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Schulte H, Schmiedl A, Mühlfeld C, Knudsen L. Teaching gross anatomy during the Covid-19 pandemic: Effects on medical students' gain of knowledge, confidence levels and pandemic-related concerns. Ann Anat 2022; 244:151986. [PMID: 35914632 PMCID: PMC9334863 DOI: 10.1016/j.aanat.2022.151986] [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: 03/04/2022] [Revised: 07/10/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022]
Abstract
For medical students the dissection course is the preferred method to learn gross anatomy. However, the added value of active cadaver dissection on knowledge gain in multimodal curricula offering a diversity of e-learning resources is unknown. The Covid-19-related lockdown forced educators to replace the dissection course by e-learning resources. At the end of the summer term 2020 loosening of pandemic-related regulations allowed offering a compact, voluntary active dissection course of the head-neck region to first-year medical students at Hannover Medical School. A study was conducted comparing a dissection group (G1, n = 115) and a non-dissection group (G2, n = 23). Knowledge gain and confidence level were measured with a multiple-choice (MC-)test. The use of e-learning resources was recorded. A questionnaire measured motivation, interest and level of concern regarding Covid-19 and anatomy teaching. No differences between groups were found regarding motivation and interest in anatomy of the head-neck region. G2, however, had significantly higher concerns regarding the Covid-19 pandemic than G1. Neither before nor after the educational intervention, differences in the scores of the MC-test were found. However, after the course G1 answered more MC-questions with highest confidence level than G2 (6.7 ± 6.0 vs. 3.6 ± 4.6, p < 0.05) and demonstrated by trend an increased improvement in the scores of image-based questions (30.8 ± 18.2 % vs. 17.1 ± 14.8 %, p = 0.06). In general, frequent users of online quizzes, a part of the e-learning resources, scored significantly better in the knowledge test. Active dissection improves self-assurance to identify anatomical structures and should be re-implemented in multimodal, blended-learning-based anatomical curricula in the post-pandemic era.
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Affiliation(s)
- Henri Schulte
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Andreas Schmiedl
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Christian Mühlfeld
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Lars Knudsen
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany.
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Mühlfeld C, Schulte H, Jansing JC, Casiraghi C, Ricci F, Catozzi C, Ochs M, Salomone F, Brandenberger C. Design-Based Stereology of the Lung in the Hyperoxic Preterm Rabbit Model of Bronchopulmonary Dysplasia. Oxid Med Cell Longev 2021; 2021:4293279. [PMID: 34659632 PMCID: PMC8514964 DOI: 10.1155/2021/4293279] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a complex condition frequently occurring in preterm newborns, and different animal models are currently used to mimic the pathophysiology of BPD. The comparability of animal models depends on the availability of quantitative data obtained by minimally biased methods. Therefore, the aim of this study was to provide the first design-based stereological analysis of the lungs in the hyperoxia-based model of BPD in the preterm rabbit. Rabbit pups were obtained on gestation day 28 (three days before term) by cesarean section and exposed to normoxic (21% O2, n = 8) or hyperoxic (95% O2, n = 8) conditions. After seven days of exposure, lung function testing was performed, and lungs were taken for stereological analysis. In addition, the ratio between pulmonary arterial acceleration and ejection time (PAAT/PAET) was measured. Inspiratory capacity and static compliance were reduced whereas tissue elastance and resistance were increased in hyperoxic animals compared with normoxic controls. Hyperoxic animals showed signs of pulmonary hypertension indicated by the decreased PAAT/PAET ratio. In hyperoxic animals, the number of alveoli and the alveolar surface area were reduced by one-third or by approximately 50% of control values, respectively. However, neither the mean linear intercept length nor the mean alveolar volume was significantly different between both groups. Hyperoxic pups had thickened alveolar septa and intra-alveolar accumulation of edema fluid and inflammatory cells. Nonparenchymal blood vessels had thickened walls, enlarged perivascular space, and smaller lumen in hyperoxic rabbits in comparison with normoxic ones. In conclusion, the findings are in line with the pathological features of human BPD. The stereological data may serve as a reference to compare this model with BPD models in other species or future therapeutic interventions.
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Affiliation(s)
- Christian Mühlfeld
- Institute of Functional and Applied Anatomy, Hannover Medical School, 30625 Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Research (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Henri Schulte
- Institute of Functional and Applied Anatomy, Hannover Medical School, 30625 Hannover, Germany
| | | | - Costanza Casiraghi
- Corporate R&D Preclinical Department, Chiesi Farmaceutici S.p.A, Via Palermo 26/a, 43122 Parma, Italy
| | - Francesca Ricci
- Corporate R&D Preclinical Department, Chiesi Farmaceutici S.p.A, Via Palermo 26/a, 43122 Parma, Italy
| | - Chiara Catozzi
- Corporate R&D Preclinical Department, Chiesi Farmaceutici S.p.A, Via Palermo 26/a, 43122 Parma, Italy
| | - Matthias Ochs
- Institute of Functional and Applied Anatomy, Hannover Medical School, 30625 Hannover, Germany
- Institute of Functional Anatomy, Charité-Universitätsmedizin Berlin, Philippstr. 11, 10115 Berlin, Germany
- German Center for Lung Research (DZL), Berlin, Germany
| | - Fabrizio Salomone
- Corporate R&D Preclinical Department, Chiesi Farmaceutici S.p.A, Via Palermo 26/a, 43122 Parma, Italy
| | - Christina Brandenberger
- Institute of Functional and Applied Anatomy, Hannover Medical School, 30625 Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Research (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
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Verhaar N, de Buhr N, von Köckritz-Blickwede M, Hewicker-Trautwein M, Pfarrer C, Mazzuoli-Weber G, Schulte H, Kästner S. Ischaemic postconditioning reduces apoptosis in experimental jejunal ischaemia in horses. BMC Vet Res 2021; 17:175. [PMID: 33902575 PMCID: PMC8077964 DOI: 10.1186/s12917-021-02877-y] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/12/2021] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Ischaemic postconditioning (IPoC) refers to brief periods of reocclusion of blood supply following an ischaemic event. This has been shown to ameliorate ischaemia reperfusion injury in different tissues, and it may represent a feasible therapeutic strategy for ischaemia reperfusion injury following strangulating small intestinal lesions in horses. The objective of this study was to assess the degree cell death, inflammation, oxidative stress, and heat shock response in an equine experimental jejunal ischaemia model with and without IPoC. METHODS In this randomized, controlled, experimental in vivo study, 14 horses were evenly assigned to a control group and a group subjected to IPoC. Under general anaesthesia, segmental ischaemia with arterial and venous occlusion was induced in 1.5 m jejunum. Following ischaemia, the mesenteric vessels were repeatedly re-occluded in group IPoC only. Full thickness intestinal samples and blood samples were taken at the end of the pre-ischaemia period, after ischaemia, and after 120 min of reperfusion. Immunohistochemical staining or enzymatic assays were performed to determine the selected variables. RESULTS The mucosal cleaved-caspase-3 and TUNEL cell counts were significantly increased after reperfusion in the control group only. The cleaved-caspase-3 cell count was significantly lower in group IPoC after reperfusion compared to the control group. After reperfusion, the tissue myeloperoxidase activity and the calprotectin positive cell counts in the mucosa were increased in both groups, and only group IPoC showed a significant increase in the serosa. Tissue malondialdehyde and superoxide dismutase as well as blood lactate levels showed significant progression during ischaemia or reperfusion. The nuclear immunoreactivity of Heat shock protein-70 increased significantly during reperfusion. None of these variables differed between the groups. The neuronal cell counts in the myenteric plexus ganglia were not affected by the ischaemia model. CONCLUSIONS A reduced apoptotic cell count was found in the group subjected to IPoC. None of the other tested variables were significantly affected by IPoC. Therefore, the clinical relevance and possible protective mechanism of IPoC in equine intestinal ischaemia remains unclear. Further research on the mechanism of action and its effect in clinical cases of strangulating colic is needed.
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Affiliation(s)
- Nicole Verhaar
- Clinic for Horses, University of Veterinary Medicine Hannover, Hannover, Germany.
| | - Nicole de Buhr
- Department of Biochemistry, University of Veterinary Medicine Hannover, Hannover, Germany
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Maren von Köckritz-Blickwede
- Department of Biochemistry, University of Veterinary Medicine Hannover, Hannover, Germany
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | | | - Christiane Pfarrer
- Institute for Anatomy, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Gemma Mazzuoli-Weber
- Institute for Physiology and Cell Biology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Henri Schulte
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Sabine Kästner
- Clinic for Horses, University of Veterinary Medicine Hannover, Hannover, Germany
- Small Animal Clinic, University of Veterinary Medicine Hannover, Hannover, Germany
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Abstract
Lung function declines with advancing age. To improve our understanding of the structure-function relationships leading to this decline, we investigated structural alterations in the lung and their impact on micromechanics and lung function in the aging mouse. Lung function analysis was performed in 3, 6, 12, 18, and 24 months old C57BL/6 mice (n = 7-8/age), followed by lung fixation and stereological sample preparation. Lung parenchymal volume, total, ductal and alveolar airspace volume, alveolar volume and number, septal volume, septal surface area and thickness were quantified by stereology as well as surfactant producing alveolar epithelial type II (ATII) cell volume and number. Parenchymal volume, total and ductal airspace volume increased in old (18 and 24 months) compared with middle-aged (6 and 12 months) and young (3 months) mice. While the alveolar number decreased from young (7.5 × 106) to middle-aged (6 × 106) and increased again in old (9 × 106) mice, the mean alveolar volume and mean septal surface area per alveolus conversely first increased in middle-aged and then declined in old mice. The ATII cell number increased from middle-aged (8.8 × 106) to old (11.8 × 106) mice, along with the alveolar number, resulting in a constant ratio of ATII cells per alveolus in all age groups (1.4 ATII cells per alveolus). Lung compliance and inspiratory capacity increased, whereas tissue elastance and tissue resistance decreased with age, showing greatest changes between young and middle-aged mice. In conclusion, alveolar size declined significantly in old mice concomitant with a widening of alveolar ducts and late alveolarization. These changes may partly explain the functional alterations during aging. Interestingly, despite age-related lung remodeling, the number of ATII cells per alveolus showed a tightly controlled relation in all age groups.
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Affiliation(s)
- Henri Schulte
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hanover, Germany
| | - Christian Mühlfeld
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hanover, Germany.,Cluster of Excellence REBIRTH (From Regenerative Biology to Reconstructive Therapy), Hanover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany
| | - Christina Brandenberger
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hanover, Germany.,Cluster of Excellence REBIRTH (From Regenerative Biology to Reconstructive Therapy), Hanover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany
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Balleisen L, Assmann G, Bailey J, Epping PH, Schulte H, van de Loo J. Epidemiological Study on Factor VII, Factor VIII and Fibrinogen in an Industrial Population - II. Baseline Data on the Relation to Blood Pressure, Blood Glucose, Uric Acid, and Lipid Fractions. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1660106] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryIn a preceding paper the baseline data in the Munster Arteriosclerosis Study (PROCAM study) of the levels of fibrinogen, factor VIIc and factor VIIIc were described, and their correlation of age, body weight, smoking, alcohol, pill-using and menopause discussed. In this part the relationship of these coagulation factors to blood pressure, blood glucose, uric acid and lipid parameters, which were examined in 4186 apparently healthy individuals, is presented. The correlations are described using two different statistical models, first the Pearson correlation coefficients after allowing each clotting factor for the effects of age, cigarette and alcohol consumption, body weight, menopausal state, pill using and the other clotting factors, and secondly by a multiple regression analysis. The data suggest that there are multiple interrelationships between hemostatic factors and the variables under consideration. The most striking positive correlations were found for factor VII c to blood glucose and triglycerides in men and women and to HDDcholesterol in women.
