Cardiovascular Mortality Can Be Predicted by Heart Rate Turbulence in Hemodialysis Patients

Background: Excess mortality in hemodialysis patients is mostly of cardiovascular origin. We examined the association of heart rate turbulence (HRT), a marker of baroreflex sensitivity, with cardiovascular mortality in hemodialysis patients. Methods: A population of 290 prevalent hemodialysis patients was followed up for a median of 3 years. HRT categories 0 (both turbulence onset [TO] and slope [TS] normal), 1 (TO or TS abnormal), and 2 (both TO and TS abnormal) were obtained from 24 h Holter recordings. The primary end-point was cardiovascular mortality. Associations of HRT categories with the endpoints were analyzed by multivariable Cox regression models including HRT, age, albumin, and the improved Charlson Comorbidity Index for hemodialysis patients. Multivariable linear regression analysis identified factors associated with TO and TS. Results: During the follow-up period, 20 patients died from cardiovascular causes. In patients with HRT categories 0, 1 and 2, cardiovascular mortality was 1, 10, and 22%, respectively. HRT category 2 showed the strongest independent association with cardiovascular mortality with a hazard ratio of 19.3 (95% confidence interval: 3.69-92.03;P < 0.001). Age, calcium phosphate product, and smoking status were associated with TO and TS. Diabetes mellitus and diastolic blood pressure were only associated with TS. Conclusion: Independent of known risk factors, HRT assessment allows identification of hemodialysis patients with low, intermediate, and high risk of cardiovascular mortality. Future prospective studies are needed to translate risk prediction into risk reduction in hemodialysis patients

Immune system deregulation in hypertensive patients chronically RAS suppressed developing albuminuria

Albuminuria development in hypertensive patients is an indicator of higher cardiovascular (CV) risk and renal damage. Chronic renin-angiotensin system (RAS) suppression facilitates blood pressure control but it does not prevent from albuminuria development. We pursued the identification of protein indicators in urine behind albuminuria development in hypertensive patients under RAS suppression. Urine was collected from 100 patients classified in three groups according to albuminuria development: (a) patients with persistent normoalbuminuria; (b) patients developing de novo albuminuria; (c) patients with maintained albuminuria. Quantitative analysis was performed in a first discovery cohort by isobaric labeling methodology. Alterations of proteins of interest were confirmed by target mass spectrometry analysis in an independent cohort. A total of 2416 proteins and 1223 functional categories (coordinated protein responses) were identified. Immune response, adhesion of immune and blood cells, and phagocytosis were found significantly altered in patients with albuminuria compared to normoalbuminuric individuals. The complement system C3 increases, while Annexin A1, CD44, S100A8 and S100A9 proteins showed significant diminishment in their urinary levels when albuminuria is present. This study reveals specific links between immune response and controlled hypertension in patients who develop albuminuria, pointing to potential protein targets for novel and future therapeutic interventions.Sin financiación4.122 JCR (2017) Q1, 12/64 Multidisciplinary Sciences0.809 SJR (2017) Q2, 4/10 OptometryNo data IDR 2017UE

Rationale and study design of the prospective, longitudinal, observational cohort study “rISk strAtification in end-stage renal disease” (ISAR) study

Background: The ISAR study is a prospective, longitudinal, observational cohort study to improve the cardiovascular risk stratification in endstage renal disease (ESRD). The major goal is to characterize the cardiovascular phenotype of the study subjects, namely alterations in micro-and macrocirculation and to determine autonomic function. Methods/design: We intend to recruit 500 prevalent dialysis patients in 17 centers in Munich and the surrounding area. Baseline examinations include: (1) biochemistry, (2) 24-h Holter Electrocardiography (ECG) recordings, (3) 24-h ambulatory blood pressure measurement (ABPM), (4) 24 h pulse wave analysis (PWA) and pulse wave velocity (PWV), (5) retinal vessel analysis (RVA) and (6) neurocognitive testing. After 24 months biochemistry and determination of single PWA, single PWV and neurocognitive testing are repeated. Patients will be followed up to 6 years for (1) hospitalizations, (2) cardiovascular and (3) non-cardiovascular events and (4) cardiovascular and (5) all-cause mortality. Discussion/conclusion: We aim to create a complex dataset to answer questions about the insufficiently understood pathophysiology leading to excessively high cardiovascular and non-cardiovascular mortality in dialysis patients. Finally we hope to improve cardiovascular risk stratification in comparison to the use of classical and non-classical (dialysis-associated) risk factors and other models of risk stratification in ESRD patients by building a multivariable Cox-Regression model using a combination of the parameters measured in the study

Zur chemischen Gasphasenabscheidung des oxidischen Hoch-T_c-Supraleiters YBa_2Cu_3O_7_-#delta#

SIGLEAvailable from TIB Hannover: DW 4021 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

