Ophthalmology

"Graefe's Archive" is a distinguished international journal that presents original clinical reports and clinically relevant experimental studies. Founded in 1854 by Albrecht von Graefe to serve as a source of useful clinical information and a stimulus for discussion, the journal has published articles by leading ophthalmologists and vision research scientists for more than a century. With peer review by an international Editorial Board and prompt English-language publication, "Graefe's Archive" provides rapid dissemination of clinical and clinically related experimental information.

Correction to: Intravitreal bevacizumab injections combined with laser photocoagulation for adult-onset Coats' disease The IRB number of the published article was A-2015-016 (page 1512, 1st paragraph of the method section).

Transcaruncular laser-assisted StopLoss Lester Jones tube surgery for lacrimal canalicular obstructions

Optical coherence tomography angiography analysis of the choriocapillary layer in treatment-naïve diabetic eyes Abstract Purpose To evaluate the capillary flow density (CFD) of choriocapillary (CC) microvasculature using optical coherence tomography angiography (OCT-A) in diabetic eyes and the association of CFD and systemic and metabolic factors. Methods Cross-sectional study. This study enrolled 282 eyes of 146 subjects, including 43 healthy control eyes, 56 diabetic eyes without diabetic retinopathy (DR), 43 eyes with mild nonproliferative DR (NPDR), 54 eyes with moderate NPDR, 38 eyes with severe NPDR, and 48 eyes with proliferative DR (PDR). CFD was measured in the CC layer. Clinical data were collected. Multiple linear regression analyses were performed to identify associated clinical variables. Results CFD in the CC layer presented a downward trend with DR progression. Comparisons of CFD in the CC layer between adjacent stages of DR revealed significant differences between severe NPDR and PDR using both 3-mm and 6-mm scan patterns (P = 0.003, P = 0.001). CFD in the CC layer in DR with diabetic macular edema (DME) was less than that in DR without DME using both 3-mm and 6-mm scan patterns (P < 0.001, P < 0.001). Coronary artery disease and atherosclerosis in other locations, estimated glomerular filtration rate, and increased HbA1c were associated with CFD in the CC layer using both 3-mm and 6-mm scan patterns (all P values < 0.05). Conclusions OCT-A revealed decreased CFD in the CC layer in the PDR stage and the presence of DME. Diabetic patients with apparently decreased CFD should be assessed carefully under general conditions.

Five-year treatment outcomes following intravitreal ranibizumab injections for neovascular age-related macular degeneration in Japanese patients Abstract Purpose To assess the real-world 5-year treatment outcomes of ranibizumab therapy in Japanese patients with neovascular age-related macular degeneration (AMD). Methods This was a retrospective, observational, and open-label effectiveness study that included 295 eyes. The participants were patients with treatment-naïve neovascular AMD who received intravitreal ranibizumab (IVR) monthly injection at least three times as the loading phase, followed by further injections as needed (pro re nata (PRN)) and follow-up assessments for 5 years. Outcomes were determined at least 5 years after the first ranibizumab injection. Results Mean logMAR best-corrected visual acuity (BCVA) at baseline was 0.52. The mean BCVA significantly improved after three loading injections; however, it declined gradually. The BCVA at 1 year was significantly better than the baseline BCVA, whereas the 3-year, 4-year, and 5-year BCVA values were significantly lower than the baseline values. The average central foveal thickness improved significantly from 366 ± 125 μm to 268 ± 134 μm (p < 0.0001). Macular atrophy was significantly more likely to occur in cases with classic choroidal neovascularization (CNV) than in cases with other AMD (p = 0.01). Conclusions IVR is well tolerated in eyes with AMD. However, a PRN regimen for AMD may have limited real-world effectiveness for long-term maintenance of improved visual acuity. Macular atrophy may occur more frequently in classic CNV. To maintain good vision, IVR treatment should be started earlier and performed continuously.

Patient characteristics of untreated chronic central serous chorioretinopathy patients with focal versus diffuse leakage Abstract Purpose To describe the characteristics and potential differences between focal and diffuse phenotypes of untreated chronic central serous chorioretinopathy (cCSC). Methods For this study, patients were divided in two groups. Focal leakage was defined as 1 "hot spot" of leakage, whereas diffuse leakage was defined as either > 1 hot spot or a larger area of widespread leakage on FA. Clinical characteristics were assessed at presentation. After Bonferroni correction, P values < 0.00125 were deemed statistically significant. Results The focal leakage group included 68 eyes (53 males), and the diffuse leakage group included 105 eyes (88 males). Mean best-corrected visual acuity (BCVA) was 77.1 ± 8.1 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters in the focal group and 76.0 ± 9.6 ETDRS letters in the diffuse group (p = 0.440). In the focal group, mean age was 46.9 ± 8.8 years, whereas this was 49.7 ± 8.3 years in the diffuse group (p = 0.033). Mean central foveal thickness was 107.1 ± 21.3 μm in the focal group and 106.2 ± 27.3 μm in the diffuse group (p = 0.818). Mean choroidal thickness was 407.5 ± 114.8 μm in the focal group and 419.1 ± 113.9 μm in the diffuse group (p = 0.578). In the focal group, subretinal fluid was present in the fellow eye in 16% of the patients, as compared to 29% in the diffuse group (p = 0.067). Conclusions In untreated cCSC patients with focal or diffuse leakage on FA, no marked differences in clinical characteristics were found. Extensive choroidal abnormalities may be present in both groups, which are presumed to lie at the basis of the development of cCSC.

Protein kinase C-mediated insulin receptor phosphorylation in diabetic rat retina Abstract Purpose Diabetic retinopathy (DR) involves a proliferation of vascular endothelial cells and loss of pericytes. There is a link among the action of protein kinase C (PKC) and insulin signaling. Thus, we investigated the differences between these cells in insulin receptor (IR) phosphorylation in DR. Methods Retinas were removed from streptozotocin-induced diabetic or healthy rats, and IR expression levels were compared by immunoblot and immunohistochemistry. In vitro assays also were performed in order to determine the expressions of phosphorylated IR in both cells cultured under 5.5 or 25 mM glucose by immunoblot. Cell viability was determined in both cells cultured under different concentrations of phorbol myristate acetate (PMA), a PKC activator. To determine the involvement of the PI3 kinase pathway of IR, PMA with or without wortmannin-induced changes in Akt was also analyzed. Results Immunoreactivity to the IR was decreased in diabetic retina. High glucose (25 mM) increased phosphorylated IR levels in endothelial cells but not in pericytes. PMA (1 nM or higher) induced death of pericytes, while endothelial cells were increased. PMA increased phosphorylated Akt in endothelial cells and decreased in pericytes. Wortmannin suppressed the PMA-induced phosphorylation of Akt in endothelial cells. Conclusions The different responses to 25 mM glucose and PMA were observed between retinal endothelial cells and pericytes. Thus, IR phosphorylation is likely important for retinal vascular cells to survive in diabetic retina.