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Affiliation(s)
- L Balleisen
- The Institute for Arteriosclerosis Research, Department of Internal Medicine and Department of Clinical Chemistry, University of Munster, Munster, West Germany
| | - G Assmann
- The Institute for Arteriosclerosis Research, Department of Internal Medicine and Department of Clinical Chemistry, University of Munster, Munster, West Germany
| | - J Bailey
- The Institute for Arteriosclerosis Research, Department of Internal Medicine and Department of Clinical Chemistry, University of Munster, Munster, West Germany
| | - P-H Epping
- The Institute for Arteriosclerosis Research, Department of Internal Medicine and Department of Clinical Chemistry, University of Munster, Munster, West Germany
| | - H Schulte
- The Institute for Arteriosclerosis Research, Department of Internal Medicine and Department of Clinical Chemistry, University of Munster, Munster, West Germany
| | - J van de Loo
- The Institute for Arteriosclerosis Research, Department of Internal Medicine and Department of Clinical Chemistry, University of Munster, Munster, West Germany
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Schmitz-Huebner U, Rüschemeyer C, Schulte H, Loo JVD. Influence of Low Molecular Weight Heparin on the Hemostatic System After Abdominal Surgery. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661300] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe hemostatic effect of two low molecular weight heparin fractions and of one unfractionated heparin preparation administered subcutaneously b. i. d. was examined in 6 healthy subjects and in 53 patients after major abdominal surgery. Among other tests platelet count, prothrombin time, fibrinogen, β-thrombo- globulin, antithrombin, antiplasmin, FPA and F-CB 3 related antigen, as well as various heparin activities, were repeatedly determined pre- and postoperatively. Under all tested conditions the low molecular weight fractions induced higher heparin levels, both in terms of anti-Xa and of anti-thrombin activity. No further significant differences of the laboratory results between the treatment groups were documented. Total blood loss measured at the first postoperative day was higher in patients with malignancy and negatively correlated with antithrombin and antiplasmin levels, while no relation was observed with the heparin activities and the other tested parameters. Whereas evidence for a hemorrhagic property of the tested low molecular weight heparin fractions was found, a particular mechanism underlying this effect could not be identified.
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Affiliation(s)
- U Schmitz-Huebner
- The Department of Medicine and Institute for Arteriosclerosis Research, University of Münster, Münster, FRG
| | - C Rüschemeyer
- The Department of Medicine and Institute for Arteriosclerosis Research, University of Münster, Münster, FRG
| | - H Schulte
- The Department of Medicine and Institute for Arteriosclerosis Research, University of Münster, Münster, FRG
| | - J van de Loo
- The Department of Medicine and Institute for Arteriosclerosis Research, University of Münster, Münster, FRG
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Gnatiuc L, Herrington WG, Halsey J, Tuomilehto J, Fang X, Kim HC, De Bacquer D, Dobson AJ, Criqui MH, Jacobs DR, Leon DA, Peters SAE, Ueshima H, Sherliker P, Peto R, Collins R, Huxley RR, Emberson JR, Woodward M, Lewington S, Aoki N, Arima H, Arnesen E, Aromaa A, Assmann G, Bachman DL, Baigent C, Bartholomew H, Benetos A, Bengtsson C, Bennett D, Björkelund C, Blackburn H, Bonaa K, Boyle E, Broadhurst R, Carstensen J, Chambless L, Chen Z, Chew SK, Clarke R, Cox C, Curb JD, D'Agostino R, Date C, Davey Smith G, De Backer G, Dhaliwal SS, Duan XF, Ducimetiere P, Duffy S, Eliassen H, Elwood P, Empana J, Garcia-Palmieri MH, Gazes P, Giles GG, Gillis C, Goldbourt U, Gu DF, Guasch-Ferre M, Guize L, Haheim L, Hart C, Hashimoto S, Hashimoto T, Heng D, Hjermann I, Ho SC, Hobbs M, Hole D, Holme I, Horibe H, Hozawa A, Hu F, Hughes K, Iida M, Imai K, Imai Y, Iso H, Jackson R, Jamrozik K, Jee SH, Jensen G, Jiang CQ, Johansen NB, Jorgensen T, Jousilahti P, Kagaya M, Keil J, Keller J, Kim IS, Kita Y, Kitamura A, Kiyohara Y, Knekt P, Knuiman M, Kornitzer M, Kromhout D, Kronmal R, Lam TH, Law M, Lee J, Leren P, Levy D, Li YH, Lissner L, Luepker R, Luszcz M, MacMahon S, Maegawa H, Marmot M, Matsutani Y, Meade T, Morris J, Morris R, Murayama T, Naito Y, Nakachi K, Nakamura M, Nakayama T, Neaton J, Nietert PJ, Nishimoto Y, Norton R, Nozaki A, Ohkubo T, Okayama A, Pan WH, Puska P, Qizilbash N, Reunanen A, Rimm E, Rodgers A, Saitoh S, Sakata K, Sato S, Schnohr P, Schulte H, Selmer R, Sharp D, Shifu X, Shimamoto K, Shipley M, Silbershatz H, Sorlie P, Sritara P, Suh I, Sutherland SE, Sweetnam P, Tamakoshi A, Tanaka H, Thomsen T, Tominaga S, Tomita M, Törnberg S, Tunstall-Pedoe H, Tverdal A, Ueshima H, Vartiainen E, Wald N, Wannamethee SG, Welborn TA, Whincup P, Whitlock G, Willett W, Woo J, Wu ZL, Yao SX, Yarnell J, Yokoyama T, Yoshiike N, Zhang XH. Sex-specific relevance of diabetes to occlusive vascular and other mortality: a collaborative meta-analysis of individual data from 980 793 adults from 68 prospective studies. Lancet Diabetes Endocrinol 2018; 6:538-546. [PMID: 29752194 PMCID: PMC6008496 DOI: 10.1016/s2213-8587(18)30079-2] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/20/2018] [Accepted: 02/26/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Several studies have shown that diabetes confers a higher relative risk of vascular mortality among women than among men, but whether this increased relative risk in women exists across age groups and within defined levels of other risk factors is uncertain. We aimed to determine whether differences in established risk factors, such as blood pressure, BMI, smoking, and cholesterol, explain the higher relative risks of vascular mortality among women than among men. METHODS In our meta-analysis, we obtained individual participant-level data from studies included in the Prospective Studies Collaboration and the Asia Pacific Cohort Studies Collaboration that had obtained baseline information on age, sex, diabetes, total cholesterol, blood pressure, tobacco use, height, and weight. Data on causes of death were obtained from medical death certificates. We used Cox regression models to assess the relevance of diabetes (any type) to occlusive vascular mortality (ischaemic heart disease, ischaemic stroke, or other atherosclerotic deaths) by age, sex, and other major vascular risk factors, and to assess whether the associations of blood pressure, total cholesterol, and body-mass index (BMI) to occlusive vascular mortality are modified by diabetes. RESULTS Individual participant-level data were analysed from 980 793 adults. During 9·8 million person-years of follow-up, among participants aged between 35 and 89 years, 19 686 (25·6%) of 76 965 deaths were attributed to occlusive vascular disease. After controlling for major vascular risk factors, diabetes roughly doubled occlusive vascular mortality risk among men (death rate ratio [RR] 2·10, 95% CI 1·97-2·24) and tripled risk among women (3·00, 2·71-3·33; χ2 test for heterogeneity p<0·0001). For both sexes combined, the occlusive vascular death RRs were higher in younger individuals (aged 35-59 years: 2·60, 2·30-2·94) than in older individuals (aged 70-89 years: 2·01, 1·85-2·19; p=0·0001 for trend across age groups), and, across age groups, the death RRs were higher among women than among men. Therefore, women aged 35-59 years had the highest death RR across all age and sex groups (5·55, 4·15-7·44). However, since underlying confounder-adjusted occlusive vascular mortality rates at any age were higher in men than in women, the adjusted absolute excess occlusive vascular mortality associated with diabetes was similar for men and women. At ages 35-59 years, the excess absolute risk was 0·05% (95% CI 0·03-0·07) per year in women compared with 0·08% (0·05-0·10) per year in men; the corresponding excess at ages 70-89 years was 1·08% (0·84-1·32) per year in women and 0·91% (0·77-1·05) per year in men. Total cholesterol, blood pressure, and BMI each showed continuous log-linear associations with occlusive vascular mortality that were similar among individuals with and without diabetes across both sexes. INTERPRETATION Independent of other major vascular risk factors, diabetes substantially increased vascular risk in both men and women. Lifestyle changes to reduce smoking and obesity and use of cost-effective drugs that target major vascular risks (eg, statins and antihypertensive drugs) are important in both men and women with diabetes, but might not reduce the relative excess risk of occlusive vascular disease in women with diabetes, which remains unexplained. FUNDING UK Medical Research Council, British Heart Foundation, Cancer Research UK, European Union BIOMED programme, and National Institute on Aging (US National Institutes of Health).
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Winkler U, Zierleyn J, Schulte H, Collet W, Schindler A. Routine screening for coagulation inhibitors prior to prescribing the pill: prevalence data from a large cohort of German pill starters. EUR J CONTRACEP REPR 2015. [DOI: 10.3109/13625187.11661694.1996] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Schulte H. [Learning to play]. Kinderkrankenschwester 2014; 33:296. [PMID: 25199259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Guijarro-Martínez R, Gellrich NC, Witte J, Tapioles D, von Briel C, Kolotas C, Achinger J, Hailemariam S, Schulte H, Rohner D, Hammer B. Optimization of the interface between radiology, surgery, radiotherapy, and pathology in head and neck tumor surgery: a navigation-assisted multidisciplinary network. Int J Oral Maxillofac Surg 2013; 43:156-62. [PMID: 24100154 DOI: 10.1016/j.ijom.2013.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 07/22/2013] [Accepted: 09/03/2013] [Indexed: 10/26/2022]
Abstract
A navigation-assisted multidisciplinary network to improve the interface between radiology, surgery, radiotherapy, and pathology in the field of head and neck cancer is described. All implicated fields are integrated by a common server platform and have remote data access in a ready-to-use format. The margins of resection and exact locations of biopsies are mapped intraoperatively. The pathologist uses the numerical coordinates of these samples to precisely trace each specimen in the anatomical field. Subsequently, map-guided radiotherapy is planned. In addition to the benefits of image-guided resection, this model enables radiotherapy planning according to the specific coordinates of the resection defect plus any residually affected sites identified by the pathologist. Irradiation of adjacent healthy structures is thereby minimized. In summary, the navigation-assisted network described grants timely multidisciplinary feedback between all fields involved, attains meticulous pathological definition, and permits optimized coordinate-directed radiotherapy.
