Total myocardial revascularization with arterial conduits: radial artery combined with internal thoracic arteries

OBJECTIVE

We prospectively tested the feasibility of achieving total arterial revascularization with the use of the radial artery to revascularize the circumflex, diagonal, and right coronary arteries combined with a left internal thoracic artery graft to the left anterior descending artery and, in some cases, a right internal thoracic artery graft to the right coronary artery.

METHODS

In 164 patients, the radial artery was used as a free Y or T graft from the left internal thoracic artery. Of 568 grafts (3.5 +/- 1 [standard deviation] per patient), 296 (1.8 +/- 0.8 per patient) were constructed with the radial artery as single grafts or as double, triple, or quadruple sequential anastomoses to the circumflex, diagonal, and posterior descending arteries. Diltiazem was administered to prevent spasm. Forty-six patients underwent coronary angiography before discharge from the hospital. Follow-up time was 1 to 19 (9.5 +/- 6.1) months.

RESULTS

Total arterial revascularization was achieved in 137 patients (83.5%). Three (1.8%) died postoperatively of sepsis, ventricular fibrillation, and heart failure, respectively. Three (1.8%) had postoperative myocardial infarction. No hand ischemia occurred. Angiography showed patency of all arterial conduits. Radial artery spasm appeared in 3 (6.5%) of 46 angiograms. Two patients (1.2%) died during the follow-up period of pneumonia and gastrointestinal tract bleeding, respectively. No other events or reoperations occurred, and 95.1% of the patients are free of symptoms.

CONCLUSIONS

The radial artery, as a free Y or T graft from the left internal thoracic artery to the circumflex, diagonal, and right coronary arteries, permits total arterial revascularization with excellent patency rates, minimal morbidity and mortality, and no need for reoperation. Longer follow-up times are necessary to draw definitive conclusions.

High prevalence of diabetes and impaired fasting glucose in urban Latin America: the CARMELA Study

AIMS

Cardiovascular risk is increased with glucose metabolism abnormalities. Prevalence data can support public health initiatives required to address this risk. The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study was designed to estimate the prevalence of Type 2 diabetes, impaired fasting glucose and related risk factors in seven urban Latin American populations.

METHODS

CARMELA was a cross-sectional, population-based study of 11 550 adults 25-64 years of age. With a multi-stage sample design of a probabilistic nature, approximately 1600 subjects were randomly selected in each city.

RESULTS

Overall, the prevalence of diabetes was 7.0% (95% confidence intervals 6.5-7.6%). The prevalence of individuals with diabetes or impaired fasting glucose increased with increasing age. In the oldest age category, 55-64 years of age, prevalence of diabetes ranged from 9 to 22% and prevalence of impaired fasting glucose ranged from 3 to 6%. Only 16.3% of people with prior diagnosis of diabetes and who were receiving pharmacologic treatment, were in good glycaemic control (fasting glucose < 6.1 mmol/l). The prevalence of diabetes in individuals with abdominal obesity was approximately twofold higher. Participants with hypertension, elevated serum triglycerides and increased common carotid artery intima-media thickness were also more likely to have diabetes.

CONCLUSIONS

The prevalence of diabetes and impaired fasting glucose is high in seven major Latin American cities; intervention is needed to avoid substantial medical and socio-economic consequences. CARMELA supports the associations of abdominal obesity, hypertension, elevated serum triglycerides and carotid intima-media thickness with diabetes.

