Aortic stenosis is a frequent valvular disease especially in elderly patients. Catheter-based valve implantation has emerged as a valuable treatment approach for these patients being either at very ...high risk for conventional surgery or even deemed inoperable. The German Aortic Valve Registry (GARY) provides data on conventional and catheter-based aortic procedures on an all-comers basis.
A total of 13 860 consecutive patients undergoing repair for aortic valve disease conventional surgery and transvascular (TV) or transapical (TA) catheter-based techniques have been enrolled in this registry during 2011 and baseline, procedural, and outcome data have been acquired. The registry summarizes the results of 6523 conventional aortic valve replacements without (AVR) and 3464 with concomitant coronary bypass surgery (AVR + CABG) as well as 2695 TV AVI and 1181 TA interventions (TA AVI). Patients undergoing catheter-based techniques were significantly older and had higher risk profiles. The stroke rate was low in all groups with 1.3% (AVR), 1.9% (AVR + CABG), 1.7% (TV AVI), and 2.3% (TA AVI). The in-hospital mortality was 2.1% (AVR) and 4.5% (AVR + CABG) for patients undergoing conventional surgery, and 5.1% (TV AVI) and AVI 7.7% (TA AVI).
The in-hospital outcome results of this registry show that conventional surgery yields excellent results in all risk groups and that catheter-based aortic valve replacements is an alternative to conventional surgery in high risk and elderly patients.
Aus einem klaren Design wurde Koronar-ART mit 21,8 % Radialisanastomosen in der SITA-Gruppe, mit skelettierten und nichtskelettierten Arteriengrafts sowie einem nennenswerten Anteil von ...Composite-Y/T-Graft-Konstruktionen unter „On“- und „Off-pump“(40 %)-Bedingungen und den dadurch verursachten statistischen Herausforderungen. Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Randomized comparison of the clinical outcome of single versus multiple arterial grafts: the ROMA trial—rationale and study protocol.
Purpose
The aim of this study was to assess the evolution of health-related quality of Life (HRQoL), emotional burden, and neurocognitive function in the first-generation metastatic melanoma ...survivors treated with pembrolizumab.
Methods
Survivors were defined as patients who achieved a durable remission for at least 6 months after initiating pembrolizumab in a single-center observational study (
N
= 141). A semi-structured interview was performed at baseline. Neurocognitive computerized testing and patient-reported outcomes were collected at 4 time points to assess HRQoL using the EORTC QLQ-C30 and the HADS to assess anxiety and depression.
Results
Out of 35 eligible patients, 25 were recruited and completed baseline assessment (18 female; median age 58 years range 28–86; 24 completed the 1-year follow-up phase. Median time since diagnosis was 30 months (range 12–84); median time since initiation of pembrolizumab was 19 months (range 6–42). At all visits, survivors reported a significantly lower global HRQoL, lower physical, emotional, cognitive, role, and social functioning compared with the European Mean of the healthy population. Fifteen patients (64%) had clinical levels of anxiety/depression at one time point during follow-up
.
The clinical interview revealed that 12 patients (48%) suffered from Cancer-Related-Post-Traumatic-Stress disorder, of whom 7 (28%) developed transient suicidal ideation, 1 patient made a suicide attempt. Neurocognitive testing revealed cognitive impairment in 8 patients (32%).
Conclusions
Metastatic melanoma survivors, treated successfully with pembrolizumab, are at risk for suffering from emotional distress and neurocognitive impairment with a persistent impact on their HRQOL. Timely detection in order to offer tailored care is indicated.
Collective optical excitations in dipole-coupled nanorings of sub-wavelength spaced quantum emitters exhibit extreme sub-radiance and field confinement facilitating an efficient and low-loss ...ring-to-ring energy transfer. We show that energy shifts, radiative lifetimes, and emission patterns of excitons and biexcitons in such rings can be tailored via the orientation of the individual dipoles. Tilting the polarization from perpendicular to tangential to the ring dramatically changes the lifetime of the symmetric exciton state from superradiance to subradiance with the radiated field acquiring orbital angular momentum. At a magic tilt angle all excitons are degenerate and the transport fidelity between two rings exhibits a minimum. Further simulations suggest that, for certain parameters, the decay decreases double-exponentially with the emitter's density. Disorder in the rings' structure can even enhance radiative lifetimes. The transport efficiency strongly depends on polarization and size, which we demonstrate by simulating a bio-inspired example of two rings with 9 and 16 dipoles as found in biological light harvesting complexes (LHC). The field distribution in the most superradiant state in a full LHC multi-ring structure shows tight sub-wavelength field confinement in the central ring, while long-lived subradiant states store energy in the outer rings.
Cooperative behavior, the costly provision of benefits to others, is common across all domains of life. This review article discusses cooperative behavior in the microbial world, mediated by the ...exchange of extracellular products called public goods. We focus on model species for which the production of a public good and the related growth disadvantage for the producing cells are well described. To unveil the biological and ecological factors promoting the emergence and stability of cooperative traits we take an interdisciplinary perspective and review insights gained from both mathematical models and well-controlled experimental model systems. Ecologically, we include crucial aspects of the microbial life cycle into our analysis and particularly consider population structures where ensembles of local communities (subpopulations) continuously emerge, grow, and disappear again. Biologically, we explicitly consider the synthesis and regulation of public good production. The discussion of the theoretical approaches includes general evolutionary concepts, population dynamics, and evolutionary game theory. As a specific but generic biological example, we consider populations of Pseudomonas putida and its regulation and use of pyoverdines, iron scavenging molecules, as public goods. The review closes with an overview on cooperation in spatially extended systems and also provides a critical assessment of the insights gained from the experimental and theoretical studies discussed. Current challenges and important new research opportunities are discussed, including the biochemical regulation of public goods, more realistic ecological scenarios resembling native environments, cell-to-cell signaling, and multispecies communities.
