in technology extensive cardiovascular monitoring is widely introduced today. An essential component of cardiovascular monitoring is the analysis of several biosignals as electrocardiogram, blood pressure and other vital signs. This manuscript provides an overview about several application fields of cardiovascular monitoring with the main focus on nonlinear dynamics analysis.

Quantification of cardiovascular and cardiorespiratory coupling during hypoxia with Joint Symbolic Dynamics

Newborn mammals suffering from moderate hypoxia during or after birth are able to compensate a transitory lack of oxygen by adaptation of their vital functions. However, limited information is available about bivariate couplings of the underlying complex processes controlled by the autonomic nervous system. In this study an animal model of seven newborn piglets (2-3 days old, 1.71 ± 0.15 kg) was used. The aim of this study was to analyze the cardiovascular and cardiorespiratory interactions of autonomous nervous system during sustained hypoxia and the interrelationship of these autonomic time series after induced reoxygenation. For this purpose we applied a new high resolution version of the nonlinear method of Joint Symbolic Dynamics (JSD) for analysis of couplings between heart rate and blood pressure and respiration rate time series, respectively. This new method is characterized by using three defined symbols (JSD3) instead of two and the application of thresholds for the symbol transformation. Our results demonstrate that in contrast to the traditional JSD the comparison of cardiovascular interactions reveals only significant differences between normoxic and hypoxic conditions using JSD3 whereas for cardiorespiratory interactions significant differences were revealed by indices from both JSD2 and JSD3 due to reoxygenation. These results suggest that the application of JSD3 reveals more detailed information about cardiovascular and cardiorespiratory interactions of autonomic regulation and might be useful for monitoring of critical human newborns.