Liver transplantation in primary biliary cirrhosis: Risk assessment and 11-year follow-up

Background/Aims: Liver transplantation (LTx) is the only established treatment in patients with end-stage primary biliary cirrhosis (PBC). Although short-term survival after LTx in this group of patients is usually good, few data exist on the long-term survival. The optimal timing of transplantation is difficult. Thus, the aims of this study were to assess the long-term survival of patients with PBC after LTx and to identify potential predictive factors for a positive outcome. Methods: Survival of 28 patients with PBC who underwent LTx between 1985 and July 1999 in a single center was studied by Kaplan-Meier analysis and was compared to predicted survival without LTx using established prognostic models for PBC, the Mayo and European risk scores. Potential prognostic parameters obtained before LTx were tested for correlation to survival. Rates of bone fractures as markers of hepatic osteodystrophy were compared before and after LTx. Results: Median follow-up after LTx was 90 months with a maximum of 140 months. Actuarial survival of patients with PBC was 89% after 1, 5, and 10 years and was significantly better than estimated survival without LTx after 1-7 years as calculated by the Mayo and European risk scores. Of several parameters tested, only serum bilirubin and the prognostic scores, but no other liver function tests obtained immediately prior to transplantation were significantly correlated with survival after LTx. The duration of intensive care after LTx was not associated with any parameters obtained before LTx. Bone fractures were diagnosed in 43% of patients of whom the vast majority were osteopenic before LTx as determined by osteodensitometry. Conclusion: Longterm survival of a well-defined group of patients with PBC was excellent after LTx and was inversely correlated with preoperative serum bilirubin levels as well as Mayo and European risk scores. Copyright (C) 2000 S. Karger AG. Basel

Fehlerquote bei der ICD-Verschlüsselung und Realisierbarkeit der Pflege-Personalregelung des Gesundheitsstrukturgesetzes

Seit 1. 1. 1993 ist auf den Erhebungsbögen der Pflege-Personalregelung des Gesundheitsstrukturgesetzes die Angabe des ICD-Schlüssels (ICD = »international classification of diseases«) der Hauptdiagnose gesetzlich vorgeschrieben. Um die Fehlerquote bei dieser Verschlüsselung und deren Ursachen zu analysieren, wurden für das 1. Halbjahr 1993 die Daten der Pflege-Personalregelung erfaßt und die ICD-Schlüssel mit den korrespondierenden Einträgen des Diagnosenarchivs abgeglichen. Bei 671 der 2308 überprüften Erhebungsbögen (29 %) wurden Fehler bei der Verschlüsselung festgestellt. Besonders hoch war die Fehlerquote in den Bereichen Kardiologie (39 %), Angiologie (37 %), Nephrologie (36 %) und Neurologie (35 %). Allerdings stammten die falschen Diagnosen in der Kardiologie und Nephrologie zu einem hohen Prozentsatz aus demselben Diagnosenteilbereich. - Im Sinne der Qualitätssicherung müssen die an der Verschlüsselung beteiligten Ärzte über die negativen Folgen für die Personalausstattung umfassend informiert werden; die Verschlüsselung muß von erfahrenen Kollegen durchgeführt, klinikintern überprüft und, falls technisch möglich, mit dem Diagnosenarchiv abgeglichen werden. Die Erfassung nur einer Hauptdiagnose ist bei multimorbiden Patienten nicht sinnvoll.Since 1 January, 1993, it has been a legal requirement to enter, for identification of the main diagnosis, the appropriate code from the International Classification of Diseases (ICD) on the documentation forms of the Nursing Personnel Regulation as prescribed under the (German Federal Government's) Health Organization Law. This study was undertaken to analyse the frequency of errors in this coding and the reasons for it. The data of the Nursing Personnel Regulations during the first 6 months of 1993 were compared with the corresponding entries in the diagnostic archives. In 671 of 2308 analysed forms (29 %) coding errors were discovered. The rate of errors was especially high in the areas of cardiology (39 %), angiology (37 %), nephrology (36 %) and neurology (35 %). However, a high percentage of the wrong codings for cardiological and nephrological diseases were still within the same diagnostic field. - These findings indicate that, to ensure quality, those doctors who do the coding should be fully informed about the potential consequences regarding staffing of such errors. All coding must be done by experienced doctors, be locally checked and, if technically possible, compared with the diagnostic archive entries. Also, the registration of only one main diagnosis is not sensible in the case of patients with multi-organ disease

Transcatheter Aortic Valve Implantation in Dialysis Patients

Background/Aims: Transcatheter aortic valve implantation (TAVI) has emerged as a new therapeutic option for high-risk patients. However, dialysis patients were excluded from all previous studies. The aim of this study is to compare the outcomes of TAVI for dialysis patients with those for patients with chronic kidney disease (CKD) stages 3 and 4 and to compare TAVI with open surgery in dialysis patients. Methods: Part I: comparison of 10 patients on chronic hemodialysis with 116 patients with non-dialysis-dependent CKD undergoing TAVI. Part II: comparison of transcatheter (n = 15) with open surgical (n = 24) aortic valve replacement in dialysis patients. Results: Part I: dialysis patients were significantly younger (72.3 vs. 82.0 years; p < 0.01). Hospital stay was significantly longer in dialysis patients (21.8 vs. 12.1 days; p = 0.01). Overall 30-day mortality was 3.17%, with no deaths among dialysis patients. Six-month survival rates were similar (log-rank p = 0.935). Part II: patient age was comparable (66.5 vs. 69.5 years; p = 0.42). Patients in the surgical group tended to stay longer in hospital than TAVI patients (29.5 vs. 22.5 days; p = 0.35). Conclusion: TAVI is a safe procedure in patients on chronic hemodialysis. Until new data become available, we find no compelling reason to refuse these patients TAVI. Copyright (C) 2012 S. Karger AG, Base

