Aims, Background and Framework of the EU-Project Smart Region

During the next years and decades the demographic change will significantly influence social structures, economies and labour markets in Europe. At this, the demographic developments will lead to considerable changes in the age composition of the labour force potential: In the close future there will not only be a steadily increasing proportion ofolder employees who attend to the labour markets but they also will-in combination with political measures to extend working lives - have to work longer. The given circumstances create challenges for the employees, employers and policy makers alike and raise a number ofquestions: What are the altematives to the prevalent practice ofearly retirement? How will it be possible for companies to remain productive and competitive with older and ageing workforces? Which measures can contribute to employees maintaining their health and their ability and motivation to work longer

Plasma TF activity predicts cardiovascular mortality in patients with acute myocardial infarction

<p>Abstract</p> <p>Objectives and Background</p> <p>Tissue factor (TF) contributes to thrombosis following plaque disruption in acute coronary syndromes (ACS). Aim of the study was to investigate the impact of plasma TF activity on prognosis in patients with ACS.</p> <p>Methods and Results</p> <p>One-hundred seventy-four patients with unstable Angina pectoris (uAP) and 112 patients with acute myocardial infarction (AMI) were included with a mean follow up time of 3.26 years. On admission, plasma TF activity was assessed. Patients were categorized into 2 groups: a high-TF activity group with TF >24 pmol/L and low TF activity group with TF ≤ 24 pmol/L. Fifteen cardiovascular deaths occurred in the uAP group and 16 in the AMI group. In AMI TF activity was 24,9 ± 2,78 pmol/l (mean ± SEM) in survivors and 40,9 ± 7,96 pmol/l in nonsurvivors (P = 0.024). In uAP no differences were observed (25.0 ± 8.04 pmol/L nonsurvivors vs. 25.7 ± 2.14 pmol/L survivors; P = 0.586). Kaplan-Meier estimates of survival at 3.26 years regarding TF activity in AMI were 81.3% and 92.2% with an hazard ratio of 3.02 (95% CI [1.05–8.79], P = 0.03). The Cox proportional hazards model adjusting for correlates of age and risk factors showed that plasma TF activity was an independent correlate of survival (hazard ratio 9.27, 95% CI [1.24–69.12], P = 0.03). In an additional group of patients with uAP and AMI, we identified circulating microparticles as the prevailing reservoir of plasma TF activity in acute coronary syndromes.</p> <p>Conclusion</p> <p>Systemic TF activity in AMI has an unfavorable prognostic value and as a marker for dysregulated coagulation may add to predict the atherothrombotic risk.</p

Regionale Standards: Ausgabe 2013

"Die 'Regionalen Standards' gehen zurück auf die Initiative eines gemeinsamen Arbeitskreises, bestehend aus Vertretern des Statistischen Bundesamtes, der Arbeitsgemeinschaft Sozialwissenschaftlicher Institute e.V. (ASI) und des ADM Arbeitskreis Deutscher Markt- und Sozialforschungsinstitute e.V. Sie stellen ein Angebot für die Forschung in der Bundesrepublik Deutschland dar. Die 'Regionalen Standards' beschreiben Gebietsabgrenzungen und Instrumente zur Typisierung von Regionen, wie sie in der Bundesrepublik Deutschland von der amtlichen Statistik und/oder der Markt- und Sozialforschung in gewisser Regelmäßigkeit eingesetzt werden. Zusätzlich werden Datensätze aus unterschiedlichen Quellen vorgestellt, die für die Regionalisierung von Bevölkerungsumfragen genutzt werden können und für die Forschung (teils jedoch mit Einschränkungen) zur Verfügung stehen. Ergänzt werden die 'Regionalen Standards' durch eine jährlich aktualisierte Tabellenanalyse aus dem Mikrozensus, zu beziehen über die Internetseiten www.destatis.de, www.gesis.org und www.adm-ev.de." (Autorenreferat

Effect of Erythropoietin in patients with acute myocardial infarction: five-year results of the REVIVAL-3 trial