Serum neopterin levels and the angiographic extent of coronary arterial narrowing in unstable angina pectoris and in non-Q-wave acute myocardial infarction

Systemic serum markers of inflammation are elevated in diseases due to atherosclerosis, but have not been associated with the extent of atherosclerotic disease. We examined the role of neopterin, a byproduct of activated macrophage metabolism, in patients with unstable angina. Baseline neopterin samples and clinical histories were obtained in 52 patients admitted with unstable angina pectoris. Coronary angiograms of 27 patients were reviewed using Sullivan's method to assess the total atherosclerotic burden in the coronary arteries. Twenty-six of the 52 patients were eventually diagnosed with a non-Q-wave acute myocardial infarction (AMI) and had higher neopterin levels (10.1 +/- 6.7 vs 7.2 +/- 4.0 nmol/L, p = 0.06) than patients with a final diagnosis of unstable angina. Patients with neopterin >8.7 were more likely to be diagnosed with a non-Q-wave AMI (75% vs 39%, p = 0.035) and were more likely to have significantly more severe and extensive angiographically determined atherosclerosis than patients with low neopterin levels. Neopterin levels correlated with the score of atherosclerotic extension (Spearman's rank correlation coefficient 0.4807, p = 0.034). This study demonstrates a correlation between immune cell activation and the extent of angiographically determined atherosclerosis and the degree of myocardial ischemia.

Antiarrhythmic Mechanisms of n-3 PUFA and the Results of the GISSI-Prevenzione Trial

The purpose of this paper is twofold: on the one hand, to confirm the positive results on n-3 PUFA from the overall results Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GlSSI)-Prevenzione trial; on the other, to summarize and describe how the results of an important trial can help generate hypotheses either on mechanisms of action or on differential results in particular subgroups of patients, as well as test the pathophysiological hypotheses that have accompanied in the years the story of the hypothesized mechanisms of action of a drug. GISSI-Prevenzione was conceived as a pragmatic population trial on patients with recent myocardial infarction and it was conducted in the framework of the Italian public health system. In GISSI-Prevenzione, 11,323 patients were enrolled in a clinical trial aimed at testing the effectiveness of n-3 polyunsaturated fatty acids (PUFA) and vitamin E. Patients were invited to follow Mediterranean dietary habits, and were treated with up-to-date preventive pharmacological interventions. Long-term n-3 PUFA at 1 g daily, but not vitamin E at 300 mg daily, was beneficial for death and for combined death, non-fatal myocardial infarction, and stroke. All the benefit, however, was attributable to the decrease in risk for overall (-20%), cardiovascular (-30%), and sudden death (-45%). At variance from the orientation of a scientific scenario largely dominated by the "cholesterol-heart hypothesis", GISSI-Prevenzione results indicate n-3 PUFA (virtually devoid of any cholesterol-lowering effect) as a relevant pharmacological treatment for secondary prevention after myocardial infarction.

Myocardial revascularization with radial and mammary arteries: initial and mid-term results

BACKGROUND

The radial artery is being used with increasing frequency instead of the saphenous vein in coronary artery bypass grafts. We analyzed the in-hospital and midterm results in patients undergoing coronary artery bypass surgery in whom a combination of arterial grafts was used, including radial artery and one or both internal mammary arteries.

METHODS

Between 1995 and 1998, 1,023 patients underwent coronary artery bypass surgery using arterial conduits. The left internal mammary artery and the right internal mammary artery were employed in combination with the radial artery.

RESULTS

An average of 3.2 grafts per patient were done. The left internal mammary artery and radial artery were used in 100% of patients, the right internal mammary artery in 21.7%, and a venous graft in 31%. The operative mortality rate was 2.5%. On repeat angiography performed in 62 patients before their discharge, the arterial conduits were patent in 98.4%. Mean follow-up was 25.0 +/- 9.6 months (1 to 48 months). The probability of survival was 92.8%.

CONCLUSIONS

Revascularization using mammary and radial artery grafts is safe. Complications are not higher than those observed with saphenous vein grafting. It was possible to use arterial conduits in all the patients, even in those with impaired left ventricular function.

[Coronary surgery in elderly patients. In-hospital and long-term results]

BACKGROUND

Taking into account the steady increase in the number of elderly patients requiring coronary artery bypass grafting, we sought to analyze the in-hospital and long-term evolution of a group of elderly patients (>/= 75 years) who underwent coronary artery bypass grafting, and to identify clinical predictors of mortality and long-term symptoms.