Elevation of the vitreous body concentrations of oxidative stress-responsive apoptosis-inducing protein (ORAIP) in proliferative diabetic retinopathy Abstract Purpose Oxidative stress has been implicated in the pathogenesis of various disorders, including diabetic retinopathy (DR). Oxidative stress-responsive apoptosis-inducing protein (ORAIP; a tyrosine-sulfated secreted form of eukaryotic translation initiation factor 5A [eIF5A]) is a recently discovered pro-apoptotic ligand that is secreted from cells in response to oxidative stress and induces apoptosis in an autocrine fashion. This study aimed to determine if ORAIP plays a role in DR. Methods To investigate the role of ORAIP in DR, we analyzed the levels of ORAIP in the vitreous body and their relationship with the extent of proliferative diabetic retinopathy (PDR). Enzyme-linked immunosorbent assay was used to quantify the levels of ORAIP, vascular endothelial growth factor (VEGF), C–C motif chemokine ligand 2 (CCL2), interleukin-6 (IL-6), and IL-8 in the vitreous body of 40 eyes from 28 patients with PDR and 11 patients with non-PDR (NPDR). We also analyzed the expression of ORAIP in insoluble proliferative tissues from vitreous body samples by immunofluorescent staining. Results The vitreous body concentration of ORAIP was significantly (P = 0.0433) higher in the PDR group (52.26 ± 8.68 [mean ± SE] ng/mL, n = 29) than in the NPDR group (28.21 ± 7.30 ng/mL, n = 11). However, there were no significant correlations between the concentration of ORAIP and those of VEGF, IL-6, CCL2, or IL-8. ORAIP expression was observed in the insoluble proliferative tissues in vitreous body samples of most patients in the PDR group, whereas almost no expression of ORAIP was observed in patients in the NPDR group. Conclusions Our findings strongly suggest that ORAIP plays a role in oxidative stress-induced retinal injury and may be a sensitive diagnostic marker and a promising therapeutic target for oxidative stress-induced cytotoxicity.

Ocular alterations, molecular findings, and three novel pathological mutations in a series of NF2 patients Abstract Purpose To evaluate ophthalmological and molecular findings in eight patients with a clinical diagnosis of neurofibromatosis type 2 (NF2). New pathological mutations are described and variability in the ophthalmic phenotype and NF2 allelic heterogeneity are discussed. Methods Eye examination was performed in eight NF2 patients, and it included the measurement of the visual acuity, biomicroscopy, dilated fundus examination, color fundus photography, infrared photography, and spectral domain optical coherence tomography (SD-OCT). Molecular analysis was performed with whole-exome sequencing using DNA derived from peripheral blood mononuclear cells from each individual. Results Ophthalmological features were present in all patients, ranging from subtle retinal alterations identified only using SD-OCT to severe ocular damage present at birth. Six mutations were observed: two patients with stop codon mutation as shown on table 1 and result section, three patients with frameshift mutation as shown on table 1 and result section. Three novel mutations were found among them. Conclusions It is a descriptive study of a rare disease, with poor previous literature. Clinical and genetic data are shown, reviving the need to further studies to clarify the genotype-phenotype correlations in NF2.

Usefulness of the dacryoscintigraphy in patients with nasolacrimal duct obstruction prior to endoscopic dacryocystorhinostomy Abstract Purpose To evaluate the clinical usefulness of the dacryoscintigraphy in patients with nasolacrimal duct obstruction prior to endoscopic dacryocystorhinostomy. Methods One hundred thirty-five lacrimal views of endoscopic dacryocystorhinostomy (DCR) with a single surgeon for primary nasolacrimal duct obstruction (PANDO) were included. These were assigned into three groups according to the type of dacryoscintigraphy. Group 1 was a pre-sac obstruction pattern. Group 2 was an intra-sac obstruction pattern. Group 3 was post-sac obstruction pattern. Each group was evaluated for an anatomical and functional surgical success, presence of complications including granuloma, synechiae, and tube-induced inflammation at least 12 months after the surgery. Results Both anatomical and functional success rate showed no significant difference among the three groups (P = .297 and .472 linear by linear association). Functional failure rate (functional failure/total failure) also showed no clinically significant differences between groups. Logistic regression analysis was performed to determine the factors associated with functional success. There were no statistically significant factors in age, sex, scintigraphy type, pre-operative endoscopic grade, post-operative granuloma, and synechiae. Conclusion In patients with nasolacrimal duct obstruction, preoperative evaluation of obstruction level using dacryoscintigraphy may be not useful for predicting the functional success of the endoscopic dacryocystorhinostomy.

Use of low-vault posterior chamber collagen copolymer phakic intraocular lenses for the correction of myopia: a 3-year follow-up Abstract Background Phakic intraocular lens (pIOL) models have indicated an association between cataract formation and inadequate vaulting. In this study, the efficacy and safety of low-vault posterior chamber pIOLs in the correction of myopia were examined over 3 years. Methods From 316 patients undergoing surgery, 14 eyes with a low vault (≤ 150 μm) were examined from 14 patients. After implanting the Visian Implantable Collamer pIOL for the correction of myopia (moderate and high), the pIOL vault, endothelial cell loss, uncorrected distance visual acuity (UDVA), corrected DVA (CDVA), and detrimental events were examined over 3 years. Results Based on the findings, the mean spherical equivalent reduced from − 8.15 ± 3.29 before surgery to − 1.02 ± 0.75 diopters 3 years after the surgery. In terms of visual outcomes, the mean UDVA (Log MAR) significantly increased from 0.95 ± 037 to 0.27 ± 0.28, and the mean CDVA also increased from 0.99 ± 0.11 to 0.06 ± 0.08 (P < 0.05). The mean indices of safety and efficacy were respectively 1.075 and 0.748. The eyes lost not more than two visual acuity lines. Based on the findings, 82% achieved 0.80 or better CDVA, while the total endothelial cell loss was 7.96% during 3 years. Overall, vision-threatening conditions were not reported. Conclusion The introduced pIOL can be considered a safe and efficient method for myopia at moderate to high levels.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Abdominal Radiology

Bare area sign These four signs (the diaphragm sign, the displaced crus sign, the interface sign, and the bare area sign) are reliable when only one abnormal fluid collection is present. Ascites or pleural effusion? CT and ultrasound differentiation. - NCBI https://www.ncbi.nlm.nih.gov/pubmed/3536306

The stalk-of-corn sign of ureter

Reply to letter to the editor: "clinical evaluation of ureteral pseudodiverticulosis"

Clinical evaluation of ureteral pseudodiverticulosis

Thimble bladder

The "hot air balloon" sign

Fadeout sign of liver

"Nodule-in-nodule" architecture of hepatocellular carcinoma

Imaging findings during and after percutaneous cryoablation of hepatic tumors Abstract Objective Imaging plays a key role in the assessment of patients before, during, and after percutaneous cryoablation of hepatic tumors. Intra-procedural and early post-procedure imaging with CT and MRI is vital to the assessment of technical success including adequacy of ablation zone coverage. Recognition of the normal expected post-procedure findings of hepatic cryoablation such as ice ball formation, hydrodissection, and the normal appearance of the ablation zone is crucial to be able to differentiate from complications including vascular, biliary, or non-target organ injury. Delayed imaging is essential for determination of clinical effectiveness and detection of unexpected findings such as residual unablated tumor and local tumor progression. The purpose of this article is to review the spectrum of expected and unexpected imaging findings that may occur during or after percutaneous cryoablation of hepatic tumors. Conclusion Differentiating expected from unexpected findings during and after hepatic cryoablation helps radiologists identify residual or recurrent tumor and detect procedure-related complications.