Erythropoietin (EPO) has been suggested to promote cardiac repair after MI. However, the randomized, double-blind, placebo controlled REVIVAL-3 trial showed that short term high dose EPO in timely reperfused myocardium does not improve left ventricular ejection fraction after 6 months. Moreover, the study raised safety concerns due to a trend towards a higher incidence of adverse clinical events as well as a increase in neointima formation after treatment with EPO. The present study therefore aimed to assess the 5-year clinical outcomes.After successful reperfusion 138 patients with STEMI were randomly assigned to receive epoetin beta (3.33×10U, n = 68) or placebo (n = 70) immediately, 24 and 48 h after percutaneous coronary intervention. The primary outcome of the present study- the combined incidence of MACE 5 years after randomization - occurred in 25% of the patients assigned to epoetin beta and 17% of the patients assigned to placebo (RR 1.5; 95% CI 0.8-3.5; p = 0.26). Target lesion revascularization was required in 15 patients (22.1%) treated with epoetin-ß and 9 patients (12.9%) treated with placebo (p = 0.15). Analysis of patients in the upper and lower quartile of baseline hemoglobin as an indirect estimate of endogenous erythropoietin levels revealed no significant impact of endogenous erythropoietin on efficiency of exogen administered epoetin-ß in terms of death and MACE.These long-term follow-up data show that epoetin beta does not improve clinical outcomes of patients with acute myocardial infarction.URL www.clinicaltrials.gov ; Unique identifier NCT00390832; trial registration date October 19th 2006

Stem cell mobilisation by granulocyte-colony stimulating factor in patients with acute myocardial infarction. Long-term results of the REVIVAL-2 trial.

Treatment with granulocyte-colony stimulating factor (G-CSF) mobilises cells from the bone marrow to the peripheral blood. Previous preclinical and early clinical trials may suggest that treatment with G-CSF leads to improved myocardial perfusion and function in acute or chronic ischaemic heart disease. In the REVIVAL-2 study we found that stem cell mobilisation by G-CSF does not influence infarct size, left ventricular function and coronary restenosis in patients with acute myocardial infarction (MI) that underwent successful percutaneous coronary intervention. The objective of the present analysis was to assess the impact of G-CSF treatment on seven-year clinical outcomes from the REVIVAL-2 trial. In the randomized, double-blind, placebo-controlled REVIVAL-2 study, 114 patients with the diagnosis of acute myocardial infarction were enrolled five days after successful reperfusion by percutaneous coronary intervention. Patients were assigned to receive 10 µg/kg G-CSF (n=56) or placebo (n=58) for five days. The primary endpoint for this long-term outcome analysis was the composite of death, myocardial infarction or stroke seven years after randomisation. The endpoint occurred in 14.3 % of patients in the G-CSF group versus 17.2 % assigned to placebo (p=0.67). The combined incidence of death or myocardial infarction occurred in 14.3 % of the patients assigned to G-CSF and 15.5 % of the patients assigned to placebo (p=0.85). In conclusion, these long-term follow-up data show that G-CSF does not improve clinical outcomes of patients with acute myocardial infarction

Ultrasound-guided thrombin injection for treatment of femoral artery pseudoaneurysm with concomitant AV-fistula - a retrospective single centre experience.

Increasing volume of complex percutaneous endovascular procedures in highly anticoagulated patients generate a not negligible percentage of femoral pseudoaneurysms (PSA) with concomitant arteriovenous fistulas (AVF). While ultrasound-guided thrombin injection (UGTI) is the therapy of choice for PSA, concomitant AVF is regarded as a contraindication for UGTI, as venous thromboembolism is feared. In this retrospective, register-based cohort study, we report on and evaluate the use of UGTI for the treatment of PSA with AFV.All patients (n = 523), who underwent UGTI for femoral PSA at the German Heart Centre Munich from January 2011 until January 2018, were retrospectively reviewed for the presence of a concomitant AVF and outcomes were recorded.Forty femoral PSA/AVFs treated by UGTI were identified. The mean enddiastolic arterial-flow-velocity above the AVF, an estimate of the AVF size, was 14.61 ± 1.7 cm/sec. The Majority of patients exhibited flow-velocities < 25 cm/sec (n = 31; 77.5 %) and were on either uninterrupted oral anticoagulation (n = 32; 80 %) or dual antiplatelet therapy (n = 8). Twenty-eight (70 %) PSA/AVFs could be successfully closed by UGTI. In eight multicompartmental PSAs, partial obliteration necessitated combined treatment with manual compression, while one partial occlusion was treated by observation. There were three failures, of which two underwent covered-stent-graft-implantation and one surgical repair. One DVT (2.5 %) occurred two days after UGTI in the by far largest AVF (60 cm/sec) included in the study. Besides two late PSA recurrences treated by surgery, no other complications were observed. AVF persisted in 65 %, all of them asymptomatic. The mean follow-up was 6 ± 15.5 months.UGTI appears to be a treatment option in femoral PSA/AVF, at least under oral anticoagulation in small fistulas with enddiastolic arterial-flow-velocities <= 25 cm/sec. However, caution is necessary in larger AVFs, which should remain a contraindication for UGTI