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Affiliation(s)
| | - N-C Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - J Witte
- Brainlab AG, Feldkirchen, Germany
| | - D Tapioles
- Hirslanden Head Office, Zürich, Switzerland
| | - C von Briel
- Department of Radiotherapy, Hirslanden Medical Center, Aarau, Switzerland
| | - C Kolotas
- Department of Radiotherapy, Hirslanden Medical Center, Aarau, Switzerland
| | | | - S Hailemariam
- Department of Pathology, Hirslanden Medical Center, Aarau, Switzerland
| | | | - D Rohner
- Craniofacial Center (CFC), Hirslanden Medical Center, Aarau, Switzerland
| | - B Hammer
- Craniofacial Center (CFC), Hirslanden Medical Center, Aarau, Switzerland
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Schulte H. ["Now go and play in a pedagogically valuable way"]. Kinderkrankenschwester 2013; 32:372. [PMID: 24303585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Schulte H. [Relaunch of "Kinderkrankenschwester"]. Kinderkrankenschwester 2013; 32:293. [PMID: 23971144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Muntoni S, Wiebusch H, Jansen-Rust M, Rust S, Schulte H, Berger K, Pisciotta L, Bertolini S, Funke H, Seedorf U, Assmann G. Heterozygosity for lysosomal acid lipase E8SJM mutation and serum lipid concentrations. Nutr Metab Cardiovasc Dis 2013; 23:732-736. [PMID: 22795295 DOI: 10.1016/j.numecd.2012.05.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 04/20/2012] [Accepted: 05/24/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIM The complete absence of the lysosomal acid lipase (LAL) enzyme function causes Wolman's Disease that is fatal within the first six months of life. Subtotal defects cause Cholesteryl ester storage disease (CESD), an autosomal recessive disorder leading to hepatic steatosis, fibrosis, micronodular cirrhosis, combined hyperlipidemia with low HDL-cholesterol, increased risk for atherosclerosis, premature death. Since the frequency of the Exon 8 splice junction mutation (c.894 G > A, E8SJM), the CESD leading mutation, is not rare in the general population (allele frequency 0.0025), we investigated the impact of this mutation on serum lipid profile in E8SJM carriers. METHODS AND RESULTS We collected E8SJM carriers both form genetic study-population analysis and from Outpatient Lipid Clinics and then we assessed their serum lipid profile. We found thirteen individuals heterozygote for E8SJM. Most of them were Germans, three Spanish and two Italian. We found a significant increase in total cholesterol levels in both sexes with E8SJM mutation, leading to a significant increase in LDL cholesterol in males. CONCLUSIONS Our results show that LAL E8SJM carriers have an alteration in lipid profile with a Polygenic Hypercholesterolemia phenotype, leading to an increase in cardiovascular risk profile.
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Affiliation(s)
- Sa Muntoni
- Department of Toxicology, Oncology and Molecular Pathology Unit, University of Cagliari, Italy.
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Abstract
Abstract
The outstanding economic importance of injection molding in plastics processing and the steadily growing requirements on the molded parts to be produced are leading to constant further developments in the process engineering for injection molding. Computer simulation is a method that has only recently come to be used to an increasing extent in the field of injection molding, and the use of computers has so far been restricted to simulation of the injection mold. One key prerequisite for the quality of the molded parts, however, is that the melt should have been prepared by the plasticating unit in a manner that comes as close to the ideal as possible.
The article presents a closed basis for calculation for the simulation of the plasticisation process in injection molding. This makes it possible for a large number of screw layout criteria to be estimated and calculated in advance. The computer simulation serves to make the plasticisation process more or less transparent and also clearer and calculable. The validity of the computation model for any size of plasticating units is demonstrated by examining the operating points of large industrial plants.
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Affiliation(s)
- H. Potente
- Department of Plastics Technology, University of Paderborn, Paderborn, Germany
| | - H. Schulte
- Department of Plastics Technology, University of Paderborn, Paderborn, Germany
| | - N. Effen
- Department of Plastics Technology, University of Paderborn, Paderborn, Germany
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Kowalski C, Wesselmann S, Kreienberg R, Schulte H, Pfaff H. The Patients' View On Accredited Breast Cancer Centers: Strengths and Potential for Improvement. Geburtshilfe Frauenheilkd 2012; 72:137-143. [PMID: 25284830 DOI: 10.1055/s-0031-1280475] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 11/25/2011] [Accepted: 12/06/2011] [Indexed: 10/28/2022] Open
Abstract
Breast Care Centers that were accredited according to the German Cancer Society criteria were offered to participate in a standardized patient survey in 2010, which was conducted by the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science and Faculty of Medicine, University of Cologne. Patients were included consecutively between March and November 2010. The Cologne Patient Questionnaire-Breast Cancer (CPQ-BC) was used, which assesses a number of aspects of hospital care as perceived by the patients, among them provider-patient interaction, the disease-specific information provided, the quality of organization, and room amenities. 128 of 195 Breast Care Centers and 160 of 251 hospitals participated in the study. 8226 patients consented to the survey. The questionnaires of 7301 patients could be included in the analyses (89 %). Overall, the results showed that patients are satisfied with their hospital stay and that the accreditation criteria are implemented in a way that serves the patients. However, there is room for improvement for a number of issues, for example with regard to the provision of information and patient involvement in decision making. In addition, for a number of indicators substantial differences were found between the hospitals. The results of the survey provide information on the breast centers' development and can be used by the centers' surgery locations for benchmarking purposes, to identify strengths and weaknesses, and to take actions.
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Affiliation(s)
- C Kowalski
- IMVR - Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft der Humanwissenschaftlichen Fakultät und der Medizinischen Fakultät der Universität zu Köln, Köln
| | | | | | - H Schulte
- Frauenselbsthilfe nach Krebs e. V., Bonn
| | - H Pfaff
- IMVR - Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft der Humanwissenschaftlichen Fakultät und der Medizinischen Fakultät der Universität zu Köln, Köln
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Albert US, Kalder M, Schulte H, Klusendick M, Diener J, Schulz-Zehden B, Kopp I, Nass-Griegoleit I. [The population-based mammography screening programme in Germany: uptake and first experiences of women in 10 federal states]. Gesundheitswesen 2011; 74:61-70. [PMID: 21229475 DOI: 10.1055/s-0030-1268441] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Within the statutory health insurance (SHI) cancer early detection programme (KFU) an organised, population-based, quality-assured mammographic screening programme in Germany was initiated for women aged 50-69 years in 2004. The aim of the study was to evaluate uptake and first experiences of participants with this new screening approach and to evaluate the background of knowledge, attitudes and intention to address a needs-assessed communication strategy. MATERIALS AND METHODS A representative, explorative survey within the female population was conducted in 10 federal states. A telephone survey of randomly selected 68,188 contacts was performed, 9,004 women gave informed consent to evaluate rates of invitation and uptake followed by a mailed questionnaire. Of these, 3,469 were returned and 3,226 were analysed. RESULTS The invitation rate of the programme was 56.6%, the uptake of mammographic screening was 66%, and the screening coverage rate was 37.3%. 90% of the participants were insured by SHI, women with lower socio-economic strata were attracted in accordance with the data of the general population. 61% of all women did not know that the risk of breast cancer increases with age and 56% believed that screening prevents breast cancer. 62.1% judged their own risk to be low. A physician's recommendation to participate was significantly associated with attendance (p<0.05). 90% of the participants would follow the next invitation. CONCLUSION The KFU targeted group of women was reached and the organised mammography screening programme was well perceived by invited women. For developing a lasting communication strategy information deficits have to be considered along with beliefs and attitudes of elegible women.
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Jackisch C, Hadji P, Harbeck N, Blettner M, Lueck HJ, Kanis R, Kuemmel S, Zaun S, Schulte H, Kreienberg R. Abstract P5-11-12: Quality of Life in the PACT-Programme (Patient's Anastrozole Compliance to Therapy Programme): Influence of a Standardized Information Service on Patient Satisfaction and Health Related Quality of Life in Postmenopausal Women with Early Breast Cancer (EBC). Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-11-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: In recent years, patient reported outcomes have become increasingly a focus in clinical investigations. Health related quality of life (HRQoL) is now regularly evaluated in clinical trials, yet data on HRQoL in postmenopausal women receiving adjuvant aromatase inhibitor treatment for early breast cancer (EBC) is limited. Here, we present the 12 months results on HRQoL and patient satisfaction from PACT, a program which aims to increase awareness, motivation and adherence to adjuvant anastrozole therapy in routine clinical practice by adding regular standardized information (brochures and motivational letters) to standard clinical care.
Methods: PACT is a prospective, randomised, two-arm parallel-group study with 60 months follow-up (NCT00555867, sponsored by AstraZeneca Germany). Postmenopausal women on anastrozole for hormone-receptor positive (HR+) EBC were randomized to routine clinical care alone or additional regular standardized information (educational arm) for the first year of adjuvant endocrine therapy. Primary endpoint was the compliance rate in the educational vs. routine arm after 12 months. Secondary endpoints include HRQoL and patient satisfaction, evaluated via EORTC IN-PATSAT32, QLQ-C30, and QLQ-BR23. The present analysis focuses on differences in HRQoL and patient satisfaction between the standard and educational arm and between compliant and non-compliant patients at 12 months after treatment initiation.
Results: 4,923 patients were enrolled into PACT by Nov. 2008. Of these, 2,707 were evaluable for analysis of the primary endpoint compliance and the secondary endpoints patient satisfaction and HRQoL. Analysis of HRQoL and patient satisfaction scores showed no differences between the standard and the educational arm at 12 months. When comparing compliant vs. non-compliant patients, however, compliant patients reached significantly higher (=better) patient satisfaction scores in all domains. In addition, compliant patients achieved significantly higher (=better) scores in the HRQoL domains of physical functioning (p=0.04), emotional functioning (p=0.018), cognitive functioning (p=0.004), social functioning (p=0.005), and sexual enjoyment (p=0.047), as well as lower (=better) scores in the domains of fatigue (p=0.01), systemic therapy (p=0.003), and arm symptoms (p=0.03). After correction for multiple testing, statistically significant differences favouring compliant patients were retained in the areas of information provision and availability (p=0.0008 and p=0.0005, respectively).
Conclusion: In postmenopausal patients with HR+ EBC assigned to adjuvant endocrine treatment with an aromatase inhibitor (anastrozole), HRQoL and patient satisfaction were not affected by the intervention. However, analysis of compliant vs. non-compliant patients revealed improved scores for patient satisfaction in multivariate analysis favouring compliant patients at 12 months after treatment initiation. PACT represents an important project in health outcomes research regarding adjuvant endocrine therapy in postmenopausal patients with HR+ EBC.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-11-12.