Diagnosis of recurrent HCC: intraindividual comparison of gadoxetic acid MRI and extracellular contrast-enhanced MRI Abstract Purpose To compare the efficacy of magnetic resonance imaging (MRI) with hepatobiliary agents (HBA-MRI) and MRI with extracellular contrast agents (ECA-MRI) for detection of recurrent hepatocellular carcinoma (HCC) after multiple treatments. Methods The institutional review board approved this retrospective study and waived the requirement for informed patient consent. A total of 135 patients with suspected HCC recurrence after 2–5 treatments (surgery, transarterial chemoembolization, and/or radiofrequency ablation) underwent both HBA-MRI and ECA-MRI within a 1 month interval. HBA-MRI and ECA-MRI were analyzed for HCC detection by two observers using a five-point scale. The diagnostic performances according to MRI modality were compared. Results A total of 136 liver lesions (121 HCCs and 15 benign lesions; median size, 1.9 cm) were identified. ECA-MRI showed greater sensitivity (90.9% vs. 76.9% for observer 1; 91.7% vs. 78.5% for observer 2) and accuracy (91.2% vs. 78.7% for observer 1; 91.9% vs. 80.2% for observer 2) than HBA-MRI for both observers (P = 0.002, 0.003). Fifteen (12.4%) HCCs were correctly diagnosed with ECA-MRI but not with HBA-MRI by both observers. Interobserver agreement was excellent (0.885) for ECA-MRI and substantial (0.749) for HBA-MRI. Conclusions For detection of recurrent HCC, ECA-MRI was superior to HBA-MRI in terms of sensitivity and accuracy. Therefore, ECA-MRI could be the preferred imaging modality over HBA-MRI for assessing HCC recurrence following multiple treatments.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Behavior Analysis

Why WIBA? Abstract Historically, men have dominated the field of behavior analysis; however, recent trends have indicated increased participation by women. As a result of these recent changes to the field of behavior analysis, the inaugural Women in Behavior Analysis Conference (WIBA) was hosted in 2017. WIBA was initially established to highlight the accomplishments of women in the field of behavior analysis, to provide opportunities for early career behavior analysts to obtain mentorship, and to encourage meaningful discourse about gender issues in the field. Since the inaugural conference, WIBA has attempted to establish a platform for promoting gender equality but most recently has incorporated efforts related to the needs surrounding social justice and inclusiveness in the field of behavior analysis. The goal of this paper is to provide an overview of the WIBA conference. The history of WIBA is discussed, including the impetus for establishing the conference. This paper highlights existing issues on gender equality in the field of behavior analysis and the larger community, serves to demonstrate how WIBA is part of the solution, and shares accomplishments to date. Furthermore, future directions and goals are presented.

Board Certified Behavior Analysts' Supervisory Practices of Trainees: Survey Results and Recommendations Abstract The field of behavior analysis relies on supervised fieldwork to shape the repertoires of individuals aspiring to sit for the Behavior Analyst Certification Board® (BACB®) exam. Board Certified Behavior Analysts® (BCBAs®) who are providing supervision to those seeking certification must follow the supervision and ethics requirements as directed by the BACB. We conducted a survey of BCBAs currently providing supervision to gather information about current practices and barriers. The top areas of success and need are presented based on the responses of 284 participants who completed the entire survey, along with recommendations.

On the Standardization of the Functional Analysis Abstract The functional analysis procedures described in the seminal Iwata et al. (1982/1994) study are prominent in the applied behavior analytic literature, having been replicated hundreds of times over the past 30 years (Beavers, Iwata, & Lerman, 2013; Hanley, McCord, Iwata, 2003). However, the extent to which particular components of this functional analysis model have become more or less prominent over time is not clear from these literature reviews. We therefore conducted a review of the functional analysis literature between the years of 1965 and 2016 to determine the trends in the usage of particular components over time and to determine if the published literature reflects a standardization of the manner in which functional analyses of problem behavior are conducted. Furthermore, we discuss whether or not this standardization of a functional analysis model is currently necessary.

Utilizing Peers to Support Academic Learning for Children With Autism Spectrum Disorder Abstract The inclusion of students with autism spectrum disorder in academic settings is becoming more common. However, most practices focus on increasing social skills even though students also struggle in academic areas. There is a need for strategies that address both social and academic skill deficits, are evidence based, and are easy to implement in the classroom. Peer-mediated interventions have evidence supporting their use in promoting social and academic behavior change and are socially valid and cost-effective. The purpose of this paper is to present examples of how to implement 2 common peer-tutoring strategies: Classwide Peer Tutoring and Peer-Assisted Learning Strategies. Examples for implementing both strategies are provided using a hypothetical student in a general education setting, followed by a brief summary of evidence supporting the peer-mediated academic instruction.

The Potential Role of Applied Behavior Analysis in the Cultural Environment of Māori Mental Health Abstract Significant mental health disparity exists in Aotearoa New Zealand between Māori and the non-Māori majority. Although much has been written about mental health and the cultural competence of health professionals, cultural context has not been specifically considered within the behavioral paradigm, and it was placed in the center of practice in multicultural societies by the behavioral community only recently. In this article, we discuss some of the problems encountered by Māori in the mental health system and the role of behavior analysts in addressing the divide in service provision. Dialogue with other disciplines that investigate the importance of indigenous cultural values is necessary. We conclude with some suggestions about strategies that may be implemented across services by behavior analysts in order to improve mental health outcomes for Māori.

Procedures and Accuracy of Discontinuous Measurement of Problem Behavior in Common Practice of Applied Behavior Analysis Abstract Discontinuous measurement involves dividing an observation into intervals and recording whether a behavior occurred during some or all of each interval (i.e., interval recording) or at the exact time of observation (i.e., momentary time sampling; MTS). Collecting discontinuous data is often easier for observers than collecting continuous data, but it also produces more measurement error. Smaller intervals (e.g., 5 s, 10 s, 15 s) tend to produce less error but may not be used in everyday practice. This study examined the most common intervals used by a large sample of data collectors and evaluated the effect of these intervals on measurement error. The most commonly used intervals fell between 2 and 5 min. We then analyzed over 800 sessions to evaluate the correspondence between continuous and discontinuous data at each commonly used interval. Intervals of 3 min or less produced the greatest correspondence, and MTS outperformed interval recording.