Zirkulierender Tissue Factor und systemische T-Zell-Aktivierung im akuten Koronarsydrom: Mechanismen und klinische Bedeutung

Die Ursachen der koronaren Atherothrombose, die unverändert zu den führenden Todesursachen der westlichen Industrienationen zählt, sind komplex und involvieren inflammatorische sowie thrombogene Prozesse. Die genauere Analyse dieser Prozesse bildet die Basis für die Entwicklung neuer spezifischer Therapien. In der vorliegenden kumulativen Habilitationsschrift werden sieben wissenschaftliche Originalarbeiten zusammengefasst, die entzündliche und thrombogene Veränderungen in der Zirkulation der symptomatischen KHK charakterisieren. Die Ergebnisse der verschiedenen Arbeiten zeigen, dass Entzündungen und Gerinnungen nicht lokal auf die Plaque beschränkt sind. Immun-inflammatorische und thrombogene Prozesse der systemischen Zirkulation sind vielmehr in differentieller Ausprägung mit den verschiedenen klinischen Stadien der Atherothrombose assoziiert und deuten so eine spezifische Integration in die Plaqueprogression und Atherogenese an

Circulating endothelial progenitor cells decrease in patients after endarterectomy

BackgroundEndothelial progenitor cells (EPC) contribute to vascular regeneration. Since surgical injury and burns induce a pro-inflammatory and proangiogenic response, we investigated the effect of vascular injury with minimal surgical trauma after endarterectomy on the number of circulating EPC and systemic inflammatory changes.Methods and ResultsForty-five patients with peripheral arterial occlusive disease were included in the study. Venous blood samples were taken before and 1 day after endarterectomy and plaque material was obtained. Ten patients with minor surgery served as controls. Circulating CD133+CD34+, VEGFR-2+CD34+ progenitor cells and surface expression of CD11b on circulating neutrophils were analysed using flow cytometry. EPCs were characterized in a culture assay as double-positive for DiI-LDL uptake and lectin binding. Cytokine concentrations of interleukin (IL)-6, IL-8, TNF-α, IL-1ß, IL-10, IL-12, SDF-1, G-CSF, and VEGF were measured in plasma and tissue samples. After endarterectomy a significant decrease in circulating EPC, CD133+CD34+, and VEGFR-2+CD34+ cells was observed. This was associated with a specific pattern of changes in circulating cytokine levels after endarterectomy with a decrease in IL-1 beta and IL-12, an increase in IL-6 and G-CSF plasma concentrations, and surface expression of CD11b on circulating neutrophils. In contrast, after minor surgery an increase in circulating CD133+CD34+ cells, IL-6, IL-8, and IL-10 was found. Interestingly there was a negative association between levels of local IL-6 within the plaque and only the preoperative levels of circulating CD133+C34+.ConclusionEndarterectomy induces changes in circulating cytokines and a decline in circulating progenitor cells, which may be due to recruitment of progenitor cells to the injured vessels. This is supported by the negative association between plaque inflammation and circulating progenitor cells before endarterectomy

Selective mobilization of CD14⁺CD16⁺monocytes by exercise

Strenuous, anaerobic exercise leads to an increase of leukocytes that are mobilized from the marginal pool. We have analyzed in human peripheral blood the effect of exercise on the number of CD14+CD16+monocytes as determined by two-color immunofluorescence and flow cytometry. We show herein that this type of monocyte responds with a dramatic up to 4.8-fold increase. Mobilization does not occur after 1 min at 100 or 200 W but 1 min at 400 W leads to a twofold increase of the CD14+CD16+monocytes immediately after exercise. The numbers remain high at 5 min and gradually decrease to reach the initial level at 20 min postexercise. After 20 min of rest, the CD14+CD16+monocytes can be mobilized again by a second exercise. The CD14+CD16+monocytes appear to be mobilized from the marginal pool where they preferentially home because of a higher expression of adhesion molecules like CD11d and very late antigen-4. Exercise goes along with an increase of catecholamines, and mobilization of the CD14+CD16+monocytes can be substantially reduced by treatment of donors with the β-adrenergic receptor blocker propranolol. Mobilization of CD14+CD16+monocytes by a catecholamine-dependent mechanism may contribute to the increase of these cells in various clinical conditions.</jats:p