Invalidisierende Kalziphylaxie (Calcific uraemic arteriolopathy)

Zusammenfassung: Ein 45-jähriger Patient mit langjährigem Diabetes mellitus Typ1 und diabetischer Nephropathie stellt sich vor. Nach zweijähriger Hämodialyse erfolgte im Alter von 35Jahren eine Nierentransplantation. Aufgrund des klinischen Verlaufs mit rezidivierenden akralen Nekrosen wurde die Diagnose Kalziphylaxie gestellt. Im weiteren Verlauf erfolgten mehrfach Amputationen im Bereich der oberen und unteren Extremitäten. Die Pathogenese, das klinisches Bild und die Behandlung der Kalziphylaxie werden im Artikel besproche

Pitfalls and premature failure of the Freedom SOLO stentless valve

OBJECTIVES This study reports a series of pitfalls, premature failures and explantations of the third-generation Freedom SOLO (FS) bovine pericardial stentless valve. METHODS A total of 149 patients underwent aortic valve replacement using the FS. Follow-up was 100% complete with an average observation time of 5.5 ± 2.3 years (maximum 8.7 years) and a total of 825 patient-years. Following intraoperative documentation, all explanted valve prostheses underwent histological examination. RESULTS Freedom from structural valve deterioration (SVD) at 5, 6, 7, 8 and 9 years was 92, 88, 80, 70 and 62%, respectively. Fourteen prostheses required explantation due to valve-independent dysfunction (n = 5; i.e. thrombus formation, oversizing, aortic dilatation, endocarditis and suture dehiscence) or valve-dependent failure (acute leaflet tears, n = 4 and severe stenosis, n = 5). Thus, freedom from explantation at 5, 6, 7, 8 and 9 years was 95, 94, 91, 81 and 72%, respectively. An acute vertical tear along the non-coronary/right coronary commissure to the base occurred at a mean of 6.0 years (range 4.3-7.3 years) and affected size 25 and 27 prostheses exclusively. Four FS required explantation after a mean of 7.5 years (range 7.0-8.3 years) due to severe functional stenosis and gross calcification that included the entire aortic root. CONCLUSIONS The FS stentless valve is safe to implant and shows satisfying mid-term results in our single institution experience. Freedom from SVD and explantation decreased markedly after only 6-7 years, so that patients with FS require close observation and follow-up. Exact sizing, symmetric positioning and observing patient limitations are crucial for optimal outcom

A virtual centre at the interface of basic and applied weather and climate research

The Hans-Ertel Centre for Weather Research is a network of German universities, research institutes and the German Weather Service (Deutscher Wetterdienst, DWD). It has been established to trigger and intensify basic research and education on weather forecasting and climate monitoring. The performed research ranges from nowcasting and short-term weather forecasting to convective-scale data assimilation, the development of parameterizations for numerical weather prediction models, climate monitoring and the communication and use of forecast information. Scientific findings from the network contribute to better understanding of the life-cycle of shallow and deep convection, representation of uncertainty in ensemble systems, effects of unresolved variability, regional climate variability, perception of forecasts and vulnerability of society. Concrete developments within the research network include dual observation-microphysics composites, satellite forward operators, tools to estimate observation impact, cloud and precipitation system tracking algorithms, large-eddy-simulations, a regional reanalysis and a probabilistic forecast test product. Within three years, the network has triggered a number of activities that include the training and education of young scientists besides the centre's core objective of complementing DWD's internal research with relevant basic research at universities and research institutes. The long term goal is to develop a self-sustaining research network that continues the close collaboration with DWD and the national and international research community

The search for valved conduit tissue grafts for adults (>22 mm): an ultrasonographic study of jugular vein diameters of horses and cattle

BACKGROUND: Natural heterologous valved conduits with a diameter greater than 22 mm that can be used for right ventricular outflow tract reconstruction in adults are not commercially available. The purpose of this study was to measure by ultrasonography the maximum diameter of the distended jugular veins of horses and cattle, respectively, to identify a population of animals that would be suitable for post-mortem collection of jugular veins at sizes greater than 22 mm. METHODS: The study population included 60 Warmblood horses, 25 Freiberger horses, 20 Brown Swiss cows, and 20 Holstein cows (including 10 Holstein and 10 Red Holstein). The maximum cross-sectional diameter of the distended jugular veins was measured at a location half-way between the mandibular angle and the thoracic inlet. The thoracic circumference (heart girth length) was used as a surrogate of body size. The jugular vein diameters of the different populations were compared by analysis of variance and the association between heart girth length and jugular vein diameter was determined in each of the four study populations by linear regression analysis. RESULTS: There was considerable individual variation of jugular vein diameters within each of the four study populations. There was no statistically significant relationship between thoracic circumference and jugular vein diameter in any of the populations. The jugular vein diameters of Brown Swiss cows were significantly larger than those of any of the other populations. Warmblood horses had significantly larger jugular vein diameters compared to Freiberger horses. CONCLUSION: The results of this study suggest that the production of bovine or equine xenografts with diameters of greater than 22 mm would be feasible. Differences between species and breeds need to be considered. However, prediction of the jugular vein diameter based on breed and heart girth length in an individual animal is inaccurate