METHODS

Between April 1996 and February 2000, 207 patients older than 75 years of age who had undergone coronary bypass grafting were prospectively and consecutively analyze. Mean age was 78.4 +/- 2.7.

RESULTS

An average of 2.6 grafts/patients was constructed. Left mammary artery was used in 93% of patients. The in-hospital incidence of heart failure, atrial fibrillation, preoperative infarction and stroke was 38%, 29%, 4.8% and 2.8% respectively. The in-hospital mortality rate was 5.8%. Mean follow-up was 18 months (25th an 75th percentiles 9-29). Late mortality rate was 4.1% in eight patients. Excluding the in-hospital deaths, the estimated probability of survival (Kaplan-Meier) at 3 years was 94% and the survival freedom from symptoms was 86%. A multivariate analysis showed that only age was predictor of in-hospital mortality (OR 1.16, p = 0.009). Only peripheral vascular disease was found as a predictor of symptoms during the long-term follow-up (p = 0.001).

CONCLUSIONS

In this series of senile patients who underwent coronary surgery, those of an older age (> 80 years) showed a higher risk of in-hospital mortality. The presence of peripheral vascular disease is useful in the prognosis assessment of the group.

Double-blind evaluation of nimesulide vs lysine-aspirin in the treatment of paediatric acute respiratory tract infections

70 children aged 4 to 12 years with acute infection and inflammation of the respiratory tract (laryngitis, tracheitis, bronchitis, pneumonia) were enrolled in a double-blind investigation and randomised to treatment with nimesulide (50mg granules twice daily) or lysine-aspirin (360mg granules twice daily) for 5 days. The drugs were similarly effective in reducing cough, asthenia and dyspnoea, although nimesulide-treated patients experienced fewer gastrointestinal adverse events. These results confirm the efficacy of nimesulide in the treatment of respiratory inflammation and provide preliminary evidence of its value in children.

The GREEN RESCUE: a 'green' experimentation to clean old varnishes on oil paintings

In cultural heritage, several initiatives are promoted to transfer the green chemistry in replacing traditional and toxic methods and products, and in ensuring safety of both artworks and restorers during cleaning operations. This study is aimed to establish the validity of new green solvents to replace toxic solvents, commonly used, to remove old paint varnishes. In particular, the research is focused on the use of acetals to remove old varnishes paintings. The acetals are common functional groups in natural products which are generated by reactions between alcohols and aldehydes. The tests were performed on four different resins (DAMAR, RETOUCHER, PVA and PMMA). Several samples were prepared to reproduce the common stratigraphy succession of the oil painting. The performances of the solvents were monitored by visible light/UV light, photography and optical microscopy, spectro-colorimetric analysis. Then, FTIR spectra of the cleaned surface have been acquired to detect the residues after cleaning.

Cardiovascular and other risk factors among people who live in slums in Buenos Aires, Argentina

OBJECTIVES

Effective planning of health policies requires the availability of accurate data, representing the burden of disease and risks to the diverse components of society. In Argentina, health information comes from the national risk factors survey (NRFS), which characterises the distribution of different risk factors. However, the NRFS has never collected information from residents living in slums, despite slums representing 10% of the population. The objective of this survey was to characterise the prevalence of cardiovascular and other risk factors among the inhabitants of one of the largest slums in Buenos Aires (Villa 31) and compare it to data from the NRFS.

STUDY DESIGN

This was a cross-sectional study.

METHODS

A cross-sectional study was carried out in 400 slum households, using the same data structure as the NRFS. The survey obtained information about economic aspects, reproductive health, addictions and risk factors. All participants had their blood pressure, weight and height measured. A total of 406 people were interviewed and their data were compared with data from 32,365 people in the NRFS. All comparisons were made on the basis of age group.

