Flow-Mediated Vasodilation Predicts Outcome in Patients With Chronic Heart Failure Comparison With B-Type Natriuretic Peptide

ObjectivesThe aim of this study was to assess the predictive potency of impaired endothelium-dependent flow-mediated vasodilation (FMD) in patients with chronic heart failure (CHF).BackgroundChronic heart failure is associated with reduced FMD; the prognostic impact of this observation is unknown.MethodsSeventy-five ambulatory CHF patients (United Network of Organ Sharing [UNOS] status 2) with a left ventricular ejection fraction (LVEF) ≤30%, despite optimized medical therapy (angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, 100%; beta-blocker, 81%), were evaluated. Using high-resolution ultrasound, FMD of the brachial artery was assessed in addition to other neurohormonal, clinical, and hemodynamic variables. Age, gender, New York Heart Association (NYHA) functional class, LVEF, hemodynamic variables, B-type natriuretic peptide (BNP) levels, medical therapy, cardiovascular risk factors, and FMD were analyzed for prediction of the combined end point conversion to UNOS status 1 or death in a multivariate Cox model.ResultsUp to three years, 21 patients (28%) converted to UNOS status 1, and 6 patients (8%) died. Univariate risk factors for the combined end point were log BNP (p = 0.0032), FMD (p = 0.0033), NYHA functional class (p = 0.0132), beta-blocker therapy (p = 0.0367), and mean blood pressure (p = 0.0406). In the multivariate analysis, only FMD (p = 0.0007), log BNP (p = 0.0032), and mean blood pressure (p = 0.0475) were independently related to the combined end point. In the Kaplan-Meier plot, significantly more patients with FMD <6.8% (median) reached the combined end point, as compared with patients with FMD >6.8% (p = 0.004).ConclusionsIn CHF, impaired FMD is a strong, independent predictor of conversion to UNOS status 1 or death

Professional development for counsellors. Current empirical findings on ProfilPASS counsellors in Germany and Austria

Welche Art von Weiterbildung passt zu mir? Mit dieser Frage wenden sich immer mehr potenzielle Weiterbildungsteilnehmende an Einrichtungen der Erwachsenenbildung. Sie erwarten sich dabei oft Hilfe bei der Planung ihrer Bildungs- und/oder Berufslaufbahn. Das deutschlandweit bekannteste und teilweise auch in Österreich eingesetzte qualitative Verfahren im Kontext der Bildungs- und Berufsberatung ist der ProfilPASS. Beim ProfilPASS handelt es sich um ein Portfolioverfahren, das eigens dafür qualifizierte ProfilPASS-BeraterInnen verwenden, um Menschen bei der Sichtbarmachung und Dokumentation ihrer Kompetenzen zu unterstützen. Doch wer sind diese BeraterInnen, vor welchem persönlichen Qualifikationshintergrund und unter welchen beruflichen und finanziellen Bedingungen leisten sie diese Beratung? Wie in Österreich sind aktuelle und fundierte Daten über sie rar. Im vorliegenden Beitrag werden Ergebnisse einer Befragung unter mehr als 700 deutschen und österreichischen ProfilPASS-BeraterInnen vorgestellt. Im Fokus steht ihre beratungsspezifische Professionalitätsentwicklung (DIPF/Orig.)What kind of continuing education is appropriate for me? More and more potential continuing education participants are turning to adult education institutions with this question. They often expect help in planning their educational and/or professional career. The ProfilPASS is the best known qualitative approach to educational and professional counselling in Germany; it is also used in some parts of Austria. The ProfilPASS is a portfolio used exclusively by qualified ProfilPASS counsellors to help people increase the visibility of their competences. Yet who are these counsellors, which personal qualifications do they have and under which professional and financial circumstances do they provide counselling? Like in Austria, current and reliable data is rare. This article presents findings from a survey of more than 700 German and Austrian ProfilPASS counsellors. The focus is on their professional development as counsellors. (DIPF/Orig.