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Affiliation(s)
- C Jackisch
- Städtisches Klinikum Offenbach, Germany; Philipps University Hospital Marburg, Germany; Breast Center, University of Cologne, Germany; Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Gynecologic-Oncological Practice Hannover, Hannover, Germany; Gynecologic-Oncological Practice Gera, Gera, Germany; Kliniken Essen-Mitte, Essen, Germany; AstraZeneca, Wedel, Germany; Neukirchen, Germany; Women‘s University Hospital, Ulm, Germany
| | - P Hadji
- Städtisches Klinikum Offenbach, Germany; Philipps University Hospital Marburg, Germany; Breast Center, University of Cologne, Germany; Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Gynecologic-Oncological Practice Hannover, Hannover, Germany; Gynecologic-Oncological Practice Gera, Gera, Germany; Kliniken Essen-Mitte, Essen, Germany; AstraZeneca, Wedel, Germany; Neukirchen, Germany; Women‘s University Hospital, Ulm, Germany
| | - N Harbeck
- Städtisches Klinikum Offenbach, Germany; Philipps University Hospital Marburg, Germany; Breast Center, University of Cologne, Germany; Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Gynecologic-Oncological Practice Hannover, Hannover, Germany; Gynecologic-Oncological Practice Gera, Gera, Germany; Kliniken Essen-Mitte, Essen, Germany; AstraZeneca, Wedel, Germany; Neukirchen, Germany; Women‘s University Hospital, Ulm, Germany
| | - M Blettner
- Städtisches Klinikum Offenbach, Germany; Philipps University Hospital Marburg, Germany; Breast Center, University of Cologne, Germany; Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Gynecologic-Oncological Practice Hannover, Hannover, Germany; Gynecologic-Oncological Practice Gera, Gera, Germany; Kliniken Essen-Mitte, Essen, Germany; AstraZeneca, Wedel, Germany; Neukirchen, Germany; Women‘s University Hospital, Ulm, Germany
| | - H-J Lueck
- Städtisches Klinikum Offenbach, Germany; Philipps University Hospital Marburg, Germany; Breast Center, University of Cologne, Germany; Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Gynecologic-Oncological Practice Hannover, Hannover, Germany; Gynecologic-Oncological Practice Gera, Gera, Germany; Kliniken Essen-Mitte, Essen, Germany; AstraZeneca, Wedel, Germany; Neukirchen, Germany; Women‘s University Hospital, Ulm, Germany
| | - R Kanis
- Städtisches Klinikum Offenbach, Germany; Philipps University Hospital Marburg, Germany; Breast Center, University of Cologne, Germany; Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Gynecologic-Oncological Practice Hannover, Hannover, Germany; Gynecologic-Oncological Practice Gera, Gera, Germany; Kliniken Essen-Mitte, Essen, Germany; AstraZeneca, Wedel, Germany; Neukirchen, Germany; Women‘s University Hospital, Ulm, Germany
| | - S Kuemmel
- Städtisches Klinikum Offenbach, Germany; Philipps University Hospital Marburg, Germany; Breast Center, University of Cologne, Germany; Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Gynecologic-Oncological Practice Hannover, Hannover, Germany; Gynecologic-Oncological Practice Gera, Gera, Germany; Kliniken Essen-Mitte, Essen, Germany; AstraZeneca, Wedel, Germany; Neukirchen, Germany; Women‘s University Hospital, Ulm, Germany
| | - S Zaun
- Städtisches Klinikum Offenbach, Germany; Philipps University Hospital Marburg, Germany; Breast Center, University of Cologne, Germany; Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Gynecologic-Oncological Practice Hannover, Hannover, Germany; Gynecologic-Oncological Practice Gera, Gera, Germany; Kliniken Essen-Mitte, Essen, Germany; AstraZeneca, Wedel, Germany; Neukirchen, Germany; Women‘s University Hospital, Ulm, Germany
| | - H Schulte
- Städtisches Klinikum Offenbach, Germany; Philipps University Hospital Marburg, Germany; Breast Center, University of Cologne, Germany; Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Gynecologic-Oncological Practice Hannover, Hannover, Germany; Gynecologic-Oncological Practice Gera, Gera, Germany; Kliniken Essen-Mitte, Essen, Germany; AstraZeneca, Wedel, Germany; Neukirchen, Germany; Women‘s University Hospital, Ulm, Germany
| | - R. Kreienberg
- Städtisches Klinikum Offenbach, Germany; Philipps University Hospital Marburg, Germany; Breast Center, University of Cologne, Germany; Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany; Gynecologic-Oncological Practice Hannover, Hannover, Germany; Gynecologic-Oncological Practice Gera, Gera, Germany; Kliniken Essen-Mitte, Essen, Germany; AstraZeneca, Wedel, Germany; Neukirchen, Germany; Women‘s University Hospital, Ulm, Germany
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Albring C, Baum E, Beckermann M, Beckmann M, Blettner M, Böhm B, Brucker C, Dören M, Emons G, Foth D, Geisthövel F, Gudermann T, Hadji P, Kiesel L, Klemperer D, König K, Lindhoff-Last E, Ludolph A, Mueck A, Naß-Griegoleit I, Noss D, Ortmann O, Petri E, Rabe T, Regitz-Zagrosek V, Schulte H, Siedentopf F, Strowitzki T, Windler E. Hormontherapie in der Peri- und Postmenopause – Kurzversion der S3-Leitlinie. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0029-1241006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Harbeck N, Hackisch C, Blettner M, Lück H, Hadji P, Landthaler R, Martin R, Schmitt D, Schulte H, Rexrodt von Fircks A, Haidinger R, Jäger D, Zaun S, Kreienberg R. First Results from the “Patient's Anastrozole Compliance to Therapy Programme” (PACT) Evaluating the Impact of a Standardized Information Service on Compliance in Postmenopausal Women with Early Breast Cancer (EBC) Receiving Adjuvant Endocrine Therapy. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-6079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In adjuvant treatment of hormone-responsive breast cancer, existing data document that 23% and 50% of patients were non-compliant after the first and fourth year of tamoxifen (TAM) therapy, respectively. Here, we present the PACT-study that aims to increase awareness, motivation and adherence to oral hormonal therapy, namely the aromatase inhibitor anastrozole, in routine clinical practice by simple interventions such as written standardized mailings and reminder services.Materials and Methods: In this two arm, parallel group trial with a primary duration of 12 months and 60 months follow-up, women with hormone receptor positive EBC receiving anastrozole once daily were randomized to either routine clinical care alone or to receiving additional standardized information for the first 12 months of adjuvant therapy. Primary endpoint is compliance rate in the standard versus intervention arm after 12 months, where compliance is defined by an 80% intake of the total medication. Secondary endpoints include persistence on therapy, reasons for non-compliance, influence of baseline characteristics, and of compliance on clinical outcome parameters.Compliance was evaluated by self report using standardized, detailed questionnaires at baseline and after each year of treatment. In addition, the prescription data for each patient from hospital records and physician recall was collected. Finally, quality of life and patient satisfaction were assessed using standardized questionnaires.Results: From July 2006 until November 2008, 4.924 women were enrolled with a median patient age of 64 years. Besides demographic data and patient characteristics results of patient's self reporting data will be shown for the first time at this meeting.Conclusion: PACT is the largest prospective investigation on compliance regarding an aromatase inhibitor as adjuvant therapy so far. The programme's goals are to clarify what aspects influence patients' adherence to prescribed medication and how motivation for regular intake can be accomplished. Furthermore, PACT seeks to prove if a simple intervention such as a standardized information and reminder services throughout the first year of treatment may improve compliance and thus eventually influence treatment outcomes.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6079.
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Affiliation(s)
| | | | | | - H. Lück
- 4Gynecologic-Oncological Practice, Germany
| | - P. Hadji
- 5University Hospital Marburg, Germany
| | | | | | - D. Schmitt
- 8Consultant Doctor-Patient Communication, Germany
| | - H. Schulte
- 9Frauenselbsthilfe Nach Krebs e.V., Germany
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Jackson D, White I, Kostis JB, Wilson AC, Folsom AR, Wu K, Chambless L, Benderly M, Goldbourt U, Willeit J, Kiechl S, Yarnell JWG, Sweetnam PM, Elwood PC, Cushman M, Psaty BM, Tracy RP, Tybjaerg-Hansen A, Haverkate F, de Maat MPM, Thompson SG, Fowkes FGR, Lee AJ, Smith FB, Salomaa V, Harald K, Rasi V, Vahtera E, Jousilahti P, D'Agostino R, Kannel WB, Wilson PWF, Tofler G, Levy D, Marchioli R, Valagussa F, Rosengren A, Wilhelmsen L, Lappas G, Eriksson H, Cremer P, Nagel D, Curb JD, Rodriguez B, Yano K, Salonen JT, Nyyssönen K, Tuomainen TP, Hedblad B, Engström G, Berglund G, Loewel H, Koenig W, Hense HW, Meade TW, Cooper JA, De Stavola B, Knottenbelt C, Miller GJ, Cooper JA, Bauer KA, Rosenberg RD, Sato S, Kitamura A, Naito Y, Iso H, Salomaa V, Harald K, Rasi V, Vahtera E, Jousilahti P, Palosuo T, Ducimetiere P, Amouyel P, Arveiler D, Evans AE, Ferrieres J, Juhan-Vague I, Bingham A, Schulte H, Assmann G, Cantin B, Lamarche B, Despres JP, Dagenais GR, Tunstall-Pedoe H, Lowe GDO, Woodward M, Ben-Shlomo Y, Davey Smith G, Palmieri V, Yeh JL, Meade TW, Rudnicka A, Brennan P, Knottenbelt C, Cooper JA, Ridker P, Rodeghiero F, Tosetto A, Shepherd J, Lowe GDO, Ford I, Robertson M, Brunner E, Shipley M, Feskens EJM, Di Angelantonio E, Kaptoge S, Lewington S, Lowe GDO, Sarwar N, Thompson SG, Walker M, Watson S, White IR, Wood AM, Danesh J. Systematically missing confounders in individual participant data meta-analysis of observational cohort studies. Stat Med 2009; 28:1218-37. [PMID: 19222087 PMCID: PMC2922684 DOI: 10.1002/sim.3540] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
One difficulty in performing meta-analyses of observational cohort studies is that the availability of confounders may vary between cohorts, so that some cohorts provide fully adjusted analyses while others only provide partially adjusted analyses. Commonly, analyses of the association between an exposure and disease either are restricted to cohorts with full confounder information, or use all cohorts but do not fully adjust for confounding. We propose using a bivariate random-effects meta-analysis model to use information from all available cohorts while still adjusting for all the potential confounders. Our method uses both the fully adjusted and the partially adjusted estimated effects in the cohorts with full confounder information, together with an estimate of their within-cohort correlation. The method is applied to estimate the association between fibrinogen level and coronary heart disease incidence using data from 154 012 participants in 31 cohorts.† Copyright © 2009 John Wiley & Sons, Ltd.
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Schulte H. Die Diagnose der erblichen Fallsucht1. Dtsch Med Wochenschr 2009. [DOI: 10.1055/s-0028-1120671] [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: 10/20/2022]
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Albert US, Altland H, Duda V, Engel J, Geraedts M, Heywang-Köbrunner S, Hölzel D, Kalbheim E, Koller M, König K, Kreienberg R, Kühn T, Lebeau A, Nass-Griegoleit I, Schlake W, Schmutzler R, Schreer I, Schulte H, Schulz-Wendtland R, Wagner U, Kopp I. [Summary of the updated stage 3 guideline for early detection of breast cancer in Germany 2008]. ROFO-FORTSCHR RONTG 2008; 180:455-65. [PMID: 18438746 DOI: 10.1055/s-2008-1027320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- U-S Albert
- Planungskommission und Arbeitsgruppenleiter der Konzertierten Aktion Brustkrebs-Früherkennung in Deutschland.
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Geritse A, Müller G, Trompetter T, Schulte H, Assmann G. [Risk factor calculator for medical underwriting of life insurers based on the PROCAM study]. Versicherungsmedizin 2008; 60:74-77. [PMID: 18595642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
For its electronic manual GEM, used to perform medical risk assessment in life insurance, SCOR Global Life Germany has developed an innovative and evidence-based calculator of the mortality risk depending on cardiovascular risk factors. The calculator contains several new findings regarding medical underwriting, which were gained from the analysis of the PROCAM (Prospective Cardiovascular Münster) study. For instance, in the overall consideration of all risk factors of a medically examined applicant, BMI is not an independent risk factor. Further, given sufficient information, the total extra mortality of a person no longer results from adding up the ratings for the single risk factors. In fact, this new approach of risk assessment considers the interdependencies between the different risk factors. The new calculator is expected to improve risk selection and standard acceptances will probably increase.