RESULTS

A fair/poor self-perceived level of health (odds ratio [OR] 3.19, 95% confidence interval [CI]: 2.60-3.91), anxiety and moderate to severe depression (OR 5.44, 95% CI: 4.43-6.69), problem drinking (OR 10.01, 95% CI 8.08-12.40), self-reported hypertension (OR 1.26, 95% CI: 1.01-1.57), overweight (OR 1.26, 95% CI: 1.03-1.55) and obesity (OR 1.72, 95% CI: 1.38-2.15) were significantly higher in the slum population. In people aged 18-24 years, the prevalence of diabetes was triple the national average (OR 3.17, 95% CI: 1.26-7.98). For all evaluated conditions in this study, the inhabitants of the slum received significantly less treatment compared with participants from the NRFS.

CONCLUSIONS

The prevalence of cardiovascular and other risk factors in the slum population has a different distribution to that reported in the NRFS. These data suggest the need to establish specific policies for slum populations.

Aldo-keto reductase 1C2 (AKR1C2) as the second gene associated to non-syndromic primary lipedema: investigating activating mutation or overexpression as causative factors

OBJECTIVE

Lipedema is a debilitating chronic condition predominantly affecting women, characterized by the abnormal accumulation of fat in a symmetrical, bilateral pattern in the extremities, often coinciding with hormonal imbalances.

PATIENTS AND METHODS

Despite the conjectured role of sex hormones in its etiology, a definitive link has remained elusive. This study explores the case of a patient possessing a mutation deletion within the C-terminal region of Aldo-keto reductases Member C2 (AKR1C2), Ser320PheTer2, that could lead to heightened enzyme activity. A cohort of 19 additional lipedema patients and 2 additional affected family members14 were enrolled in this study. The two additional affected family members are relatives of the patient with the AKR1C1 L213Q variant, which is included in the 19 cohorts and described in literature.

RESULTS

Our investigation revealed that AKR1C2 was overexpressed, as quantified by qPCR, in 5 out of 21 (24%) lipedema patients who did not possess mutations in the AKR1C2 gene. Collectively, these findings implicate AKR1C2 in the pathogenesis of lipedema, substantiating its causative role.

CONCLUSIONS

This study demonstrates that the activating mutation in the enzyme or its overexpression is a causative factor in the development of lipedema. Further exploration and replication in diverse populations will bolster our understanding of this significant connection.

Author Correction: Aldo-keto reductase 1C2 (AKR1C2) as the second gene associated to non-syndromic primary lipedema: investigating activating mutation or overexpression as causative factors

Correction to: Eur Rev Med Pharmacol Sci 2023; 27 (6 Suppl): 127-136-DOI: 10.26355/eurrev_202312_34697 After publication and following some post-publication concerns, the authors have applied the following corrections to the galley proof. -       The conflict of interest section has been amended as follows: J. Kaftalli and G. Marceddu are employees at MAGI EUREGIO. K. Donato is employee at MAGI EUREGIO and MAGISNAT. M. Bertelli is president of MAGI EUREGIO, MAGISNAT, and MAGI's LAB. G. Bonetti, K. Dhuli, A. Macchia, and P.E. Maltese are employees at MAGI's LAB. M. Bertelli, P.E. Maltese, K. Louise Herbst, Sa. Michelini, Se. Michelini, and P. Chiurazzi are patent inventors (US20220362260A1). M. Bertelli, P.E. Maltese, G. Marceddu are patent inventors (US20230173003A1). M. Bertelli, K. Dhuli and P.E. Maltese are patent inventors (WO2022079498A1). M. Bertelli, P.E. Maltese, Sa. Michelini, Se. Michelini, P. Chiurazzi, K. Louise Herbst, J. Kaftalli, K. Donato, and A. Bernini are patent applicants (Application Number 18/516,241). M. Bertelli, K. Donato, P. Chiurazzi, G. Marceddu, K. Dhuli, G. Bonetti and J. Kaftalli are patent applicants (Application Number: 18/466.879). M. Bertelli, G. Bonetti, G. Marceddu, K. Donato, K. Dhuli, J. Kaftalli, Sa. Michelini, and K. Louise Herbst are patent applicants (Application Number 63/495,155). The remaining authors have no conflict of interest to disclose. -       Figure 5 has been modified as follows to better distinguish outliers: -       The legend of Figure 5 has to be modified as follows: Relative expression of AKR1C1 and AKR1C3 in different groups (CTR = non affected controls, L = lipedema patients without overexpression of AKR1C2, L-over = Lipedema patients with overexpression of AKR1C2), showing that lipedema patients expressed AKR1C1 and AKR1C3 levels similar to the control group. Outliers are reported as black triangles. There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/34697.