Correction to: Police Academy Training, Performance, and Learning The original version of this article was corrected to use the correct version of Fig. 2.

Improving Classroom Appearance and Organization Through a Supervisory Performance Improvement Intervention Abstract This study evaluated the effects of a supervisory intervention on maintenance of appearance and organization in classrooms at a human services program for children and youths. The intervention combined performance feedback to classroom staff, public posting of performance outcomes, and eligibility for a performance-based incentive. Conducted in a multiple-baseline design, intervention was immediately and consistently effective in all classrooms. These findings support organizational behavior management applications within human services programs to improve performance that is related to environmental care.

Using Pictures Depicting App Icons to Conduct an MSWO Preference Assessment on a Tablet Device Abstract Identifying preferred content on tablet devices may be important when using such devices in programming. This study included six adults with disabilities and examined using laminated picture cards depicting application (app) icons to conduct multiple-stimulus without replacement (MSWO) preference assessments of iPad content. Following identification of preference hierarchies, we conducted reinforcer assessments to validate preference assessment results by demonstrating that selected apps functioned as reinforcers. We identified preference hierarchies for all participants, and the highest preferred app functioned as a reinforcer for a vocational task in five out of six participants' reinforcer assessments.

Considerations of Baseline Classroom Conditions in Conducting Functional Behavior Assessments in School Settings Abstract Research has shown that environmental classroom variables affect academic performance and student behavior, and appropriate behavior is often related to the presence of effective teaching practices and classroom management (Moore Partin, Robertson, Maggin, Oliver, & Wehby Preventing School Failure, 54, 172–178, 2010). For behavior analysts consulting in elementary education, some referrals for assessment and treatment of individual student behavior can be resolved by helping teachers establish effective class-wide practices. For this reason, some researchers suggest that behavior analysts should assess baseline classroom conditions as part of a functional behavior assessment (FBA; Anderson & St. Peter Behavior Analysis in Practice, 6(2), 62, 2013; Sutherland & Wehby Journal of Emotional and Behavioral Disorders, 11, 239–248, 2001). Through a literature review on effective classroom practices, we identified four specific classroom variables that have large effects on both learning outcomes and student behavior; we suggest consultants consider these four variables in baseline classroom assessments: (a) rates of active student responding (ASR), (b) appropriateness of the curriculum, (c) feedback and reinforcement, and (d) effective instructions and transitions. In this article, we will discuss each of these variables, describe how they can affect classroom behavior, and provide recommended targets from the research literature. We also provide a data-collection form for practitioners to use in their assessments of baseline classroom ecology, and for situations when these practices are not in place, we suggest potential resources for antecedent- and consequence-based interventions to decrease challenging classroom behavior.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Der Chirurg

Laparoskopische Enukleation von Insulinomen

Hypertherme intraperitoneale Chemotherapie Zusammenfassung Zytoreduktive Chirurgie (CRS) und hypertherme intraperitoneale Chemotherapie (HIPEC) sind fester Bestandteil der Therapie peritonealer Malignome. Eine vollständige makroskopische Zytoreduktion ist die Grundlage einer erfolgreichen multimodalen Therapie. Der Stellenwert der intraperitonealen Chemotherapie ist weiterhin unklar. Diese Übersichtsarbeit erklärt die Prinzipien und die Bedeutung der HIPEC innerhalb des multimodalen Therapiekonzeptes.

Leitliniengerechte Therapie des nichtkleinzelligen Bronchialkarzinoms

Seltener intraabdomineller Tumor

Interventionelle Versorgung tracheo-/bronchopleuraler Fisteln Zusammenfassung Hintergrund Bei fehlender Möglichkeit einer operativen Intervention stellt die interventionelle Bronchoskopie eine unverzichtbare Option in der Versorgung broncho- oder tracheopleuraler Fisteln dar. Methoden Die Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed sowie eigenen Erfahrungen. Ergebnisse Zum interventionellen Verschluss broncho- oder tracheopleuraler Fisteln können verschiedene Interventionsmethoden zur Anwendung kommen. Vor allem die Implantation endobronchialer Ventile oder eines Stents haben hier aktuell einen wichtigen Stellenwert. Neben Erfahrung in der starren und flexiblen sowie der interventionellen Bronchoskopie ist ein routinierter Umgang der anästhesiologischen Kollegen mit der Hochfrequenz-Jet-Ventilation im Rahmen der Bronchoskopie und Thoraxanästhesie unbedingt erforderlich. Diskussion Da standardisierte Therapieempfehlungen zur interventionellen Therapie der bronchopleuralen Fistel fehlen, muss für jeden Patienten in Abhängigkeit von der Lokalisation der bronchopleuralen Fistel sowie den Komorbiditäten ein individuelles Therapiekonzept erstellt werden.

Orale vs. enterale Ernährung bei Patienten mit postoperativer Pankreasfistel

Laparoskopische Pankreatoduodenektomie: Risiko ohne Nutzen?

Können nichtinvasive follikuläre Schilddrüsenneoplasien mit papillären Kernveränderungen (NIFTP) metastasieren?

Zentralisierung der komplexen Magenchirurgie in Deutschland

Sarkome – Bewährtes, Neues und Herausforderungen im multimodalen Management

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Genes & Genomics

Pre-labelled oligo probe-FISH karyotype analyses of four Araliaceae species using rDNA and telomeric repeat Abstract Background The family Araliaceae contains many medicinal species including ginseng of which the whole genome sequencing analyses have been going on these days. Objective To characterize the chromosomal distribution of 5S and 45S rDNAs and telomeric repeat in four ginseng related species of Aralia elata (Miq.) Seem., Dendropanax morbiferus H. Lév., Eleutherococcus sessiliflorus (Rupr. Et Maxim.) Seem., Kalopanax septemlobus (Thunb. ex A.Murr.) Koidz. Method Pre-labelled oligoprobe (PLOP)-fluorescence in situ hybridization (FISH) was carried out. Results The chromosome number of A. elata was 2n = 24, whereas that of the other three species of D. morbiferus, E. sessiliflorus, and K. septemlobus was 2n = 48, corresponding to diploid and tetraploid, respectively, based on the basic chromosome number x = 12 in Araliaceae. In all four species, one pair of 5S signals were detected in the proximal regions of the short arms of chromosome 3, whereas in K. septemlobus, the 5S rDNA signals localized in the subtelomeric region of short arm of chromosome 3, while all the 45S rDNA signals localized at the paracentromeric region of the short arm of chromosome 1. And the telomeric repeat signals were detected at the telomeric region of both short and long arms of most chromosomes. Conclusion The PLOP-FISH was very effective compared with conventional FISH method. These results provide useful comparative cytogenetic information to better understand the genome structure of each species and will be useful to trace the history of ginseng genomic constitution.