Extremal Dependence Indices: improved verification measures for deterministic forecasts of rare binary events

Copyright © 2011 American Meteorological Society (AMS). Permission to use figures, tables, and brief excerpts from this work in scientific and educational works is hereby granted provided that the source is acknowledged. Any use of material in this work that is determined to be “fair use” under Section 107 of the U.S. Copyright Act September 2010 Page 2 or that satisfies the conditions specified in Section 108 of the U.S. Copyright Act (17 USC §108, as revised by P.L. 94-553) does not require the AMS’s permission. Republication, systematic reproduction, posting in electronic form, such as on a web site or in a searchable database, or other uses of this material, except as exempted by the above statement, requires written permission or a license from the AMS. Additional details are provided in the AMS Copyright Policy, available on the AMS Web site located at (http://www.ametsoc.org/) or from the AMS at 617-227-2425 or [email protected] forecasts of rare events is challenging, in part because traditional performance measures degenerate to trivial values as events become rarer. The extreme dependency score was proposed recently as a nondegenerating measure for the quality of deterministic forecasts of rare binary events. This measure has some undesirable properties, including being both easy to hedge and dependent on the base rate. A symmetric extreme dependency score was also proposed recently, but this too is dependent on the base rate. These two scores and their properties are reviewed and the meanings of several properties, such as base-rate dependence and complement symmetry that have caused confusion are clarified. Two modified versions of the extreme dependency score, the extremal dependence index, and the symmetric extremal dependence index, are then proposed and are shown to overcome all of its shortcomings. The new measures are nondegenerating, base-rate independent, asymptotically equitable, harder to hedge, and have regular isopleths that correspond to symmetric and asymmetric relative operating characteristic curves

Clinical Relevance of Troponin T Profile Following Cardiac Surgery

Background: Peak post-operative cardiac troponin T (cTnT) independently predicts mid- and long-term outcome of cardiac surgery patients. A few studies however have reported two peaks of cTnT over the first 48–72 h following myocardial reperfusion. The aim of the current study was to better understand underlying reasons of these different cTnT profiles and their possible relevance in terms of clinical outcome.Methods: All consecutive adult cardiac surgical procedures performed with an extra-corporeal circulation during a >6 years period were retrospectively evaluated. Patients with a myocardial infarction (MI) < 8 days were excluded. cTnT profile of patients with at least one value ≥1 ng/mL value were categorized according to the time occurrence of the peak value. Univariable and multivariable analysis were performed to identify factors influencing early vs. late increase of cTnT values, and to verify the correlation of early vs. late increase with clinical outcome.Results: Data of 5,146 patients were retrieved from our prospectively managed registry. From 953 with at least one cTnT value ≥1 ng/mL, peak occurred ≤ 6 h (n = 22), >6 to ≤ 12 h (n = 366), >12 to ≤ 18 h (n = 176), >18 to ≤ 24 h (171), >24 h (218). Age (OR: 1.023; CI: 1.016–1.030) and isolated CABG (OR: 1.779; CI: 1.114–2.839) were independent predictors of a late increase of cTnT over a limit of 1 ng/ml (p < 0.05), whereas isolated valve procedures (OR: 0.685; CI: 0.471–0.998) and cross-clamp duration (OR: 0.993; CI: 0.990–0.997) independently predicted an early elevation (p < 0.05). Delayed elevation as opposed to early elevation correlated with a higher rate of post-operative complications including MI (19.8 vs. 7.2%), new renal insufficiency (16.3 vs. 6.7%), MACCE (32.0 vs. 15.5%), or death (7.4 vs. 4.4%).Conclusion: Profile of cTnT elevation following cardiac surgery depends on patients' intrinsic factors, type of surgery and duration of cross-clamp time. Delayed increase is of higher clinically relevance than prompt post-operative elevation