Genetic Study of HGF-MET Signaling Pathway in Primary Lymphedema Patients: Supporting Evidence for Loss of Function Variants in HGF

The lymphatic system is composed of lymphatic vessels that connect lymphatic organs and play a critical role in draining lymph fluid from the intracellular environment. Disruptions in this system can lead to defects in lymphatic development and lymphedema which is characterized by chronic inflammation and fluid accumulation in tissues, finally resulting in swelling, pain, and fibrosis. If caused by genetic variants, this condition is referred to as primary lymphedema. This study explores the genetic basis of primary lymphedema in an Italian cohort retrospectively analyzing sequencing data and focusing specifically on genes involved in the HGF/MET signaling pathway. This pathway is crucial for lymphangiogenesis and lymphatic function, but the involved genes miss a clear association with lymphedema in clinical practice. The analysis identified 8 variants in three key genes, namely HGF, MET, and CBL, among 8 unrelated patients. Seven of these variants have never been reported in literature as associated with lymphedema. We performed molecular modeling studies to evaluate the effect of the three identified missense variants in MET, supporting the pathogenicity of two of them. The identification of these variants supports the significance of alterations in HGF/MET signaling pathway as possible causes of primary lymphedema.

Autistic Adults Avoid Unpredictability in Decision-Making

Decision-making under unpredictable conditions can cause discomfort in autistic persons due to their preference for predictability. Decision-making impairments might furthermore be associated with a dysregulation of sex and stress hormones. This prospective, cross-sectional study investigated decision-making in 32 autistic participants (AP, 14 female) and 31 non-autistic participants (NAP, 20 female) aged 18-64 years. The Iowa Gambling Task (IGT) and the Cambridge Risk Task (CRT) were used to assess decision-making under ambiguity and under risk with known outcome probabilities, respectively. Cortisol, estradiol, and testosterone serum levels were related to decision-making performance. Groups did not differ in overall IGT and CRT performance, but compared with NAP, AP preferred less profitable card decks with predictable outcomes while avoiding those with unpredictable outcomes. AP required more time to reach decisions compared to NAP. Additionally, AP without comorbid depression performed significantly worse than NAP in the IGT. Estradiol and cortisol concentrations were significant predictors of CRT scores in NAP, but not in AP. The study results imply that AP are 'risk-averse' in decision-making under ambiguity as they avoided choice options with unpredictable losses in comparison to NAP. Our findings highlight the intolerance for uncertainty, particularly in ambiguous situations. Thus, we recommend being as transparent and precise as possible when interacting with autistic individuals. Future research should explore decision-making in social situations among individuals with ASD, factoring in person-dependent variables such as depression.

Anti-human skeletal muscle glycolipid antibodies in unstable angina

BACKGROUND

We studied whether the level of anti-skeletal muscle glycolipid antibodies (AGA), a marker of acute rejection in heart transplantation, may be associated with an adverse prognosis in unstable angina.