Comparative transcriptome analysis of salt-sensitive and salt-tolerant maize reveals potential mechanisms to enhance salt resistance Abstract Background Salt stress is a devastating environmental stress that causes plant growth inhibition and yield reduction. Objective The identification of salt-tolerant genes brings hope for the generation of salinity-tolerant crop plants through molecular breeding. Methods In this study, one salt-sensitive and one salt-tolerant maize inbred line were screened from 242 maize inbred lines. Reactive oxygen species (ROS)-related enzyme activities were detected and salt-responsive comparative transcriptome analysis was performed for control and 220 mM NaCl treated maize leaves. Results Salt-tolerant maize inbred line (L87) showed higher ROS-related enzyme (SOD, POD, APX and CAT) activities and accumulated relatively lower levels of ROS under salt stress. Of the total DEGs, 1856 upregulated DEGs were specific to L87, including stress tolerance-related members of the 70kDa family of heat shock proteins (Hsp70s) and aquaporins. The DEGs involved in the abscisic acid (ABA), ethylene, jasmonic acid (JA) and salicylic acid (SA) signal transduction pathways may determine the difference in salt tolerance between the two varieties, especially one central component SnRK2, that positively regulates ABA signaling and was only upregulated in L87. Analysis of DEGs related to ROS scavenging showed that some peroxidase (POD), glutathione S-transferase (GST), catalase (CAT) and superoxide dismutase (SOD) genes specific to L87 probably enhanced its salt tolerance. The analysis of differentially expressed transcription factors (TFs) suggested that WRKY TFs could contribute to the difference in salt tolerance between the two maize lines. Conclusion Compared with Salt-sensitive maize inbred line (L29), L87 exhibits specific regulatory mechanisms related to salt tolerance, including plant hormone interactions, ROS scavenging and the regulation of TFs. Our study identifies new candidate genes that may regulate maize tolerance to salt stress and provides useful information for breeding maize with high salt resistance.

Pathogenic potential of non-typhoidal Salmonella serovars isolated from aquatic environments in Mexico Abstract Background River water has been implicated as a source of non-typhoidal Salmonella (NTS) serovars in Mexico. Objective To dissect the molecular pathogenesis and defense strategies of seven NTS strains isolated from river water in Mexico. Methods The genome of Salmonella serovars Give, Pomona, Kedougou, Stanley, Oranienburg, Sandiego, and Muenchen were sequenced using the whole-genome shotgun methodology in the Illumina Miseq platform. The genoma annotation and evolutionary analyses were conducted in the RAST and FigTree servers, respectively. The MLST was performed using the SRST2 tool and the comparisons between strains were clustered and visualized using the Gview server. Experimental virulence assay was included to evaluate the pathogenic potential of strains. Results We report seven high-quality draft genomes, ranging from ~ 4.61 to ~ 5.12 Mb, with a median G + C value, coding DNA sequence, and protein values of 52.1%, 4697 bp, and 4,589 bp, respectively. The NTS serovars presented with an open pan-genome, offering novel genetic content. Each NTS serovar had an indistinguishable virulotype with a core genome (352 virulence genes) closely associated with Salmonella pathogenicity; 13 genes were characterized as serotype specific, which could explain differences in pathogenicity. All strains maintained highly conserved genetic content regarding the Salmonella pathogenicity islands (1–5) (86.9–100%), fimbriae (84.6%), and hypermutation (100%) genes. Adherence and invasion capacity were confirmed among NTS strains in Caco-2 cells. Conclusion Our results demonstrated the arsenal of virulence and defense molecular factors harbored on NTS serovars and highlight that environmental NTS strains are waterborne pathogens worthy of attention.

Evidence for relaxed selection of mitogenome in rapid-flow cyprinids Abstract Background Hypoxia adaptation is developed in many fish species, which helped them to habitat most of water bodies. However, fishes living under high oxygen concentration may lose this feature. Rapid flows provide high level and stable dissolved oxygen, which facilitate organism's oxygen supply and energy production. Previous studies showed that fish species from rapid-flow habitats exhibited lower hypoxia tolerance compared with fish from intermediate- and slow-flow habitats. Mitochondrial genomes code 13 key components in oxidative phosphorylation pathway; these genes may be under relaxed selection in rapid-flow species. Objectives The primary objectives of this study is to investigate the evolutionary patterns of the 13 mitochondrial OXPHOS genes among nine cyprinids from different water bodies and to test the hypotheses that mitochondrial OXPHOS genes may experience relaxed selection in rapid-flow habitats. Methods We classified nine cyprinid fish species into three groups based on their habitats: rapid-flow, intermediate-flow and slow-flow. To detect relaxed selections, we investigated the 13 protein-coding genes with codon evolution programs RELAX; to estimate evolutionary rates among the cyprinids, free-ratio model in Codeml program was applied; Branch-site models were applied to detect positive selection sites. The polymorphisms of homologous sites were evaluated with PROVEAN program and projected to 3D structure prediction of the proteins using SWISS-MODEL. Results We found that nine out of the 13 genes are under relaxed selection in rapid-flow species. Furthermore, dN, dS and dN/dS are relatively increased when compared with those of intermediate-flow species. More amino acid polymorphic sites are presented in rapid-flow species than in intermediate- and slow-flow species. Furthermore, rapid-flow species had more deleterious substitutions than other groups. 3D structure prediction of these proteins and projection of the polymorphic sites indicated that these sites were randomly distributed, suggesting relaxed functional constraints of these proteins in rapid-flow species. Conclusion Our results suggest that mitochondrial genes are under relaxed selection in rapid-flow cyprinids.

Deep sequencing reveals microRNA signature is altered in the rat epididymis following bilateral castration Abstract Background In the epididymis of bilateral castrated male rat, gene expression profile changed significantly. However, up to date, no study has investigated how these genes were regulated by microRNAs (miRNAs). Objective We investigated the alterations in the miRNA signature of the epididymis from sham-operated and bilaterally castrated rats. Methods By employing deep sequencing technology and qPCR, the global alterations of epididymal miRNA signature between sham-operated (Con-EP library) and bilaterally castrated rats (Cas-EP library) were explored. MiRNA-target interaction networks were annotated by GO and KEGG enrichment. Results We identified 313 and 306 known miRNAs as well as 152 and 114 novel miRNAs in the Con-EP and Cas-EP libraries, respectively. 59 miRNAs were differentially expressed, including 24 up-regulated and 35 down-regulated miRNAs, among which two up-regulated and three down-regulated ones were validated using qPCR. The expression of these miRNAs in the epididymides of rats at different postnatal ages showed regular changes from birth to adult, suggesting they were androgen-regulated. GO analysis showed that many of the miRNA targets were enriched in metabolic processes. KEGG analysis demonstrated that the targets mainly participated in the mitogen-activated protein kinase (MAPK) pathway. Moreover, 3 and 6 functional modules were detected among the up- and down-regulated miRNA target interaction networks, respectively, and these modules were involved in various biological processes. Conclusion This study represents the first systematic investigation of alterations in the miRNA signature of the epididymis from bilaterally castrated rats and will provide useful resources for functional studies of the miRNAs in the male reproductive system.