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Lux MP, Radosavac D, Tänzer TD, Kara H, Bani MR, Schrauder M, Schmitt DC, Haidinger R, Overbeck-Schulte B, Schulte H, Beckmann MW, Fasching PA. Einflussfaktoren von Patientinnen mit einem Mammakarzinom auf die Vorstellung über Therapieeffektivitäten und Akzeptanz von Therapieoptionen – Ergebnisse der Gut Informieren – Gemeinsam Entscheiden!-Studie. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1079206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Lux MP, Radosavac D, Tänzer TD, Kara H, Bani MR, Schrauder M, Schmitt DC, Haidinger R, Overbeck-Schulte B, Schulte H, Beckmann MW, Fasching PA. Patientinnen mit einem Mammakarzinom und ihre Ärztinnen und Ärzte unterscheiden sich in der Beurteilung des notwendigen Benefits von Therapieoption – Ergebnisse der Gut Informieren – Gemeinsam Entscheiden!-Studie. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1079205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Albert US, Altland H, Duda V, Engel J, Geraedts M, Heywang-Köbrunner S, Hölzel D, Kalbheim E, Koller M, König K, Kreienberg R, Kühn T, Lebeau A, Naß-Griegoleit I, Schlake W, Schmutzler R, Schreer I, Schulte H, Schulz-Wendtland R, Wagner U, Kopp I. Kurzfassung der aktualisierten Stufe-3-Leitlinie Brustkrebs-Früherkennung in Deutschland 2008. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1038511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Assmann G, Schulte H, Cullen P, Seedorf U. Assessing risk of myocardial infarction and stroke: new data from the Prospective Cardiovascular Münster (PROCAM) study. Eur J Clin Invest 2007; 37:925-32. [PMID: 18036028 DOI: 10.1111/j.1365-2362.2007.01888.x] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [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: 11/27/2022]
Abstract
OBJECTIVES Based on the data of the Prospective Cardiovascular Münster (PROCAM) study, a prospective study of men and women at work in the north-west of Germany, we aimed (i) to develop a refined scoring scheme for calculating the risk of acute coronary events among adult and elderly men and women; and (ii) to generate a new scoring scheme for calculating the risk of ischaemic stroke or transient ischaemic attack (TIA). METHODS The coronary risk score was derived from a Weibull function using data from 18 460 men and 8515 women who were recruited before 1996 and had a mean follow-up period of 12+/-6 years. The stroke score was derived using a Cox proportional hazards model using data of 5905 men and 2225 women aged 35-65 years with at least 10 years of unbroken follow-up. RESULTS The coronary risk score was based on 511 major coronary events, 462 (168 fatal, 294 non-fatal) in men and 49 (18 fatal, 31 non-fatal) in women and included the risk factors LDL cholesterol, HDL cholesterol, systolic blood pressure, smoking status, triglycerides and diabetes mellitus status. It was accurate in both sexes over an age range from 20 to 75 years with an area under the receiver-operating characteristics (ROC) curve of 0.82. The stroke score was based on 85 cerebral ischaemic events (21 TIAs, 64 ischaemic strokes) and included the risk factors age, sex, diabetes mellitus status, smoking status and systolic blood pressure. It had an area under the ROC curve of 0.78 and identified a high-risk group comprising only 4% of the study population that contained 31% of all cerebral ischaemic events. CONCLUSION Both new PROCAM risk scores provide simple and effective ways to assess the risk of acute coronary events and ischaemic stroke in the general population and will improve the ability of physicians to target measures in an effort to prevent these potentially devastating conditions.
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Affiliation(s)
- G Assmann
- Leibniz-Institute of Arteriosclerosis Research, University of Münster, Germany.
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Albert U, Altland H, Duda V, Engel J, Geraedts M, Heywang-Köbrunner S, Hölzel D, Kalbheim E, Kaufmann M, Kreienberg R, Kreipe H, Lebeau A, Loibl S, Nass-Griegoleit I, Nestle-Krämling C, Possinger K, Schlake W, Schmutzler R, Schreer I, Schulte H, Schulz K, Schulz-Wendtland R, Wallwiener D, Bender H. Onkologie. Aktuelle Gesundheitsziele zur Sekundärprävention von Brustkrebs in Deutschland. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-965775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Danesh J, Erqou S, Walker M, Thompson SG, Tipping R, Ford C, Pressel S, Walldius G, Jungner I, Folsom AR, Chambless LE, Knuiman M, Whincup PH, Wannamethee SG, Morris RW, Willeit J, Kiechl S, Santer P, Mayr A, Wald N, Ebrahim S, Lawlor DA, Yarnell JWG, Gallacher J, Casiglia E, Tikhonoff V, Nietert PJ, Sutherland SE, Bachman DL, Keil JE, Cushman M, Psaty BM, Tracy RP, Tybjaerg-Hansen A, Nordestgaard BG, Frikke-Schmidt R, Giampaoli S, Palmieri L, Panico S, Vanuzzo D, Pilotto L, Simons L, McCallum J, Friedlander Y, Fowkes FGR, Lee AJ, Smith FB, Taylor J, Guralnik J, Phillips C, Wallace R, Blazer D, Khaw KT, Jansson JH, Donfrancesco C, Salomaa V, Harald K, Jousilahti P, Vartiainen E, Woodward M, D'Agostino RB, Wolf PA, Vasan RS, Pencina MJ, Bladbjerg EM, Jorgensen T, Moller L, Jespersen J, Dankner R, Chetrit A, Lubin F, Rosengren A, Wilhelmsen L, Lappas G, Eriksson H, Bjorkelund C, Cremer P, Nagel D, Tilvis R, Strandberg T, Rodriguez B, Bouter LM, Heine RJ, Dekker JM, Nijpels G, Stehouwer CDA, Rimm E, Pai J, Sato S, Iso H, Kitamura A, Noda H, Goldbourt U, Salomaa V, Salonen JT, Nyyssönen K, Tuomainen TP, Deeg D, Poppelaars JL, Meade T, Cooper J, Hedblad B, Berglund G, Engstrom G, Döring A, Koenig W, Meisinger C, Mraz W, Kuller L, Selmer R, Tverdal A, Nystad W, Gillum R, Mussolino M, Hankinson S, Manson J, De Stavola B, Knottenbelt C, Cooper JA, Bauer KA, Rosenberg RD, Sato S, Naito Y, Holme I, Nakagawa H, Miura H, Ducimetiere P, Jouven X, Crespo C, Garcia-Palmieri M, Amouyel P, Arveiler D, Evans A, Ferrieres J, Schulte H, Assmann G, Shepherd J, Packard C, Sattar N, Cantin B, Lamarche B, Després JP, Dagenais GR, Barrett-Connor E, Wingard D, Bettencourt R, Gudnason V, Aspelund T, Sigurdsson G, Thorsson B, Trevisan M, Witteman J, Kardys I, Breteler M, Hofman A, Tunstall-Pedoe H, Tavendale R, Lowe GDO, Ben-Shlomo Y, Howard BV, Zhang Y, Best L, Umans J, Onat A, Meade TW, Njolstad I, Mathiesen E, Lochen ML, Wilsgaard T, Gaziano JM, Stampfer M, Ridker P, Ulmer H, Diem G, Concin H, Rodeghiero F, Tosetto A, Brunner E, Shipley M, Buring J, Cobbe SM, Ford I, Robertson M, He Y, Ibanez AM, Feskens EJM, Kromhout D, Collins R, Di Angelantonio E, Kaptoge S, Lewington S, Orfei L, Pennells L, Perry P, Ray K, Sarwar N, Scherman M, Thompson A, Watson S, Wensley F, White IR, Wood AM. The Emerging Risk Factors Collaboration: analysis of individual data on lipid, inflammatory and other markers in over 1.1 million participants in 104 prospective studies of cardiovascular diseases. Eur J Epidemiol 2007; 22:839-69. [PMID: 17876711 DOI: 10.1007/s10654-007-9165-7] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 07/02/2007] [Indexed: 01/22/2023]
Abstract
Many long-term prospective studies have reported on associations of cardiovascular diseases with circulating lipid markers and/or inflammatory markers. Studies have not, however, generally been designed to provide reliable estimates under different circumstances and to correct for within-person variability. The Emerging Risk Factors Collaboration has established a central database on over 1.1 million participants from 104 prospective population-based studies, in which subsets have information on lipid and inflammatory markers, other characteristics, as well as major cardiovascular morbidity and cause-specific mortality. Information on repeat measurements on relevant characteristics has been collected in approximately 340,000 participants to enable estimation of and correction for within-person variability. Re-analysis of individual data will yield up to approximately 69,000 incident fatal or nonfatal first ever major cardiovascular outcomes recorded during about 11.7 million person years at risk. The primary analyses will involve age-specific regression models in people without known baseline cardiovascular disease in relation to fatal or nonfatal first ever coronary heart disease outcomes. This initiative will characterize more precisely and in greater detail than has previously been possible the shape and strength of the age- and sex-specific associations of several lipid and inflammatory markers with incident coronary heart disease outcomes (and, secondarily, with other incident cardiovascular outcomes) under a wide range of circumstances. It will, therefore, help to determine to what extent such associations are independent from possible confounding factors and to what extent such markers (separately and in combination) provide incremental predictive value.
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Mai K, Bobbert T, Reinecke F, Andres J, Bähr V, Maser-Gluth C, Schulte H, Diederich S, Pfeiffer AF, Spranger J. Free fatty acids increase androgen precursors in vivo in young healthy women. Exp Clin Endocrinol Diabetes 2007. [DOI: 10.1055/s-2007-972449] [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: 10/21/2022]
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Assmann G, Schulte H, Cullen P, Neiss A, Bestehorn K. Treatment of Hyperlipidemia in Primary Practise in Germany: Sub-group Analyses from the 4E-registry with Particular Emphasis on Men and Women with Diabetes Mellitus. Exp Clin Endocrinol Diabetes 2007; 115:85-91. [PMID: 17318766 DOI: 10.1055/s-2007-955094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS To investigate the achievement of treatment goals for low density lipoprotein (LDL) cholesterol in men and women with diabetes mellitus receiving statins in a primary-care setting in Germany. METHODS 6,827 men and 5,989 women with diabetes mellitus were recruited from among the 28,200 men and 24,200 women participating in the 4E registry of patients being treated with statins for primary hypercholesterolemia unresponsive to diet and lifestyle. Participants were assessed after 6 weeks and 9 months of statin therapy. Attainment of treatment targets was assessed (i) using individual LDL goals based on each participant's individual level of risk and (ii) based on the 2.6 mmol/L target recommended by current European and U.S. guidelines for persons with diabetes. RESULTS At baseline, patients with and without diabetes mellitus had similar LDL cholesterol levels patients (men: 4.5+/-1 vs. 4.7+/-1 mmol/L, women: 4.7+/-1 vs. 4.9+/-1 mmol/L respectively). The mean drop in LDL cholesterol on statin therapy was similar in men and women with and without diabetes, ranging from 26-27 percent all subgroups. After 9 months of statins, individual LDL goals were achieved by 25% of men and 24% of women with diabetes, while only 16% of diabetic men and 12% of diabetic women achieved the 2.6 mmol/L LDL target. These success rates were similar to those of non-diabetics, including those at high risk, in 4E. CONCLUSIONS Patients with diabetes mellitus in 4E responded just as well to statins as patients without diabetes. However, achievement of treatment goals in patients with diabetes was just as poor as in other high-risk groups in the 4E cohort.