METHODS AND RESULTS

The in-hospital evolution of 50 patients with unstable angina (Braunwald class III B) was assessed. We determined the incidence of death, myocardial infarction, and refractory angina. Blood was collected at admission and 24 hours later for determination of AGA levels by enzyme-linked immunosorbent assay. Twenty-three patients showed a decrease in the AGA level at 24 hours after admission. Ten in-hospital cardiac events occurred in these patients (43.4%) as compared with 4 (14.8%) in the 27 patients who did not show a decrease (P =.025). In patients with previous myocardial infarction (n = 26), the AGA assay was a powerful predictor of outcome. In this subgroup, 66.6% of patients who had decreased AGA levels (8 of 12) had cardiac events as compared with 14.2% (2 of 14) of those who did not have that decrease (P =.001).

CONCLUSIONS

We conclude that a decrease of AGA levels 24 hours after admission is associated with a complicated in-hospital course. This finding may provide new insights in the phenomenon of plaque instability involved in the development of acute coronary syndromes.

Intranasal Oxytocin Modulates Decision-Making Depending on Outcome Predictability-A Randomized Within-Subject Controlled Trial in Healthy Males

Oxytocin (OT) has been extensively studied with regard to its socio-cognitive and -behavioral effects. Its potential as a therapeutic agent is being discussed for a range of neuropsychiatric conditions. However, there is limited evidence of its effects on non-social cognition in general and decision-making in particular, despite the importance of these functions in neuropsychiatry. Using a crossover/within-subject, blinded, randomized design, we investigated for the first time if intranasal OT (24 IU) affects decision-making differently depending on outcome predictability/ambiguity in healthy males. The Iowa Gambling Task (IGT) and the Cambridge Risk Task (CRT) were used to assess decision-making under low outcome predictability/high ambiguity and under high outcome probability/low ambiguity, respectively. After administration of OT, subjects performed worse and exhibited riskier performance in the IGT (low outcome predictability/high ambiguity), whereas they made borderline-significant less risky decisions in the CRT (high outcome probability/low ambiguity) as compared to the control condition. Decision-making in healthy males may therefore be influenced by OT and adjusted as a function of contextual information, with implications for clinical trials investigating OT in neuropsychiatric conditions.

Safety and immunogenicity of heterologous COVID-19 vaccine regimens to deal with product shortage: A randomised clinical trial in an elderly population

Objectives

In a context of COVID-19 vaccine shortages, this study sought to evaluate the safety and efficacy of receiving one dose of Gam-COVID-Vac rAd26 followed by a second COVID-19 vaccine dose of either Gam-COVID-Vac rAd5, ChAdOx1 nCoV-19 or BBIBP-CorV in a cohort of older adults.

Study design

Single-centre, randomised, open label, non-inferiority trial.

Methods

Adults aged ≥65 years who had received one dose of Gam-COVID-Vac rAd26 were randomised in a 1:1:1 ratio to receive a second-dose COVID-19 vaccination of either Gam-COVID-Vac rAd5, ChAdOx1 nCoV-19 or BBIBP-CorV. The primary outcome was the assessment of the humoral immune response to vaccination (i.e. antibody titres of SARS-CoV-2 spike protein at 28 days after second-dose vaccination). In addition, neutralising antibody titres at day 28 for the three schedules were measured.

Results

Of 85 participants who were enrolled in the study between 26 and July 30, 2021, 31 individuals were randomised to receive Gam-COVID-Vac rAd5, 27 to ChAdOx1 nCoV-19 and 27 to BBIBP-CorV. The mean age of participants was 68.2 years (SD 2.9) and 49 (57.6%) were female. Participants who received Gam-COVID-Vac rAd5 and ChAdOx1 nCoV1-19 showed significantly increased anti-S titres at 28 days after second-dose vaccination, but this magnitude of difference was not observed for those who received BBIBP-CorV. The ratio between the geometric mean at day 28 and baseline within each group was 11.8 (6.98-19.89) among patients assigned to Gam-COVID-Vac rAd26/rAd5, 4.81 (2.14-10.81) for the rAd26/ChAdOx1 nCoV-19 group and 1.53 (0.74-3.20) for the rAd26/BBIBP-CorV group. All of the schedules were shown to be safe.