Evolutionary and functional implications of 3′ untranslated region length of mRNAs by comprehensive investigation among four taxonomically diverse metazoan species Abstract Background In eukaryotic organisms, it has been well acknowledged that 3′ untranslated regions (3′ UTRs) of mRNA are actively involved in post-transcriptional regulations of gene expression. Although both shortening and lengthening of 3′ UTRs of specific candidate genes were explicitly documented to have functional consequences, landscape of 3′ UTR lengths in relation to evolutionary dynamics and biological meanings remains to be elucidated when large-scale data become available. Objectives The primary objective of this study was to revealed different inter- and intra-species patterns on length distribution of 3′ UTRs in comparison with 5′ UTRs and coding regions. Methods In the present study, we investigated 3′ UTR lengths in a highly curated set of 57,135 mRNA sequences among four well-studied and taxonomically diverse metazoan species (fruit fly, zebrafish, mouse and human). Results The average length ratio of 3′–5′ UTRs considerably increased from fruit fly (twofold) to human (fivefold). Moreover, genes can be characterized by the obviously different patterns of evolutionary change on 3′ UTR lengths. By utilizing the Gene Ontology annotations, genes with differential lengths of 3′ UTRs were suggested to have the divergent functional implications. In human, we further revealed that ubiquitously transcribed genes had higher median lengths of 3′ UTRs than the genes of tissue-restricted expressions. Conclusion We conducted a comprehensive analysis and provided an overview regarding 3′ UTRs biology of mRNAs in animals, whereas the mechanistic explanations of 3′ UTRs length variation in correlation to regulation of gene expression still remain to be further studied.

A comprehensive analysis of the Baboon-specific full-length LINE-1 retrotransposons Abstract Background Long interspersed elements-1 (LINE-1s or L1s) and Alu elements are most successful retrotransposons that have generated genetic diversity and genomic fluidity in the primate genome. They account for ~ 27.7% of the primate genome. Interestingly, a previous study has shown that the retrotransposition rate of Alu elements is nine times higher in baboons than in humans. Objective The expansion of Alu copies could be dependent on the activity of L1-encoded proteins. Thus, we aimed to investigate full-length baboon-specific L1s and characterize structurally and functionally intact baboon-specific L1s (ORF1p/ORF2p and ORF2p only) that could induce trans-mobilization of Alu elements in the baboon genome. Results A total of 673 baboon-specific L1 candidates (> 4 kb) were identified through the comparative genomic analysis. Applying the baboon-specific correction value obtained from the experimental validation, it demonstrated that approximately 446 baboon-specific L1s (> 4 kb) were present in the baboon reference genome (papAnu2). In addition, we observed phylogenetic relationship of the baboon-specific L1s through the neighbor-joining method and they diverged from the L1PA6 consensus sequence. Finally, we identified 36 full-length baboon-specific L1s that were intact both ORF1p and ORF2p. Conclusion The number of baboon-specific full-length L1s is fewer than the number of human-specific full-length L1s. Therefore, there is possibility that the "L1 master gene" or "L1 source gene" is more abundant in the baboon genome, or that in trans retrotransposition activity of baboon-specific L1s is relatively stronger than in the other genomes.

Long noncoding RNA UCA1 inhibits ischaemia/reperfusion injury induced cardiomyocytes apoptosis via suppression of endoplasmic reticulum stress Abstract Background Ischemia heart disease is one of the major causes of death worldwide which often associated with tissue infarction and limit the recovery of function. Multiple factors involved in the I/R-induced cardiomyocyte dysfunction which were consistent with a role of oxidative stress and altered endothelium-dependent responses. However, the pathogenic mechanisms in I/R injury remain unclear. Materials and methods The H9C2 cells were in the ischaemia/reperfusion (I/R) condition. After I/R, the cells were transfected with or without adenovirus-urothelial carcinoma associated 1(Ad-UCA1). Then qRT-PCR analysis was performed to quantify mRNA expression of different treatment groups. Cell apoptosis rate was assessed using flow cytometry and ER stress biomarker expression were measured by immunoblotting. Intracellular and mitochondrial ROS generation were assayed by fluorescence microscope after staining with the DCFDA or MitoSOX. Results I/R conditions trigger lncRNAs UCA1 expression, cellular and mitochondria ROS production, resulting in cell apoptosis through the induction of oxidative and ER stress. Overexpression of UCA1 protects H9C2 cells from I/R-induced ER stress and cell apoptosis. Moreover, UCA1 might be a potential regulator in the protective effect of I/R‑induced oxidative stress and mitochondria dysfunction. Subsequently, ER stress inhibitor attenuated the effect of siUCA1 induced injury in H9C2 cells. Conclusion The expression of UCA1 against I/R induced oxidative stress and mitochondria dysfunction via suppression of endoplasmic reticulum stress. UCA1 might be a biomarker to improved diagnosis of I/R injury.

Transcriptome-wide identification of miRNA targets and a TAS3-homologous gene in Populus by degradome sequencing Abstract Background Degradome sequencing has been applied to identify miRNA-directed mRNA cleavage and understand the biological function of miRNAs and their target genes in plants defense to stress. miRNAs involved in the response to cold stress have been identified in Populus, however, there are few reports about the validated targets of miRNAs in Populus under cold stress. Objectives The primary objective of this investigation was to globally identify and validate the targets of the miRNAs and regulatory components in Populus under cold stress. Methods Populus plantlets grown in vitro were treated with cold (4 °C for 8 h) and total RNA was extracted using Trizol reagent. Approximately 200 µg total RNA was used for the construction of the degradome library, and degradome sequencing was conducted on an Illumina HiSeq 2000. The sequences were mapped to Populus genome using SOAP 2.0 and then were collected for degradome analysis. Additionally, trans-acting siRNA sequences from transacting siRNA gene 3 sequences and mature miRNAs cleaved from precursor miRNAs of Populus were analyzed. 5′ RNA ligase-mediated-RACE (5′-RACE) were further conducted. Results 80 genes were experimentally determined to be the target of 51 unique miRNAs, including three down-regulated miRNAs (pto-miR156k, pto-miR169i-m, and pto-miR394a-5p/b-5p) and two up-regulated miRNAs (pto-miR167a-d and pto-miR167f/g). The specificity and diversity of cleavage sites of miRNA targets were validated through 5′-RACE experiment and the results were similar with that of degradome sequencing, further supporting the empirical cleavage of miRNAs on targets in vivo in Populus. Interestingly, the TAS-homologous gene pto-TAS3 (EF146176.1) was identified and 11 potential ta-siRNAs [D1(+)–D11(+)] and their possible biogenesis sites within the pto-TAS3 transcript sequence were predicted in Populus. In addition, the biosynthesis of miRNA from precursor miRNA (pre-miRNA) was also validated through the detection of a total of 17 pre-miRNAs. Conclusion Our investigation expands the application of degradome sequencing for evaluating miRNA regulatory elements and evidence of the miRNA synthesis process, and provides empirical evidence of bona fide cleavage of target genes by miRNAs in Populus, which might be used for the research of miRNA-mediated regulation mechanism and molecular improvement of resistance to cold stress.