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•Cooperation and public good production of microbial communities.•Evolutionary stability of cooperation in structured microbial population.•Theoretical concepts and models to analyze evolutionary dynamics in structured populations.•Pyoverdine – a public good of Pseudomonas populations: regulation and benefits.•The public good dilemma in spatially extended systems.
Wohin führt der Weg?“, https://doi.org/10.1007/s00398-017-0160-3) gibt auf den ersten Blick einen gut fundierten Überblick über den aktuellen Stand der wissenschaftlichen Ergebnisse zu TAVI im ...Kontrast zur konventionellen Aortenklappenchirurgie vor dem Hintergrund der Realitätsveränderungen in der Prozedurenanwendung in Deutschland: weniger prozedurale Komplikationen, bessere „TAVI-Implantate“, immer mehr Prozeduren – auch bei jüngeren und gesünderen Patienten. An verschiedenen Stellen kann der Leser auch die Qualität der wissenschaftlichen Information nicht so ohne Weiteres erkennen: Das trifft sich besonders gut, denn gerade jetzt hat an vielen deutschen Zentren die Einschlussphase für die DEDICATE-Studie begonnen, die gerade viele konzeptionelle Nachteile der bisherigen Studien nicht hat: 1600 Patienten, offene untere Altersgrenze, STS-Score 2–6, primärer Fünfjahresendpunkt, Corelab-Echo-Untersuchungen, keine kardialen Reoperationen, und vielleicht fallen auch noch substanzielle Informationen zum Prothesenendokarditisrisiko ab. Transcatheter versus surgical aortic-valve replacement in high-risk patients. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve Stenosis: 1‑year results from the all-comers NOTION randomized clinical trial. Transcatheter aortic-valve replacement with a self-expanding prosthesis. Mack, MJ; Leon, MB; Smith, CR et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): A randomized controlled trial.
The ART of CABG in doubt“? Cremer, J.
Zeitschrift für Herz-, Thorax- und Gefässchirurgie,
2/2017, Volume:
31, Issue:
1
Journal Article
Im Follow-up bis 20 Jahre ergab sich ein kontinuierlich größer werdender Überlebensvorteil nach „BIMA grafting“. „Maybe we deal with inhomogeneity of concepts“: Während in den früheren ...Landmarkanalysen nur „in situ pedicle grafts“ an der Herz-Lungen-Maschine operiert wurden, erlaubt die Operationskunst von ART „on-pump or off-pump 2, 4, skeletonized or pedicled and in situ or Y‑/T-grafting“. „My statement: time to wait“: … wie beim Surgical Treatment for Ischemic Heart Failure (STICH) Trial. Taggart, DP; Altman, DG; Gray, AM; Lees, B; Nugara, F; Yu, L-M; Campbell, H; Flather, M. Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1‑year results of the Arterial Revascularisation Trial (ART). Kurlansky, PA; Traad, EA; Dorman, MJ; Galbut, DL; Ebra, G. Bilateral versus single internal mammary artery grafting in the elderly: long-term survival benefit.
Background Functional capacity is associated with mortality, although the prognostic value of achieved estimated metabolic equivalents (METs) across various exercise protocols is not established. We ...sought to determine whether achieved METs had different prognostic implications according to the protocol employed. Methods and Results From 1991 to 2015, we identified 120 705 consecutive patients from a stress testing registry who underwent the following 7 different standardized exercise protocols: Bruce, modified Bruce, Cornell 0%, Cornell 5%, Cornell 10%, Naughton, and modified Naughton. The primary outcome was all-cause mortality. There were 74 953 Bruce, 8368 modified Bruce, 2648 Cornell 0%, 9972 Cornell 5%, 20 425 Cornell 10%, 1226 Naughton, and 3113 modified Naughton protocols. During a mean follow-up of 8.7 years, a total of 8426 deaths (6.9%) occurred. When compared with the Bruce protocol, after multivariable adjustment for clinical risk factors, medications, and functional capacity, test protocol was independently associated with mortality (modified Naughton hazard ratio (HR), 2.51; 95% CI, 2.26-2.8, Naughton HR, 1.79; 95% CI, 1.57-2.04, Cornell 0% HR, 1.79; 95% CI, 1.59-2.01, modified Bruce HR, 1.62; 95% CI, 1.48-1.76, Cornell 5% HR, 1.61; 95% CI, 1.47-1.75, and Cornell 10% HR, 1.32; 95% CI, 1.22-1.42). Across all protocols, higher estimated METs were associated with lower mortality, although the equivalent METs achieved were associated with a worse prognosis in less-demanding protocols. Conclusions Higher estimated METs are reliably associated with lower mortality in all exercise protocols, although the prognostic value is not transferable across different tests. Consequently, the prognostic value of METs achieved during a stress test should be considered protocol dependent.
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