CVD OF SUPERCONDUCTIVE YBa2 Cu3 O7-δ

Le dépôt chimique en phase vapeur est une méthode prometteuse pour produire des supraconducteurs à haute température. En effet cette technique permet le dépôt sous haut potentiel d'oxygène avec des vitesses élevées par rapport à celles obtenues pour les autres méthodes de dépôt. Sa potentialité est grande et on peut revêtir des substrats de géométrie complexe (ex : fibres). Les β-dicétone chelates de Y, Ba, Cu ont été utilisés commme précurseurs pour le dépôt, de YBa2Cu3O7-δ. Pour définir le procédé de dépôt, l'hydrodynamique du réacteur a été déterminée par des simulations et des expériences (fumées de TiO2). Les dépôts effectués sur monocristal de SrTiO3, et sur des substrats polycristallins de zircone stabilisée à l'yttrium, sont supraconducteurs au-dessus de 94 K et ayant dans le cas des substrats SrTiO3 une densité de courant de 105 A cm-2 pour un champ magnétique disponible maximal de B = 5.5 Tesla, à 77 K.Chemical Vapour Deposition is a very promising method to produce High-Tc superconductors because of the following reasons : the deposition is possible at a very high oxygen potential, the deposition rates can be high compared to those achieved by other deposition techniques and it has an excellent throwing power which is necessary if complicated substrates (e.g. fibers) have to be coated. As source materials for the YBa2Cu3O7-δ-deposition experiments β-diketone chelates have been used for Y, Ba and Cu, respectively. In order to define the deposition process, the gas flow phenomena in the reactor were studied by TiO2 fume experiments and by computer simulations. The deposition experiments were carried out on singlecrystalline (100) SrTiO3- and Y-stabilized polycrystalline ZrO2- substrates (YSZ) showing in each case superconductivity above 94 Kelvin and current densities of 105 Acm-2 at the maximum available magnetic field of B = 5.5 Tesla and 77 Kelvin when using SrTiO3 substrates

THE Ba-PROBLEM IN CVD-YBa2 Cu3 O7-[MATH] HTC SUPERCONDUCTORS

The evaporation behaviour of Ba(thd)2 in a CVD-process for HTc-Superconductors is presented. The long-time stability as well as possibilities to increase the evaporation rates by changing the geometry of the evaporator and the process conditions are discussed

HIGH-TC-SUPERCONDUCTORS PREPARED BY CVD

YBa2Cu3O7-δ - deposition experiments were carried out in a cold wall stagnation flow CVD-reactor on single crystalline (100)-oriented SrTiO3-substrates at a total pressure of 10 mbar. As source materials different β-diketonate derivates of yttrium, barium and copper were investigated concerning their volatility and decomposition behaviour. Finally for the YBa2Cu3O7-δ deposition process Y(thd)3, Ba(thd)2 and Cu(thd)2 were used. The evaporation temperatures Tv were 112, 208 and 117 °C respectively. High quality films can be obtained with the c-axis perdendicular to the substrate surface at temperatures higher than 850 °C. The transition temperatures of the coatings are higher than 90 K and the critical current densities are in the order of jc = 106 A/cm2 at 77 K and self magnetic field

Prospektive Verlaufsbeobachtung einer universitären Rheumaambulanzkohorte während der ersten Welle der COVID-19-Pandemie

Background!#!In March 2020 the SARS-CoV‑2 pandemic disseminated initially especially in Bavaria. At that time data on patients with rheumatic diseases and immunomodulatory treatment was lacking.!##!Objective!#!The aim was to analyze the influence of the SARS-CoV‑2 pandemic on the clinical treatment strategy.!##!Material and methods!#!Between 16 March and 31 July 2020 all patients who consecutively presented at the rheumatology outpatient clinic of the Klinikum rechts der Isar of the Technical University of Munich were included in the study. Individual treatment adjustments were based on clinical judgment and the recommendations for action of the German Society for Rheumatology (DGRh).!##!Results!#!A total of 322 patients were included. The most frequent diagnosis was rheumatoid arthritis with 17%, ANCA-associated vasculitis (AAV) with 14% and SLE with 12%. Of the patients 262 were on DMARD treatment and 77 received oral glucocorticoids. There were 5 cases of suspected SARS-CoV‑2 infection; however, no patient verifiably became ill due to COVID-19. In 40 patients, treatment adjustments were done due to the pandemic, whereby 3 patients developed a flare of the underlying disease. In retrospect, treatment de-escalation occurred most frequently in AAV, IgG4-related disease, immunosuppressive treatment with rituximab and the simultaneous presence of malignant diseases.!##!Conclusion!#!The total lack of confirmed SARS-CoV‑2 infections in an otherwise strongly affected region could indicate that the infection risk for SARS-CoV‑2 is not substantially increased for patients with inflammatory rheumatic diseases. A continuation of most immunosuppressive medications therefore seems reasonable during the ongoing pandemic