Sugar metabolism as input signals and fuel for leaf senescence Abstract Senescence in plants is an active and acquired developmental process that occurs at the last developmental stage during the life cycle of a plant. Leaf senescence is a relatively slow process, which is characterized by loss of photosynthetic activity and breakdown of macromolecules, to compensate for reduced energy production. Sugars, major photosynthetic assimilates, are key substrates required for cellular respiration to produce intermediate sources of energy and reducing power, which are known to be essential for the maintenance of cellular processes during senescence. In addition, sugars play roles as signaling molecules to facilitate a wide range of developmental processes as metabolic sensors. However, the roles of sugar during the entire period of senescence remain fragmentary. The purpose of the present review was to examine and explore changes in production, sources, and functions of sugars during leaf senescence. Further, the review explores the current state of knowledge on how sugars mediate the onset or progression of leaf senescence. Progress in the area would facilitate the determination of more sophisticated ways of manipulating the senescence process in plants and offer insights that guide efforts to maintain nutrients in leafy plants during postharvest storage.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Heart Failure

Experimental models of cardiac physiology and pathology Abstract Experimental models of cardiac disease play a key role in understanding the pathophysiology of the disease and developing new therapies. The features of the experimental models should reflect the clinical phenotype, which can have a wide spectrum of underlying mechanisms. We review characteristics of commonly used experimental models of cardiac physiology and pathophysiology in all translational steps including in vitro, small animal, and large animal models. Understanding their characteristics and relevance to clinical disease is the key for successful translation to effective therapies.

Cardiorenal syndrome in heart failure with preserved ejection fraction—an under-recognized clinical entity Abstract Cardiorenal syndrome (CRS) results from the complex and bidirectional interaction between the failing heart and the kidneys. Limited information exists about the pathophysiology and treatment options for worsening kidney function in the setting of heart failure with preserved ejection fraction (HFpEF). This review summarizes the salient pathophysiological pathways in CRS in patients with HFpEF, with emphasis on type 1 and type 2 phenotypes, and outlines diagnostic and therapeutic strategies that are applicable in this population. Elevated central venous and intra-abdominal pressure, left ventricular hypertrophy, LV strain, RAAS activation, oxidative injury, pulmonary hypertension, and RV dysfunction play key roles in the pathogenesis of CRS in the backdrop of HFpEF. The availability of biomarkers of renal and cardiac injury offer a new dimension in accurately diagnosing and quantifying end organ damage in CRS and will improve the accuracy of goal-directed therapies in this population. Novel targeted therapies such as the development of angiotensin/neprilysin inhibitors and sodium-glucose cotransporter-2 (SGLT-2) inhibitors offer new territory in realizing potential benefits in reduction of cardio-renal adverse outcomes in this population. Future studies focusing exclusively on renal outcomes in patients with HFpEF are crucial in delivering optimal therapies in this subset of patients.

Valuing health-related quality of life in heart failure: a systematic review of methods to derive quality-adjusted life years (QALYs) in trial-based cost–utility analyses Abstract The accurate measurement of health-related quality of life (HRQoL) and the value of improving it for patients are essential for deriving quality-adjusted life years (QALYs) to inform treatment choice and resource allocation. The objective of this review was to identify and describe the approaches used to measure and value change in HRQoL in trial-based economic evaluations of heart failure interventions which derive QALYs as an outcome. Three databases (PubMed, CINAHL, Cochrane) were systematically searched. Twenty studies reporting economic evaluations based on 18 individual trials were identified. Most studies (n = 17) utilised generic preference-based measures to describe HRQoL and derive QALYs, commonly the EQ-5D-3L. Of these, three studies (from the same trial) also used mapping from a condition-specific to a generic measure. The remaining three studies used patients' direct valuation of their own health or physician-reported outcomes to derive QALYs. Only 7 of the 20 studies reported significant incremental QALY gains. Most interventions were reported as being likely to be cost-effective at specified willingness to pay thresholds. The substantial variation in the approach applied to derive QALYs in the measurement of and value attributed to HRQoL in heart failure requires further investigation.

Advances in the diagnosis and treatment of transthyretin amyloidosis with cardiac involvement Abstract Amyloidosis is caused by extracellular deposition of insoluble abnormal fibrils constituted by misfolded proteins, which can modify tissue anatomy and hinder the function of multiple organs including the heart. Amyloidosis that can affect the heart includes mostly systemic amyloidosis (amyloid light chain, AL) and transthyretin amyloidosis (ATTR). The latter can be acquired in elderly patients (ATTRwt), or be inherited in younger individuals (ATTRm). The diagnosis is demanding given the high phenotypic heterogeneity of the disease. Therefore, "red flags," which are suggestive features giving support to diagnostic suspicion, are extremely valuable. However, the lack of broad awareness among clinicians represents a major obstacle for early diagnosis and treatment of ATTR. Furthermore, recent implementation of noninvasive diagnostic techniques has revisited the need for endomyocardial biopsy (EMB). In fact, unlike AL amyloidosis, which requires tissue confirmation and typing for diagnosis, ATTR can now be diagnosed noninvasively with the combination of bone scintigraphy and the absence of a monoclonal protein. Securing the correct diagnosis is pivotal for the newly available therapeutic options targeting both ATTRm and ATTRwt, and are directed to either stabilization of the abnormal protein or the reduction of the production of transthyretin. The purpose of this article is to review the contemporary aspects of diagnosis and management of transthyretin amyloidosis with cardiac involvement, summarizing also the recent therapeutic advances with tafamidis, patisiran, and inotersen.

READY: relative efficacy of loop diuretics in patients with chronic systolic heart failure—a systematic review and network meta-analysis of randomised trials Abstract The majority of patients with chronic heart failure (HF) receive long-term treatment with loop diuretics. The comparative effectiveness of different loop diuretics is unknown. We searched PubMed, clinicaltrials.gov, the Cochrane Central Register of Controlled Trials and the European Union Clinical Trials Register for randomised clinical trials exploring the efficacy of the loop diuretics azosemide, bumetanide, furosemide or torasemide in patients with HF. Comparators included placebo, standard medical care or any other active treatment. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular mortality, HF-related hospitalisation and any combined endpoint thereof. Hypokalaemia and acute renal failure were defined as additional safety endpoints. Evidence was synthesised using network meta-analysis (NMA). Thirty-four trials reporting on 2647 patients were included. The overall quality of evidence was rated as moderate. NMA demonstrated no significant differences between loop diuretics with respect to all-cause mortality, cardiovascular mortality or hypokalaemia. In contrast, torasemide ranked best in terms of HF hospitalisation, and there was a trend towards benefits with torasemide with regard to occurrence of acute renal failure. Sensitivity analyses excluding trials with a follow-up < 6 months, trials with a cross-over design and those including < 25 patients confirmed the main results. We found no significant superiority of either loop diuretic with respect to mortality and safety endpoints. However, clinicians may prefer torasemide, as it was associated with fewer HF-related hospitalisations.