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Affiliation(s)
- G Assmann
- Leibniz-Institute of Arteriosclerosis Research at the University of Münster, Münster, Germany
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Assmann G, Cullen P, Stoll M, Schulte H. Th-W50:3 Emerging markers in cardiovascular risk assessment in the procam study. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Danesh J, Lewington S, Thompson SG, Lowe GDO, Collins R, Kostis JB, Wilson AC, Folsom AR, Wu K, Benderly M, Goldbourt U, Willeit J, Kiechl S, Yarnell JWG, Sweetnam PM, Elwood PC, Cushman M, Psaty BM, Tracy RP, Tybjaerg-Hansen A, Haverkate F, de Maat MPM, Fowkes FGR, Lee AJ, Smith FB, Salomaa V, Harald K, Rasi R, Vahtera E, Jousilahti P, Pekkanen J, D'Agostino R, Kannel WB, Wilson PWF, Tofler G, Arocha-Piñango CL, Rodriguez-Larralde A, Nagy E, Mijares M, Espinosa R, Rodriquez-Roa E, Ryder E, Diez-Ewald MP, Campos G, Fernandez V, Torres E, Marchioli R, Valagussa F, Rosengren A, Wilhelmsen L, Lappas G, Eriksson H, Cremer P, Nagel D, Curb JD, Rodriguez B, Yano K, Salonen JT, Nyyssönen K, Tuomainen TP, Hedblad B, Lind P, Loewel H, Koenig W, Meade TW, Cooper JA, De Stavola B, Knottenbelt C, Miller GJ, Cooper JA, Bauer KA, Rosenberg RD, Sato S, Kitamura A, Naito Y, Palosuo T, Ducimetiere P, Amouyel P, Arveiler D, Evans AE, Ferrieres J, Juhan-Vague I, Bingham A, Schulte H, Assmann G, Cantin B, Lamarche B, Després JP, Dagenais GR, Tunstall-Pedoe H, Woodward M, Ben-Shlomo Y, Davey Smith G, Palmieri V, Yeh JL, Rudnicka A, Ridker P, Rodeghiero F, Tosetto A, Shepherd J, Ford I, Robertson M, Brunner E, Shipley M, Feskens EJM, Kromhout D, Dickinson A, Ireland B, Juzwishin K, Kaptoge S, Lewington S, Memon A, Sarwar N, Walker M, Wheeler J, White I, Wood A. Plasma fibrinogen level and the risk of major cardiovascular diseases and nonvascular mortality: an individual participant meta-analysis. JAMA 2005; 294:1799-809. [PMID: 16219884 DOI: 10.1001/jama.294.14.1799] [Citation(s) in RCA: 460] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Plasma fibrinogen levels may be associated with the risk of coronary heart disease (CHD) and stroke. OBJECTIVE To assess the relationships of fibrinogen levels with risk of major vascular and with risk of nonvascular outcomes based on individual participant data. DATA SOURCES Relevant studies were identified by computer-assisted searches, hand searches of reference lists, and personal communication with relevant investigators. STUDY SELECTION All identified prospective studies were included with information available on baseline fibrinogen levels and details of subsequent major vascular morbidity and/or cause-specific mortality during at least 1 year of follow-up. Studies were excluded if they recruited participants on the basis of having had a previous history of cardiovascular disease; participants with known preexisting CHD or stroke were excluded. DATA EXTRACTION Individual records were provided on each of 154,211 participants in 31 prospective studies. During 1.38 million person-years of follow-up, there were 6944 first nonfatal myocardial infarctions or stroke events and 13,210 deaths. Cause-specific mortality was generally available. Analyses involved proportional hazards modeling with adjustment for confounding by known cardiovascular risk factors and for regression dilution bias. DATA SYNTHESIS Within each age group considered (40-59, 60-69, and > or =70 years), there was an approximately log-linear association with usual fibrinogen level for the risk of any CHD, any stroke, other vascular (eg, non-CHD, nonstroke) mortality, and nonvascular mortality. There was no evidence of a threshold within the range of usual fibrinogen level studied at any age. The age- and sex- adjusted hazard ratio per 1-g/L increase in usual fibrinogen level for CHD was 2.42 (95% confidence interval [CI], 2.24-2.60); stroke, 2.06 (95% CI, 1.83-2.33); other vascular mortality, 2.76 (95% CI, 2.28-3.35); and nonvascular mortality, 2.03 (95% CI, 1.90-2.18). The hazard ratios for CHD and stroke were reduced to about 1.8 after further adjustment for measured values of several established vascular risk factors. In a subset of 7011 participants with available C-reactive protein values, the findings for CHD were essentially unchanged following additional adjustment for C-reactive protein. The associations of fibrinogen level with CHD or stroke did not differ substantially according to sex, smoking, blood pressure, blood lipid levels, or several features of study design. CONCLUSIONS In this large individual participant meta-analysis, moderately strong associations were found between usual plasma fibrinogen level and the risks of CHD, stroke, other vascular mortality, and nonvascular mortality in a wide range of circumstances in healthy middle-aged adults. Assessment of any causal relevance of elevated fibrinogen levels to disease requires additional research.
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Cullen P, Schulte H, Assmann G. Lipid metabolism and risk of myocardial infarction - new findings and implications for treatment. Dtsch Med Wochenschr 2005; 130:2220-5. [PMID: 16189760 DOI: 10.1055/s-2005-916368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- P Cullen
- Leibniz-Institut für Arterioskleroseforschung an der Universität Münster
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Gröhn YT, González RN, Wilson DJ, Hertl JA, Bennett G, Schulte H, Schukken YH. Effect of pathogen-specific clinical mastitis on herd life in two New York State dairy herds. Prev Vet Med 2005; 71:105-25. [PMID: 16111778 DOI: 10.1016/j.prevetmed.2005.06.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2004] [Revised: 06/06/2005] [Accepted: 06/09/2005] [Indexed: 11/21/2022]
Abstract
The objective of this study was to estimate the effects of clinical mastitis (CM) (both with and without specific pathogen identification) occurring in different stages of lactation on length of herd life in two New York State dairy farms. The 2,697 cows in the study were followed for one lactation (the first-occurring one on or after 1 October 1999), until it ended because of a new lactation, culling, or end of study (31 March 2001 in one farm; 31 July 2001 in the other). A Cox proportional hazards model with time-dependent covariates, in SAS((R)), was used to measure, within a lactation, the effect of the first occurrence of CM (without specific pathogen identification) occurring 1--7, 8--66, 67--100, 101--225, or >or=226 days in milk (DIM), on how long cows remained in the herd. For the first occurrence of CM due to Streptococcus spp., Staphylococcus aureus, Staphylococcus spp., Escherichia coli, Klebsiella spp., and 'no pathogen isolated', the intervals were before and after the median DIM of first occurrence of each pathogen. There were too few cases due to Arcanobacterium pyogenes, and 'other pathogens grouped together' to split into intervals, so they were modeled as binary variables, i.e. as they occurred. CM was modeled using time-dependent covariates, to account for its differing effects throughout lactation on culling. Other variables controlled for were herd, parity, calving season, and other significant diseases. In the dataset, the lactational incidence risk of the first occurrence of CM was 18.2%; 20.0% of the cows did not survive the lactation that was studied. The overall annual culling percentage for both herds during the study period (including all cows, whether eligible for the study or not) was 35.6%. For cows with CM without pathogen identification, their highest hazard ratio (HR) of culling occurred from 67 to 100 DIM. All of the pathogens modeled markedly reduced herd life. On average over the entire lactation, cows with Staphylococcus spp. CM had the highest HRs for culling, although there were no significant differences among pathogens (at p=0.0018 (reflecting 28 pairwise comparisons)). For early-occurring (before median DIM of first occurrence) S. aureus CM, the daily rate of change of the HR of culling increased over time. The HRs for culling were particularly high for late-occurring (after median DIM of first occurrence) E. coli and Klebsiella spp. CM early in the interval, but the daily rate of change of the hazard of culling for these two pathogens decreased sharply over time. Treating CM as time-dependent therefore allowed us to measure in greater detail, its varying effects (of when it occurred) on herd life.
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Affiliation(s)
- Y T Gröhn
- Section of Epidemiology, Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
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Abstract
Our objective was to estimate the effects of the first occurrence of pathogen-specific clinical mastitis (CM) on milk yield in 3071 dairy cows in 2 New York State farms. The pathogens studied were Streptococcus spp.,Staphylococcus aureus, Staphylococcus spp., Escherichia coli, Klebsiella spp., Arcanobacterium pyogenes, other pathogens grouped together, and "no pathogen isolated." Data were collected from October 1999 to July 2001. Milk samples were collected from cows showing signs of CM and were sent to the Quality Milk Production Services laboratory at Cornell University for microbiological culture. The SAS statistical procedure PROC MIXED, with an autoregressive covariance structure, was used to quantify the effect of CM and several other control variables (herd, calving season, parity, month of lactation, J-5 vaccination status, and other diseases) on weekly milk yield. Separate models were fitted for primipara and multipara, because of the different shapes of their lactation curves. To observe effects of mastitis, milk weights were divided into several periods both pre- and postdiagnosis, according to when they were measured in relation to disease occurrence. Another category contained cows without the type of CM being modeled. Because all pathogens were modeled simultaneously, a control cow was one without CM. Among primipara, Staph. aureus, E. coli, Klebsiella spp., and "no pathogen isolated" caused the greatest losses. Milk yield generally began to drop 1 or 2 wk before diagnosis; the greatest loss occurred immediately following diagnosis. Mastitic cows often never recovered their potential yield. Among older cows, Streptococcus spp., Staph. aureus, A. pyogenes, E. coli, and Klebsiella spp. caused the most significant losses. Many multipara that developed CM were actually higher producers before diagnosis than their nonmastitic herd-mates. As in primipara, milk yield in multipara often began to decline shortly before diagnosis; the greatest loss occurred immediately following diagnosis. Milk loss persisted until at least 70 d after diagnosis for Streptococcus spp., Klebsiella spp., and A. pyogenes. The tendency for higher producing cows to contract CM may mask its impact on cow health and production. These findings provide dairy producers with more information on which pathogen-specific CM cases should receive treatment and how to manage these cows, thereby reducing CM impact on cow well being and profitability.
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Affiliation(s)
- Y T Gröhn
- Section of Epidemiology, Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
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von Eckardstein A, Schulte H, Assmann G. Vergleich internationaler Konsensus-Empfehlungen zur Erkennung des präsymptomatischen Hochrisikopatienten für den Herzinfarkt in Deutschland. ACTA ACUST UNITED AC 2005; 94:52-60. [PMID: 15668832 DOI: 10.1007/s00392-005-0150-4] [Citation(s) in RCA: 6] [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] [Received: 04/22/2004] [Accepted: 07/13/2004] [Indexed: 10/25/2022]
Abstract
The recommendations of the International Task Force for the Prevention of Coronary Heart Disease/International Atherosclerosis Society (ITF/IAS), the US-American Adult Treatment Panel III of the National Cholesterol Education Programs (ATP III) and the 3rd Joint European Guidelines (3JE) for the prevention coronary heart disease (CHD) show good agreement in tertiary prevention. All three guidelines recommend that patients with manifest CHD should have a blood pressure below 140/90 mm Hg and LDL-cholesterol below 2.6 mmol/l (100 mg/dl). By contrast, the three recommendations differ with respect to the prevention of cardiovascular events in asymptomatic high risk patients (secondary prevention), notably in the strategy to be used for risk assessment. Both the ITF/IAS guidelines and the 3JE guidelines can be adapted and realized in the various European countries. We therefore compared the prognostic values of the three recommendations by applying them to the data of male participants of the Prospective Cardiovascular Munster (PROCAM) Study. The ITF/IAS recommendations show the highest specificity (94.5%), positive predictive value (32.0%) and diagnostic efficacy (90.5%); the 3JE guidelines have the highest sensitivity (64.6%) but lowest specificity (77.9%), positive predictive value (17.5%) and diagnostic efficacy (77.0%). The application of the 3JE recommendations would target 25% of German men aged 35-65 years as cardiovascular high risk patients, by contrast to 7.5% through application of the ITF/IAS guidelines. In view of the limited resources in the public health systemthe application of the ITF/IAS guidelines in Germany appears more appropriate.
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Affiliation(s)
- A von Eckardstein
- Institut für Klinische Chemie, Universitätsspital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland.
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Cullen P, Schulte H, Assmann G. [Use of risk factors in determining individual coronary risk]. Z Kardiol 2005; 94 Suppl 4:IV/65-69. [PMID: 16416068 DOI: 10.1007/s00392-005-1415-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The "Deutschland SCORE" has low predictive power and greatly overestimates the true risk of coronary heart disease in Germany. Widespread use of this score would lead to massive over-treatment. For this reason, we cannot recommend this score for general use.
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Affiliation(s)
- P Cullen
- Leibniz-Institut für Arterioskleroseforschung, Domagkstrasse 3, 48147 Münster.
