Opioid-Erhaltungstherapie in der Schwangerschaft

Hintergrund: Opioidabhängigkeit während der Schwangerschaft stellt ein signifikantes und wachsendes Problem im Gesundheitswesen dar. Die Suchterkrankung wird mit gesundheitlichen Risiken für Mutter und Kind assoziiert, vor allem aufgrund von im Rahmen dieser Erkrankung auftretenden Risikoverhaltensweisen. Methodik: Es wurde aktuelle Literatur zum Thema Opioid-Erhaltungstherapie (OET) während der Schwangerschaft in Zusammenhang mit neonatalen Outcome-Parametern über die Datenbank «pubmed.gov» recherchiert. Ergebnisse: OET mit Methadon (MMT) stellt die «state-of-the-art» Behandlung bei Opioidabhängigkeit während der Schwangerschaft dar, wird jedoch mit einer Prävalenz des Neonatalen Abstinenz Syndroms (NAS) von 60–80 % assoziiert. Als vielversprechende Alternative erscheint Buprenorphin, einzelne Studien weisen auf eine geringere Prävalenz von NAS bei OET mit Buprenorphin. Schlussfolgerungen: Bisherige, hauptsächlich retrospektiv durchgeführte Studien zu Buprenorphin und Methadon lassen aufgrund von methodischen Mängeln nur bedingt Rückschlüsse auf Vor- und Nachteile bezüglich NAS zu. Die «MOTHER» Studie soll hier als Modell für evidenzbasierte klinische Studien fungieren. </jats:p

Molecular models.

<p>Schematic representation of the constructed DN molecular model and the tacrolimus MoA molecular model with the list of significantly enriched molecular pathways based on the two molecular model features sets. Molecular pathways in bold font within the red border were significantly enriched in molecular features of both molecular model sets. Each box in the molecular model representations depicts one process unit, characterized by highly inter-connected proteins, with individual nodes representing protein coding genes.</p

Prediction models for living organ transplantation are poorly developed, reported and validated: a systematic review

OBJECTIVE: To identify and critically appraise risk prediction models for living donor solid organ transplant counselling. STUDY DESIGN AND SETTING: We systematically reviewed articles describing the development or validation of prognostic risk prediction models about living donor solid organ (kidney and liver) transplantation indexed in Medline until April 4(th) 2021. Models were eligible if intended to predict, at transplant counselling, any outcome occurring after transplantation or donation in recipients or donors. Duplicate study selection, data extraction, assessment for risk of bias and quality of reporting was done using the CHARMS checklist, PRISMA recommendations, PROBAST tool, and TRIPOD Statement. RESULTS: We screened 4691 titles and included 49 studies describing 68 models (35 kidney, 33 liver transplantation). We identified 49 new risk prediction models and 19 external validations of existing models. Most models predicted recipients outcomes (n=38, 75%), e.g., kidney graft loss (29%), or mortality of liver transplant recipients (55%). Many new models (n= 46, 94%) and external validations (n=17, 89%) had a high risk of bias because of methodological weaknesses. The quality of reporting was generally poor. CONCLUSION: We advise against applying poorly developed, reported or validated prediction models. Future studies could validate or update the few identified methodologically appropriate models

Interference network.

<p>Depicted is the diabetic nephropathy molecular model with molecular features affected by tacrolimus being displayed with larger nodes and annotated with the official Gene Symbols. Molecular features upregulated by tacrolimus are highlighted in red, with downregulated molecular features displayed in green. Molecular features with contradictory evidence, i.e. up- and down-regulated are depicted in yellow. Annotated grey nodes depict molecular features being associated with effects of tacrolimus, in most cases SNPs in these genes having impact on tacrolimus efficacy. Prognostic and diagnostic biomarkers are indicated by a P or D respectively.</p

Cardiac remodeling in ambitious endurance-trained amateur athletes older than 50 years-an observational study.

BackgroundData on cardiac remodeling in veteran athletes are conflicting but of clinical importance.MethodsSixty-nine clinically stable and healthy individuals >50 years were identified (median 55 (IQR 52-64), 26% female). Echocardiographic features were identified in individuals, who have performed endurance sports at 70% of their maximum heart rate for at least 1 hour 3 times/ week over the previous 5 years.ResultsMedian training time in all participants was 6 hours per week. Therefore, based on these 6 hours of weekly training, participants were grouped into 45 ambitious endurance-trained amateur athletes (EAA) and 24 recreationally active endurance-trained athletes (RAP) training ≥6 hours (6-10) and ConclusionsEndurance training in healthy athletes >50 years is not associated with chamber dilatation or LV hypertrophy. A weekly training duration of ≥6 hours seems beneficial to preserve diastolic function associated with an increased LA reservoir function