Pathophysiology and imaging of heart failure in women with autoimmune rheumatic diseases Abstract Autoimmune rheumatic diseases (ARDs) affect 8% of the population, and approximately 78% of them are women. Cardiovascular disease (CVD) in ARDs encompasses different pathophysiologic processes, such as endothelial dysfunction, myocardial/vascular inflammation and accelerated atherosclerosis with silent clinical presentation, leading to heart failure (HF), usually with preserved ejection fraction. Echocardiography and cardiovascular magnetic resonance (CMR) are the two most commonly used noninvasive imaging modalities for the evaluation of HF in patients with ARDs. Echocardiography currently represents the main diagnostic tool for cardiac imaging in clinical practice. However, the demand for more efficient and prompt diagnostic and therapeutic approach in this specific population necessitates the implementation of modalities capable of providing a more detailed and quantified information from the point of tissue characterization. Furthermore, echocardiography is an operator and acoustic window depended modality, with relatively low reproducibility and unable to perform tissue characterization. CMR is a noninvasive modality without radiation that can give reproducible and operator-independent information about both myocardial function and tissue characterization. By providing quantification of oedema, stress perfusion defects and fibrosis, CMR can diagnose myocardial inflammation, micro–macro-vascular myocardial ischemia and replacement or diffuse fibrosis, respectively. Tissue characterization allows for moving beyond the cardiac function to the assessment of intra- and inter-cellular alterations and promotes the development of personalized cardiac and anti-rheumatic treatment in ARDs with HF. ARDs are mainly female diseases. Cardiac involvement leading in HF is not unusual in ARDs and remains the main cause of death. Noninvasive, nonradiating imaging modalities such as echocardiography and CMR represent the main diagnostic tools. Specifically, echocardiography represents the first diagnostic approach; however, it is CMR that gives information about the pathophysiologic background behind HF in ARDs.

Effects of exercise training on cardiac function, exercise capacity, and quality of life in heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials Abstract Left ventricular (LV) diastolic dysfunction is associated with the pathophysiology of heart failure with preserved ejection fraction (HFpEF) and contributes importantly to exercise intolerance that results in a reduced quality of life (QOL) in HFpEF patients. Although the effects of exercise training on LV diastolic function, exercise capacity, or QOL in HFpEF patients have been examined in randomized clinical trials (RCTs), results are inconsistent due partly to limited power with small sample sizes. We aimed to conduct a meta-analysis of RCTs examining the effects of exercise training on LV diastolic function and exercise capacity as well as QOL in HFpEF patients. The search of electronic databases identified 8 RCTs with 436 patients. The duration of exercise training ranged from 12 to 24 weeks. In the pooled analysis, exercise training improved peak exercise oxygen uptake (weighted mean difference [95% CI], 1.660 [0.973, 2.348] ml/min/kg), 6-min walk distance (33.883 [12.384 55.381] m), and Minnesota Living With Heart Failure Questionnaire total score (9.059 [3.083, 15.035] point) compared with control. In contrast, exercise training did not significantly change early diastolic mitral annular velocity (weighted mean difference [95% CI], 0.317 [− 0.952, 1.587] cm/s), the ratio of early diastolic mitral inflow to annular velocities (− 1.203 [− 4.065, 1.658]), or LV ejection fraction (0.850 [− 0.128, 1.828] %) compared with control. In conclusion, the present meta-analysis suggests that exercise training improves exercise capacity and QOL without significant change in LV systolic or diastolic function in HFpEF patients.

Nutrition intervention in heart failure: should consumption of the DASH eating pattern be recommended to improve outcomes? Abstract Heart failure (HF) is a chronic, systemic disorder that presents a serious and growing public health problem due to its high prevalence, mortality, and cost of care. Due to the aging of the population and medical advances that prolong the life of HF patients, more effective, widespread strategies for improved HF management in this rapidly growing patient population are needed. While the prevalence of malnutrition in HF patients has been well characterized, evidence is limited regarding the effects of specific macro- and micronutrient deficiencies on HF outcomes and their interaction with other aspects of HF management, including pharmacotherapy. There is a mounting appreciation for the effects of nutritional intervention on pathophysiology, treatment, and outcomes in patients with HF. Heart-healthy dietary patterns, such as the Dietary Approaches to Stop Hypertension (DASH), carry importance for the prevention and treatment of hypertension. While preliminary evidence looks promising regarding effects of DASH eating pattern consumption on ventricular function and 30-day hospitalizations in HF patients, more research is needed to confirm its effects on short-term and long-term HF outcomes while better understand underlying mechanisms in the context of HF pharmacotherapy.

Effects of European Society of Cardiology guidelines on medication profiles after hospitalization for heart failure in 22,476 Dutch patients: from 2001 until 2015 Abstract Prescriber adherence to guideline-recommended medication in patients with heart failure (HF) in clinical practice is suboptimal. We analyzed how evolving guideline recommendations influenced medication profiles after a first HF hospitalization. We extracted medication profiles from the Dutch PHARMO Database Network for 22,476 patients with a diagnosis of HF at hospital discharge between 2001 and 2015. The percentage of patients prescribed the combination of a beta-blocker (BB) and an angiotensin-converting-enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB) increased from 24 to approximately 45% within this 15-year period. The percentage of patients who also used a mineralocorticoid-receptor antagonist (MRA) reached approximately 20%. The probability of being prescribed these combinations decreased with increasing age. As a consequence of the policy change in the ESC guideline 2001, the use of BB increased from less than 40% in 2001 to about 70% by 2015. The percentage of patients prescribed an ACEI and/or an ARB, an MRA, or a diuretic was about stable, at respectively 63%, 37%, and 82%. Although the 2012 ESC guideline also advised MRA in the New York Heart Association (NYHA) class II, there was no increase in MRA prescriptions. Compliance with the ESC guidelines varied for the individual recommendations. Remarkably, there was no significant increase in MRA prescriptions. At the same time, developments were demonstrated, which were not instigated by the guidelines, like the shift from ACEI to ARB. Although the exact HF classification of our patients was unknown, given a relatively stable case mix, our data provide insight into "real-world" pharmacological management.

Personalized physiology-guided resuscitation in highly monitored patients with cardiac arrest—the PERSEUS resuscitation protocol Abstract Resuscitation guidelines remain uniform across all cardiac arrest patients, focusing on the delivery of chest compressions to a standardized rate and depth and algorithmic vasopressor dosing. However, individualizing resuscitation to the appropriate hemodynamic and ventilatory goals rather than a standard "one-size-fits-all" treatment seems a promising new therapeutic strategy. In this article, we present a new physiology-guided treatment strategy to titrate the resuscitation efforts to patient's physiologic response after cardiac arrest. This approach can be applied during resuscitation attempts in highly monitored patients, such as those in the operating room or the intensive care unit, and could serve as a method for improving tissue perfusion and oxygenation while decreasing post-resuscitation adverse effects.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com