Patient-reported outcomes and final overall survival results from the randomized phase 3 PENELOPE trial evaluating pertuzumab in low tumor human epidermal growth factor receptor 3 (HER3) mRNA-expressing platinum-resistant ovarian cancer

Introduction: The PENELOPE trial evaluated pertuzumab added to chemotherapy for biomarker-selected platinum-resistant ovarian cancer. As previously reported, pertuzumab did not statistically significantly improve progression-free survival (primary end point: HR 0.74, 95% CI 0.50 to 1.11), although results in the paclitaxel and gemcitabine cohorts suggested activity. Here, we report final overall survival and patient-reported outcomes. Patients and methods: Eligible patients had ovarian carcinoma that progressed during/within 6 months of completing ≥4 platinum cycles, low tumor human epidermal growth factor receptor 3 (HER3) mRNA expression, and ≤2 prior chemotherapy lines. Investigators selected single-agent topotecan, gemcitabine or weekly paclitaxel before patients were randomized to either placebo or pertuzumab (840→420 mg every 3 weeks), stratified by selected chemotherapy, prior anti-angiogenic therapy, and platinum-free interval. Final overall survival analysis (key secondary end point) was pre-specified after 129 deaths. Patient-reported outcomes (secondary end point) were assessed at baseline and every 9 weeks until disease progression. Results: At database lock (June 9, 2016), 130 (83%) of 156 randomized patients had died. Median follow-up was 27 months in the pertuzumab arm versus 26 months in the control arm. In the intent-to-treat population there was no overall survival difference between treatment arms (stratified HR 0.90, 95% CI 0.61 to 1.32; p=0.60). Results in subgroups defined by stratification factors indicated heterogeneity similar to previous progression-free survival results. Updated safety was similar to previously published results. Compliance with patient-reported outcomes questionnaire completion was >75% for all validated patient-reported outcomes measures. Pertuzumab demonstrated neither beneficial nor detrimental effects on patient-reported outcomes compared with placebo, except for increased diarrhea symptoms. Discussion: Consistent with the primary results, adding pertuzumab to chemotherapy for low tumor HER3 mRNA-expressing platinum-resistant ovarian cancer did not improve overall survival, but showed trends in some cohorts. Except for increased diarrhea symptoms, pertuzumab had no impact on patient-reported outcomes. ClinicalTrials.gov: ClinicalTrials.gov: NCT01684878

Device Performance of Emerging Photovoltaic Materials (Version 2)

Following the 1st release of the “Emerging photovoltaic (PV) reports”, the best achievements in the performance of emerging photovoltaic devices in diverse emerging photovoltaic research subjects are summarized, as reported in peer-reviewed articles in academic journals since August 2020. Updated graphs, tables, and analyses are provided with several performance parameters, e.g., power conversion efficiency, open-circuit voltage, short-circuit current density, fill factor, light utilization efficiency, and stability test energy yield. These parameters are presented as a function of the photovoltaic bandgap energy and the average visible transmittance for each technology and application and are put into perspective using, e.g., the detailed balance efficiency limit. The 2nd instalment of the “Emerging PV reports” extends the scope toward tandem solar cells and presents the current state-of-the-art in tandem solar cell performance for various material combinations.</p

Device Performance of Emerging Photovoltaic Materials (Version 1)

Emerging photovoltaics (PVs) focus on a variety of applications complementing large scale electricity generation. Organic, dye‐sensitized, and some perovskite solar cells are considered in building integration, greenhouses, wearable, and indoor applications, thereby motivating research on flexible, transparent, semitransparent, and multi‐junction PVs. Nevertheless, it can be very time consuming to find or develop an up‐to‐date overview of the state‐of‐the‐art performance for these systems and applications. Two important resources for recording research cells efficiencies are the National Renewable Energy Laboratory chart and the efficiency tables compiled biannually by Martin Green and colleagues. Both publications provide an effective coverage over the established technologies, bridging research and industry. An alternative approach is proposed here summarizing the best reports in the diverse research subjects for emerging PVs. Best performance parameters are provided as a function of the photovoltaic bandgap energy for each technology and application, and are put into perspective using, e.g., the Shockley–Queisser limit. In all cases, the reported data correspond to published and/or properly described certified results, with enough details provided for prospective data reproduction. Additionally, the stability test energy yield is included as an analysis parameter among state‐of‐the‐art emerging PVs

Expression patterns of protein C inhibitor in mouse development

Proteolysis of extracellular matrix is an important requirement for embryonic development and is instrumental in processes such as morphogenesis, angiogenesis, and cell migration. Efficient remodeling requires controlled spatio-temporal expression of both the proteases and their inhibitors. Protein C inhibitor (PCI) effectively blocks a range of serine proteases, and recently has been suggested to play a role in cell differentiation and angiogenesis. In this study, we mapped the expression pattern of PCI throughout mouse development using in situ hybridization and immunohistochemistry. We detected a wide-spread, yet distinct expression pattern with prominent PCI levels in skin including vibrissae, and in fore- and hindgut. Further sites of PCI expression were choroid plexus of brain ventricles, heart, skeletal muscles, urogenital tract, and cartilages. A strong and stage-dependent PCI expression was observed in the developing lung. In the pseudoglandular stage, PCI expression was present in distal branching tubules whereas proximal tubules did not express PCI. Later in development, in the saccular stage, PCI expression was restricted to distal bronchioli whereas sacculi did not express PCI. PCI expression declined in postnatal stages and was not detected in adult lungs. In general, embryonic PCI expression indicates multifunctional roles of PCI during mouse development. The expression pattern of PCI during lung development suggests its possible involvement in lung morphogenesis and angiogenesis