Data from: Does one model fit all? patterns of beech mortality in natural forests of three European regions

Data from: Does one model fit all? patterns of beech mortality in natural forests of three European region

Data from: Does one model fit all? patterns of beech mortality in natural forests of three European regions

Data from: Does one model fit all? patterns of beech mortality in natural forests of three European region

Impaired High-Density Lipoprotein Anti-Oxidant Function Predicts Poor Outcome in Critically Ill Patients.

INTRODUCTION:Oxidative stress affects clinical outcome in critically ill patients. Although high-density lipoprotein (HDL) particles generally possess anti-oxidant capacities, deleterious properties of HDL have been described in acutely ill patients. The impact of anti-oxidant HDL capacities on clinical outcome in critically ill patients is unknown. We therefore analyzed the predictive value of anti-oxidant HDL function on mortality in an unselected cohort of critically ill patients. METHOD:We prospectively enrolled 270 consecutive patients admitted to a university-affiliated intensive care unit (ICU) and determined anti-oxidant HDL function using the HDL oxidant index (HOI). Based on their HOI, the study population was stratified into patients with impaired anti-oxidant HDL function and the residual study population. RESULTS:During a median follow-up time of 9.8 years (IQR: 9.2 to 10.0), 69% of patients died. Cox regression analysis revealed a significant and independent association between impaired anti-oxidant HDL function and short-term mortality with an adjusted HR of 1.65 (95% CI 1.22-2.24; p = 0.001) as well as 10-year mortality with an adj. HR of 1.19 (95% CI 1.02-1.40; p = 0.032) when compared to the residual study population. Anti-oxidant HDL function correlated with the amount of oxidative stress as determined by Cu/Zn superoxide dismutase (r = 0.38; p<0.001). CONCLUSION:Impaired anti-oxidant HDL function represents a strong and independent predictor of 30-day mortality as well as long-term mortality in critically ill patients

Circulating bile acids predict outcome in critically ill patients

Abstract Background Jaundice and cholestatic hepatic dysfunction are frequent findings in critically ill patients associated with increased mortality. Cholestasis in critically ill patients is closely associated with stimulation of pro-inflammatory cytokines resulting in impaired bile secretion and subsequent accumulation of bile acids. Aim of this study was to evaluate the clinical role of circulating bile acids in critically ill patients. Methods Total and individual serum bile acids were assessed via high-performance liquid chromatography in 320 critically ill patients and 19 controls. Results Total serum bile acids were threefold higher in septic than cardiogenic shock patients and sixfold higher than in post-surgical patients or controls (p < 0.001). Elevated bile acid levels correlated with severity of illness, renal dysfunction and inflammation (p < 0.05). Total bile acids predicted 28-day mortality independently of sex, age, serum bilirubin and severity of illness (HR 1.041, 95% CI 1.013–1.071, p < 0.005). Best prediction of mortality of total bile acids was seen in patients suffering from septic shock. Conclusions Individual and total BAs are elevated by various degrees in different shock conditions. BAs represent an early predictor of short-term survival in a mixed cohort of ICU patients and may serve as marker for early risk stratification in critically ill patients. Future studies should elucidate whether modulation of BA metabolism and signalling influences the clinical course and outcome in critically ill patients

Baseline characteristics of total study population and for patients with impaired anti-oxidant HDL function (HDL oxidant index (HOI)>5.90) and the residual study population (HOI≤5.90).

<p>Baseline characteristics of total study population and for patients with impaired anti-oxidant HDL function (HDL oxidant index (HOI)>5.90) and the residual study population (HOI≤5.90).</p

Impaired High-Density Lipoprotein Anti-Oxidant Function Predicts Poor Outcome in Critically Ill Patients - Table 1

<p>Impaired High-Density Lipoprotein Anti-Oxidant Function Predicts Poor Outcome in Critically Ill Patients</p> - Table

Impaired High-Density Lipoprotein Anti-Oxidant Function Predicts Poor Outcome in Critically Ill Patients - Fig 1

<p>Kaplan-Meier plots showing 30-day mortality A) and 10-year mortality B) for critically ill patients with impaired anti-oxidant HDL function [high-density lipoprotein inflammatory index (HOI>5.90)] and the residual study population (HOI≤5.90). Indicated p-values were derived from log rank test.</p