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Albert US, Schulz KD, Alt D, Beck V, Doherty J, Holsteg K, Kalbheim E, Müller J, Nass-Griegoleit I, Nill J, Nioduschewski G, Schulte H, von Wietersheim A, Kopp I. [A guideline for guidelines--methodological report and use of the guideline women's information]. ACTA ACUST UNITED AC 2004; 125:484-93. [PMID: 14755359 DOI: 10.1055/s-2003-44816] [Citation(s) in RCA: 5] [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: 10/26/2022]
Abstract
UNLABELLED Information and education is needed to empower autonomy and self-determination of patients (informed consent). Furthermore reliable and accurate medical information is necessary for patients who want to take an active part in medical decision-making. The aim of this work is to define the requirements helping to assure the development of good qualified information material relevant for women and female patients as "a guideline on women information". An example of its use is given by embeding this guideline in the guideline for early detection of breast cancer in Germany by defining the specific elements required for developing qualified information on this issue for women. METHODS A systematic, stepwise methodological process according to a level two guideline of the German Association of the Scientific Medical Societies (AWMF) and the Agency for Quality in Medicine (AZQ) was performed with the following elements: 1. Establishing an expert panel, 2. Generating the guideline statements by a formal, consensus based nominal group process, 3. External review process and finding supportive partners for the guideline on women information, 4. Using the guideline for guidelines: implementing the concept in the guideline of early detection of breast cancer in Germany. RESULTS The "guideline women information" comprises nine elements of quality assuring requirements for the development of gender-specific information material and eleven specific elements which directly relate to the guideline statements on early detection of breast cancer. After external review 30 organisations gave their written support for future implementation of the guideline. The "guideline women information" was integrated as a tool for quality assurance of lay information into the "guideline for early detection of breast cancer in Germany". CONCLUSION The "guideline women information" is a systematically developed, consensus-based recommendation to improve the development of qualified lay information at the point of its process by defining gender-specific aspects required for good lay information and its evaluation. As a guideline for guidelines its use is demonstrated by integrating this guideline into the "guideline for early detection of breast cancer in Germany" to ensure the development of qualified guideline compliant information.
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Affiliation(s)
- U-S Albert
- Klinik für Gynäkologie, Gynäkologische Endokrinologie und Onkologie, Philipps-Universität Marburg.
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Schulte H, Graven-Nielsen T, Sollevi A, Jansson Y, Arendt-Nielsen L, Segerdahl M. Pharmacological modulation of experimental phasic and tonic muscle pain by morphine, alfentanil and ketamine in healthy volunteers. Acta Anaesthesiol Scand 2003; 47:1020-30. [PMID: 12904196 DOI: 10.1034/j.1399-6576.2003.00204.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [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: 11/23/2022]
Abstract
BACKGROUND Muscle pain is a major clinical problem but the underlying mechanisms and its pharmacological modulation need further investigation. This study on 15 volunteers evaluates if two experimental muscle pain models are sensitive to micro -receptor agonists and to an N-methyl-D-aspartate (NMDA)-receptor antagonist. METHODS In the left tibialis anterior, intramuscular electrical (IMES) pain thresholds were determined for single (SPTmuscle) and five (RPTmuscle) repeated stimuli. Also pain to suprathreshold stimulation at 150% of RPTmuscle, 10 s, was assessed on a visual analog scale (VAS) as AUCimes (area under the VAS curve). In the right TA muscle, pain intensity on infusion of 0.5 ml of hypertonic saline, 5% (AUCsaline) and pain distribution indicated as local and referred were evaluated. Pain variables were assessed before, during and after intravenous infusions of morphine (10 microg x kg-1 min-1, 10 min), alfentanil (target-controlled infusion, plasma concentration; 60 ng ml-1, 60 min) and ketamine (10 microg x kg-1 min-1, 60 min). All data were normalized to baseline pain values (before drug infusions were initiated) and compared with placebo (midazolam, 2 microg x kg-1 min-1, 10 min). RESULTS SPTmuscle increased (log mean values +/- SD, mA) with morphine (0.11 +/- 0.17, P < 0.05), alfentanil (0.28 +/- 0.24, P < 0.001) and ketamine (0.19 +/- 0.18, P < 0.01) as compared with placebo (-0.03 +/- 0.12). Alfentanil and ketamine also increased RPTmuscle (0.25 +/- 0.21, P < 0.01 and 0.21 +/- 0.19, P < 0.05, respectively) as compared with placebo (0.00 +/- 0.17). Pain to IMES (AUCimes) was reduced (median values [25th-75th percentiles], cm x s) by alfentanil and ketamine (-19.7 [-14.6 - -29.6] and-12.8 [-8.3 - -27.8], P < 0.05, respectively) vs. placebo (-0.8 [1.6 - -12.3]). Similar drug effects were seen when pain to infusion of hypertonic saline (AUCsaline) was assessed (alfentanil:-388 [-99 - -677] and ketamine:-326 [-227 - -573], P < 0.05 compared with placebo: 150 [449--240]). Ketamine also reduced the size of the local pain area (-58.4 [-21.2 - -176.1], < 0.05) as compared with placebo (-0.4 [70.6 - -13.4]). The frequency of referred pain was also lower when ketamine was given (3/13, P < 0.05) vs. placebo (9/14). CONCLUSION The study demonstrates that experimental muscle pain induced in humans by electrical stimulation and infusion of hypertonic saline is sensitive to pharmacological modulation similar to preclinical animal tests and clinical trials. The data suggest that these models can be valuable tools in analgesic drug development.
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Affiliation(s)
- H Schulte
- Department of Anaesthesia and Intensive Care, Huddinge University Hospital, Stockholm, Sweden.
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Abstract
OBJECTIVES Autologous arterio-venous (AV) fistulas seem to be superior to prothetic grafts in hemodialysis access surgery. We used an algorithm which enabled us to use autologous vein in over 99% of all fistula operations. DESIGN All patients undergoing hemodialysis surgery during a three year period (n = 102) were enrolled in an open prospective observation study with the end points feasibility, perioperative complications and patency. MATERIALS One hundred and two patients were followed until the end of the observation period (30/6/01). METHODS All relevant data were recorded prospectively. The status of the individual fistula was recorded twice a year until the end of the observation period. Fistula-patency was calculated by life-table-analysis according to Kaplan-Meier. RESULTS Except one patient presenting with a recurrent shunt aneurysm, no patient received prothetic material. At the end of the observation period all patients alive and under dialysis could use their autologous fistula. There was no perioperative mortality. One reoperation was required for a septic anastomotic rupture. Otherwise, only minor complications were observed. Cumulative 1-year and 3-year patency were 78.5 and 62.8% respectively for the Cimino and 75.2 and 66.8% for elbow fistulas. CONCLUSIONS An autologous approach is nearly always possible. Besides fewer complications, the approach seems to be cost effective.
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Affiliation(s)
- U Sulkowski
- Department of Surgery, Stadtkrankenhaus Soest, Akademisches Lehrkrankenhaus der Westfälischen Wilhelms-Universität, Senator-Schwartz-Ring, D-59494 Soest, Germany
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von Eckardstein A, Schulte H, Assmann G. [Recognizing patients at high risk for myocardial infarct]]. Praxis (Bern 1994) 2003; 92:441-447. [PMID: 12674587 DOI: 10.1024/0369-8394.92.10.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Several controlled intervention trials proved the benefit of antihypertensive and hypolipidemic drugs for the prevention of coronary heart disease (CHD). International guidelines for the prevention of CHD agree in their recommendations for secondary prevention and recommend to lower blood pressure below 140/90 mm Hg and LDL-cholesterol below 3 mmol/l (or even < 2.6 mmol/l) in patients with manifest CHD. Novel recommendations for primary prevention are focused on the treatment of the presymptomatic high risk patient with an estimated risk of higher than 2% per year. For the calculation of this risk, the physician must record the following risk factors: gender, age, family history of premature myocardial infarction, smoking, diabetes, blood pressure, total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglyceride. This information allows computing the absolute risk of myocardial infarction by using scores or algorithms which have been deduced from results of epidemiological studies.
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Langenbach MR, Korbmacher B, Schulte H, Zirngibl H, Grabensee B, Plum J. Perioperative levels of atrial natriuretic peptide and troponin-T in patients with uncomplicated coronary artery surgery. J Cardiovasc Surg (Torino) 2002; 43:595-601. [PMID: 12386569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND HYPOTHESIS increased ANP levels after uncomplicated coronary artery surgery (CAS) indicate functional reduction. METHODS EXPERIMENTAL DESIGN prospective, randomized. Preoperative upto the 12 week postoperative. SETTING Thoracic and Cardiovascular Surgery, University of Düsseldorf. PATIENTS 15 patients (mean age: 58+/-6.1 years; 13 months, 2 weeks; no myocardial infarction, no congestive heart failure) with 3 vessel disease. INTERVENTIONS levels of atrial natriuretic peptide (ANP) (pg/ml; radioimmunoassay), Troponin T (TnT) (ng/ml; ELISA test), haemodynamic parameters, ECG monitoring, m-mode echocardiography (Echo). MEASURES increase of ANP, TnT levels during extracorporeal circulation (ECC), decrease after operation. RESULTS Maximal increase of ANP from preoperative 90+/-10 (M+/-SEM) pg/ml (p<0.05) up to intraoperative 380+/-38 pg/ml. Ten days postoperative ANP (26+/-33 pg/ml) still threefold increased compared to preoperative level. Increasement of TnT from preoperative 0.02+/-0.01 ng/ml upto intraoperative 3.44+/-0.47 ng/ml. Ten days postoperative TnT concentration normal (0.13+/-0.11 ng/ml). Correlation of ANP and TnT five min after bypass up to 6 hrs postoperative (p<0.05, r =3.4). Increase of left atrial diameter preoperative 42.2+/-1.1 mm up to 46.8+/-1.2 mm (p<0.05) 10 days postoperative. LVEDD, EF changed from preoperative 51.1+/-0.9 mm, 73+/-2% to 54.5+/-1.2 mm, 65+/-4% 10 days postoperative. CONCLUSIONS Threefold increase of ANP 10 days postoperative and return of TnT levels to normal under consideration of datas of echo show, that ANP is suitable to indicate the meanterm, functional, myocardial reduction. Increased ANP levels, atrial dilatation and dysfunction are important signs of cardial functional reduction after CAS.
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Affiliation(s)
- M R Langenbach
- Department of Surgery, University Witten-Herdecke, Wuppertal, Germany
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44
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Benze G, Heinrich J, Schulte H, Rust S, Nowak-Göttl U, Tataru MC, Köhler E, Assmann G, Junker R. Association of the GPIa C807T and GPIIIa PlA1/A2 polymorphisms with premature myocardial infarction in men. Eur Heart J 2002; 23:325-30. [PMID: 11812069 DOI: 10.1053/euhj.2001.2776] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aims Recent studies have reported an association between the platelet glycoprotein (GP) Ia C807T polymorphism and myocardial infarction, whereas other studies have reported contradictory results concerning the platelet GPIIIa PlA1/A2 polymorphism. In most of these studies the patients were older than 45 years. Thus we decided to examine both genotypes in 287 men who had their first myocardial infarction before age 45, and a group of 138 healthy controls. Methods and Results The frequency of T807 allele carriers was similar among myocardial infarction patients and among controls (54.6% vs 62.3%; odds ratio (OR) 0.73; 95% confidence interval (CI), 0.47-1.12). The frequency of PlA2 carriers was higher in cases than in controls (26.5% vs 15.2%; OR 1.65; CI, 1.09-2.54). After performing a logistic regression analysis, taking into account other cardiovascular risk factors, this difference did not remain significant. The combination of the risk alleles of both genotypes had no major effect on the myocardial infarction risk. Conclusions The GPIIIa PlA2 allele is not independently associated with the risk of premature myocardial infarction. The T807 allele of the GPIa gene alone or in combination with the PlA2 allele had no major effect on premature myocardial infarction risk.