Conclusions

The findings in this study contribute to the scarce information published on the safety and immunogenicity of Gam-COVID-Vac heterologous regimens and will help the development of guidelines and vaccine programme management.

Unraveling the Role of Prickly Pear Extract as a Potent Nutraceutical Agent Against Metabolic Syndromes

Background

Prickly pear (Opuntia) extracts have garnered con-siderable attention in recent years due to their promising medicinal and nutritional properties. This comprehensive review explores the multifaceted potential of prickly pear extracts in mitigating various chronic diseases, including cardiovascular diseases (CVDs), diabetes, obesity, cancer, neuronal diseases, and renal diseases.

Methods

This review provides a comprehensive overview of the diverse therapeutic applications of Opuntia extracts in managing chronic diseases. The collective evidence underscores the potential of prickly pear as a valuable natural resource for addressing global health challenges. Further research and clinical investigations are warranted to unlock the full potential of Opuntia in the prevention and treatment of chronic diseases.

Results

Studies have suggested that the bioactive compounds within prickly pear may influence glucose metabolism by improving insulin sensitivity, reducing insulin resistance, and modulating gut microbiota composition. These pathways exhibit potential in the reduction of hyperglycemia, which is a fundamental aspect of metabolic syndromes. Opuntia extracts demonstrate also antioxidant, anti-inflammatory capabilities that can contribute to improving health in various conditions.

Conclusion

Further research and clinical investigations are warranted to unlock the full potential of Opuntia in the prevention and treatment of chronic diseases.

Trait dissociation in borderline personality disorder: influence on immediate therapy outcomes, follow-up assessments, and self-harm patterns

Background: Dissociative symptoms are suggested to compete with the effectiveness of psychotherapeutic treatment and frequently co-occur with early life trauma and self-harm patterns, including self-injury, suicidal ideation, and suicide attempts, which are characteristic for borderline personality disorder (BPD).Objective: We explore the connections between dissociation and other BPD features like self-harm and childhood traumatization and examine the impact of trait dissociation on both immediate and follow-up psychotherapy outcomes.Method: In this naturalistic prospective evaluation study, we investigated psychopathology including general psychological distress (SCL-90), depression (BDI-II), and borderline-specific pathology (BSL) in 131 patients with BPD pre and post of a certified 8-week inpatient Dialectical Behaviour Therapy (DBT), as well as 3- and 6-month post inpatient treatment. Prior to therapy, we evaluated trait dissociation (Dissociative Experience Scale), early life trauma (Childhood Trauma Questionnaire), and self-harm patterns (clinical interview). We performed a network analysis to explore the interplay between dissociation, self-harm, and childhood traumatization. To analyse the influence of dissociation on treatment outcomes, we employed linear mixed models.Results: Psychopathology (SCL-90, BDI-II and BSL) exhibited significant reductions at post-treatment and follow-up assessments when compared to baseline measurements. Higher levels of trait dissociation were consistently related to higher psychopathology but did not suggest poorer symptom reduction during DBT. However, trait dissociation predicted reduced 6-month follow-up benefits from DBT, regardless of the baseline symptom burden. The network analysis revealed a close association between self-injury and derealization/depersonalization, while the frequency of suicide attempts was more closely connected to childhood emotional abuse, which was identified as a central node of the network.Conclusions: Dissociation was not related to poorer outcomes regarding inpatient DBT. However, trait dissociation predicted reduced follow-up benefits, highlighting the need to address dissociation during psychotherapeutic interventions. Based on the estimated network structure, treating dissociative symptoms could potentially mitigate self-injury while especially childhood emotional abuse was linked with suicide attempts.