Aktuelle evidenzbasierte Situation in der Koronarrevaskularisation—: CABG vs. PCI und Diabetes?

Summary: A variety of randomized, controlled trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) found similar results in mortality but significant differences in number of reinterventions in favor of CABG. This work gives an overview about the relevance and limitations of these studies in line with newly published large scale observational studies, which reveal significantly lower mortality-rates in CABG patients. Emphasis is placed on the special situation in the diabetic patien

Impact of the Incubation Medium on the Endothelium of Autologous Vein Grafts: Damage Scoring by Scanning Electron Microscopy

The aim of this study was to examine the influence of different incubation media on the morphology of the endothelium of great saphenous vein grafts and establish a suitable scoring system for the evaluation of damage caused by these media. Fifty specimens of saphenous veins from ten patients during elective aorto-coronary bypass surgery were used. Ten specimens served as controls; the others were assigned to test groups and exposed to heparinized whole blood, Bretschneider\u27s HTK, human albumin or Ringer\u27s solution. Specimens exposed to heparinized blood showed only slight morphological alterations, whereas the other three mediums caused severe damage. Thus, heparinized blood seems to be most suitable as a rinsing and incubation medium. A widely accepted scoring system for the quantification of endothelial damage caused by the incubation media did not adequately reflect the morphological alterations in the cytoskeleton and membrane topology. The proposed scoring system, which is based on endothelial cell separation, endothelial cell loss, amount of deposits, endothelial cell surface homogeneity, in addition to the frequency of spikes and blebs, seems to be suitable for characterizing differences in endothelial morphology

Invasive pulmonary aspergillosis: effects of early resection in a neutropenic rat model

Objective: Invasive pulmonary aspergillosis is frequent in neutropenic patients. Usually localized in the beginning, the disease spreads and mortality is high despite antifungal treatment. The role of early adjuvant surgery is not clear. Surgery may help to confirm fungal disease, may control fungal disease locally and may prevent systemic spreading. This study examines effects of early resection on survival and dissemination in a rat model of localized invasive pulmonary aspergillosis. Methods: Forty persistently neutropenic male albino rats were challenged with standardized conidial aspergillus inoculum injected into peripheral lung tissue of the right upper lobe under direct vision. Animals were divided into four groups. Twenty animals were treated with amphotericin B at 1 mg/kg per day beginning 48 h after inoculation, 20 animals were left untreated. In each group half the animals underwent early resection of localized invasive aspergillosis by lobectomy. Animals were checked daily and mortality was recorded up to 28 days after which surviving animals were sacrificed. Results: Significantly higher survival was observed in resected animals in the non-Am B groups (survival: 10±19% without early resection and 50±32% with early resection; P=0.044). However, early resection did not lead to improved survival in animals treated with amphotericin B (survival 70±29% without early resection and 50±32% with early resection; P=0.316). Conclusions: In this rat model of localized invasive pulmonary aspergillosis effects of early resection on survival could be demonstrated only in animals not receiving amphotericin B treatmen

Reticular synthesis of porous molecular 1D nanotubes and 3D networks

Synthetic control over pore size and pore connectivity is the crowning achievement for porous metal–organic frameworks (MOFs). The same level of control has not been achieved for molecular crystals, which are not defined by strong, directional intermolecular coordination bonds. Hence, molecular crystallization is inherently less controllable than framework crystallization, and there are fewer examples of ‘reticular synthesis’, in which multiple building blocks can be assembled according to a common assembly motif. Here we apply a chiral recognition strategy to a new family of tubular covalent cages to create both 1D porous nanotubes and 3D diamondoid pillared porous networks. The diamondoid networks are analogous to MOFs prepared from tetrahedral metal nodes and linear ditopic organic linkers. The crystal structures can be rationalized by computational lattice-energy searches, which provide an in silico screening method to evaluate candidate molecular building blocks. These results are a blueprint for applying the ‘node and strut’ principles of reticular synthesis to molecular crystals