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Affiliation(s)
- G Benze
- Institut für Klinische Chemie und Laboratoriumsmedizin, Westfälische Wilhelms-Universität Münster, Münster, Germany
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von Eckardstein A, Fischer F, Schulte H, Tataru M, Köhler E, Assmann G. Association of serum apolipoprotein A-I (but not high-density lipoprotein cholesterol) with healed myocardial infarction in men independent of serum insulin and C-peptide. Am J Cardiol 2001; 88:723-6. [PMID: 11589836 DOI: 10.1016/s0002-9149(01)01840-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Low serum levels of high-density lipoprotein (HDL) cholesterol or apolipoprotein A-I and high serum levels of insulin increase the risk of coronary heart disease (CHD) and can indicate insulin resistance. We tested the strength, independence, and interactions of associations between HDL cholesterol (or apolipoprotein A-I), insulin (or C-peptide), glucose, and CHD in 95 male nondiabetic patients with CHD who were <60 years old, in 92 probands from the PROCAM study, and in 61 non-cardiologic patients; all subjects were matched by age, body mass index, and smoking habits. Systemic hypertension (odds radio [OR] 2.8, 95% confidence intervals [CI] 1.6 to 4.8), high serum levels of glucose (OR 2.3, 95% CI 1.6 to 4.8), insulin (OR 2.1, 95% CI 1.3 to 3.6), and C-peptide (OR 4.1, 95% CI 2.2 to 7.5) as well as low serum levels of HDL cholesterol (OR 2.0, 95% CI 1.1 to 3.5) or apolipoprotein A-I (OR 3.9, 95% CI 2.1 to 7.1) had significant associations with CHD. At multivariate analysis, systolic blood pressure, glucose, apolipoprotein A-I, and C-peptide, but not HDL cholesterol and insulin, had consistent independent associations with CHD. Thus, the combined measurement of apolipoprotein A-I and C-peptide may improve the identification of nondiabetic patients at increased risk for CHD.
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Affiliation(s)
- A von Eckardstein
- Institut für Klinische Chemie und Laboratoriumsmedizin, Zentrallaboratorium, Westfälische Wilhelms-Universität Münster, Münster, Germany.
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Tataru MC, Schulte H, von Eckardstein A, Heinrich J, Assmann G, Koehler E. Plasma fibrinogen in relation to the severity of arteriosclerosis in patients with stable angina pectoris after myocardial infarction. Coron Artery Dis 2001; 12:157-65. [PMID: 11352071 DOI: 10.1097/00019501-200105000-00001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Authors both of retrospective and of prospective studies have demonstrated that there is a relationship between concentration of fibrinogen in plasma and the angiographically determined severity of coronary heart disease (CHD). OBJECTIVE To determine the relevance of the plasma fibrinogen concentration for the severity of CHD, particularly in cases with additional arteriosclerotic changes in the extracranial arteries supplying the brain [cerebrovascular disease (CVD)], in the pelvic/leg arteries [peripheral occlusive arterial disease (POAD)], or in both. PATIENTS AND METHODS In a retrospective cross-sectional survey the cardiological and angiographical status of a total of 1112 male and 299 female patients with stable angina pectoris after sustained myocardial infarction and an age-matched control group of 326 male and 138 female subjects with no clinical symptoms of CHD was determined, together with measurements of plasma fibrinogen, dynamic plasma viscosity and D-dimers. RESULTS More than two-thirds of the patients with arteriosclerosis had plasma fibrinogen concentrations in the uppermost tertile of the control range (men > 2.75; women > 2.83 g/l). Plasma fibrinogen concentration was correlated to the severity of CHD (for men r = 0.173, P < 0.001; for women r= 0.144, P < 0.013). Patients with generalized arteriosclerosis had higher plasma fibrinogen concentrations than did those suffering from CHD only (for men, control 2.65 +/- 0.51, CHD 3.07 +/- 0.73, CHD plus POAD 3.17 +/- 0.77 and CHD plus POAD plus CVD 3.45 +/- 0.78 g/l; for women, control 2.69 +/- 0.44, CHD 3.25 +/- 0.67, CHD plus POAD 3.19 +/- 0.77, CHD plus POAD plus CVD 3.60 +/- 0.84 g/l). Multivariate analysis showed that C-reactive protein, D-dimers and dynamic plasma viscosity accounted for 48.2% (for men) and 49.4% (for women) of the variance in plasma fibrinogen concentration. CONCLUSIONS Our findings demonstrate that there is not only a correlation between plasma fibrinogen concentration and the severity of CHD, but also a correlation to the incidence of additional POAD or CVD.
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Affiliation(s)
- M C Tataru
- Herz- und Gefässklinik, Bad Neustadt an der Saale, Rhön-Klinikum AG, D-Bad Neustadt, Germany.
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Abstract
UNLABELLED PROBANDS AND METHOD: In the Prospective Cardiovascular Münster (PROCAM) Study, 16,288 men aged 40.5 +/- 11.3 years (mean +/- SD) and 7,328 women aged 35.8 +/- 12.3 years were enrolled between 1979 and 1991. RESULTS Mean body mass indices (BMI) were 25.6 +/- 3.3 kg/m2 and 23.8 +/- 4.1 kg/m2 in men and women, respectively. There was a graded positive interaction in both men and women between BMI and age-standardized levels of serum total cholesterol, low density lipoprotein cholesterol, triglycerides, fasting blood glucose, uric acid, and blood pressure (both systolic and diastolic). High density lipoprotein cholesterol tended to decrease with increases in BMI in both sexes. In the subgroup of male participants aged 40-65 years without a prior history of myocardial infarction or stroke in an 8-year follow-up 258 major coronary events were observed. Although incidences of major coronary events increased with increase in relative body weight in a multiple logistic function analysis BMI did not independently contribute to cardiovascular risk, indicating that the effect of overweight on coronary heart disease is mediated via other risk factors.
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Affiliation(s)
- H Schulte
- Institut für Arterioskleroseforschung, Zentrallaboratorium, Westfälische Wilhelms-Universität Münster.
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Junker R, Pieke B, Schulte H, Nofer R, Neufeld M, Assmann G, Wahrburg U. Changes in hemostasis during treatment of hypertriglyceridemia with a diet rich in monounsaturated and n-3 polyunsaturated fatty acids in comparison with a low-fat diet. Thromb Res 2001; 101:355-66. [PMID: 11297752 DOI: 10.1016/s0049-3848(00)00421-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [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
High levels of fibrinogen, factor (F) VIIc, plasminogen activator inhibitor-1 (PAI-1), and plasma viscosity are associated with an increased coronary risk. As positive correlations of these parameters with triglycerides have been shown, the increased coronary risk associated with high levels of triglycerides may be assumed to be due to alterations within the hemostatic system. To reduce the coronary risk to which hypertriglyceridemic patients are exposed, dietary treatment is recommended; the optimal composition of such a diet is, however, a matter of debate. With regard to the effects on hemostasis, we compared in a sequential approach two diets for treatment of 25 nonobese male patients (age, mean+/-S.D., 40.4+/-8.7 years) with fasting triglycerides >2.3 mmol/l. The first diet (high fat) was rich in monounsaturated fatty acids (MUFA) and marine n-3 polyunsaturated fatty acids (PUFA), whereas the second diet (low-fat) was rich in complex carbohydrates and dietary fiber. The high-fat diet induced a significant lowering of FIIc, FIXc, FXc, FVIIc, FVIIa, FXIIa, PAI-1, plasma viscosity, and platelet activity, but led to an increase in fibrinogen, whereas the low-fat diet lowered FXIIc values and induced a nonsignificant decrease in fibrinogen. Probands on this diet had a slightly higher FVIIa and platelet activity than those on the high-fat diet. However, as all changes appeared to be within the normal range of each hemostatic parameter, it remains to be clarified whether the likely beneficial effects of the high-fat diet on most hemostatic factors are outweighed by the small increase in fibrinogen levels.
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MESH Headings
- Adult
- Blood Coagulation Factors/analysis
- Body Mass Index
- Cholesterol/blood
- Cholesterol, HDL/blood
- Cholesterol, LDL/blood
- Diet, Fat-Restricted
- Dietary Fats
- Dietary Fats, Unsaturated/therapeutic use
- Fatty Acids, Monounsaturated/administration & dosage
- Fatty Acids, Monounsaturated/therapeutic use
- Fatty Acids, Omega-3/administration & dosage
- Fatty Acids, Omega-3/therapeutic use
- Fatty Acids, Omega-6
- Fatty Acids, Unsaturated
- Hemostasis
- Humans
- Hypertriglyceridemia/blood
- Hypertriglyceridemia/diet therapy
- Male
- Triglycerides/blood
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Affiliation(s)
- R Junker
- Institute of Clinical Chemistry and Laboratory Medicine, University of Münster, Münster, Germany.
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Junker R, Kratz M, Neufeld M, Erren M, Nofer JR, Schulte H, Nowak-Göttl U, Assmann G, Wahrburg U. Effects of diets containing olive oil, sunflower oil, or rapeseed oil on the hemostatic system. Thromb Haemost 2001; 85:280-6. [PMID: 11246548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Various studies have already shown that the fatty acid composition of dietary fat has different effects on hemostasis and platelet function. However, knowledge on this topic is incomplete. In the present study, fifty-eight healthy students received either a 4-week rapeseed oil [high content of monounsaturated fatty acids (MUFA) and high n-3/n-6 PUFA ratio], an olive oil (high content of MUFA, low n-3/n-6 PUFA ratio) or a sunflower oil (low content of MUFA, low n-3/n-6 PUFA ratio) diet. In each group, effects on hemostatic parameters were compared with a wash-in diet rich in saturated fatty acids with respect to intermediate-time effects on the hemostatic system and platelet function. With the olive oil diet, a reduction of coagulation factors VIIc, XIIc, XIIa, and Xc was found, whereas sunflower oil led to lower values of coagulation factors XIIc, XIIa, and IXc. In all study groups levels of plasmin-alpha2-antiplasmin were lower in week 4 than at baseline. Lower fibrinogen binding on platelets was found after the sunflower oil diet, whereas expression of CD62 and spontaneous platelet aggregation were slightly higher after the olive oil diet. However, given the major differences in the fatty acid compositions of the diets, the differences between the groups with respect to hemostasis tended to be small. Therefore, the clinical significance of the present findings remains to be evaluated.
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Affiliation(s)
- R Junker
- Institute of Clinical Chemistry and Laboratory Medicine, University of Münster, Germany.
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Abstract
OBJECTIVES This prospective population study was conducted to assess the role of elevated lipoprotein(a) [Lp(a)] as a coronary risk factor. BACKGROUND The role of elevated Lp(a) as a risk factor for coronary heart disease is controversial. In addition, little attention has been paid to the interaction of Lp(a) with other risk factors. METHODS A total of 788 male participants of the Prospective Cardiovascular Münster (PROCAM) study aged 35 to 65 years were followed for 10 years. Both Lp(a) and traditional cardiovascular risk factors (e.g., age, low density lipoprotein [LDL] cholesterol, high density lipoprotein [HDL] cholesterol, triglycerides, systolic blood pressure, cigarette smoking, diabetes mellitus, angina pectoris, and family history of myocardial infarction) were evaluated in 44 men who suffered from myocardial infarction, and in 744 men who survived without major coronary events or stroke. A multiple logistic function algorithm was used to estimate global cardiovascular risk by the combined effects of traditional risk factors. RESULTS Overall, the risk of a coronary event in men with an Lp(a) > or =0.2 g/liter was 2.7 times that of men with lower levels (95% confidence interval [CI]: 1.4 to 5.2). This increase in risk was most prominent in men with LDL cholesterol level > or =4.1 mmol/liter (relative risk [RR]: 2.6; 95% CI: 1.2 to 5.7), with HDL cholesterol < or =0.9 mmol/liter (RR 8.3; 95% CI: 2.0 to 35.5), with hypertension (RR 3.2; 95% CI: 1.4 to 7.2), or within the two highest global risk quintiles (relative risk: 2.7; 95% CI: 1.3 to 5.7). CONCLUSIONS Lp(a) increases the coronary risk, especially in men with high LDL cholesterol, low HDL cholesterol, hypertension and/or high global cardiovascular risk.
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Affiliation(s)
- A von Eckardstein
- Institut für Klinische Chemie und Laboratoriumsmedizin, Zentrallaboratorium, Westfälische Wilhelms-Universität Münster, Germany.
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