Angiotensin-converting enzyme insertion/deletion polymorphism does not influence the restenosis rate after coronary stent implantation

Background. Experimental studies have shown an activation of the angiotensin-converting enzyme (ACE) system as a response to endothelial injury. Recent publications have elucidated the hypothesis that the ACE gene polymorphism may influence the level of late luminal loss after coronary stent implantation. It is still unclear whether the polymorphism of the angiotensin gene is a major predictor of the extent of neointimal hyperplasia. In this multicenter study, we therefore tested the relationship between the ACE gene polymorphism and the restenosis rate after coronary stent implantation. Methods: As a substudy of the optimization with intracoronary, ultrasound (ICUS) to reduce stent restenosis (OPTICUS) study, we analyzed ACE serum levels and the ACE gene polymorphism in 154 patients at 9 different centers. All patients underwent elective coronary stent implantation in a stenosis of a major coronary vessel. Balloon inflations were repeated until a satisfactory result was achieved in on-line quantitative coronary angiography or ICUS fulfilling the OPTICUS study criteria. After follow-up of 6 months, all patients underwent reangiography tinder identical projections as the baseline procedure. A blinded quantitative analysis of the initial procedure as well as the follow-up examinations were performed by an independent core laboratory. ACE gene polymorphism and ACE serum activity were measured at the 6-month follow-up in a double-blinded setting. Results: With respect to the ACE gene polymorphism, there were three subgroups: DID genotype (48 patients), ID (83 patients) and 11 (23 patients). The subgroups did not differ in regard to age, gender, extent of coronary artery disease, stenosis length, initial degree of stenosis or degree of stenosis after stent implantation. In all, 39 patients (25.3%) had significant restenosis: 12 DD patients (25.0%), 18 ID patients (21.7%) and 9 II patients (39.1%) (odds ratio 2.164, 95% confidence interval 0.853-5.493). We obtained the following results for ACE serum levels: 0.53 mumol/l/s in the DD subgroup, 0.29 mumol/l/s in the ID

Colon Capsule Endoscopy: Indications, Findings, and Complications – Data from a Prospective German Colon Capsule Registry Trial (DEKOR)

Background/Aims Reliable and especially widely accepted preventive measures are crucial to further reduce the incidence of colorectal cancer (CRC). Colon capsule endoscopy (CCE) might increase the screening numbers among patients unable or unwilling to undergo conventional colonoscopy. This registry trial aimed to document and determine the CCE indications, findings, complications, and adverse events in outpatient practices and clinics throughout Germany. Methods Patients undergoing CCE between 2010 and 2015 were enrolled in this prospective multicenter registry trial at six German centers. Patient demographics, outcomes, and complications were evaluated. Results A total of 161 patients were included. Of the CCE evaluations, 111 (68.9%) were considered successful. Pathological findings in the colon (n=92, 60.1%) and in the remaining gastrointestinal tract (n=38, 24.8%) were recorded. The main finding was the presence of polyps (n=52, 32.3%). Furthermore, five carcinomas (3.1%) were detected and histologically confirmed later. Adequate bowel cleanliness was more likely to be achieved in the outpatient setting (p<0.0001). Interestingly, 85 patients (55.6%) chose to undergo CCE based on personal motivation. Conclusions CCE seems to be a reliable and safe endoscopic tool for screening for CRC and detecting other diseases. Its patient acceptance and feasibility seems to be high, especially in the outpatient setting

Myokardrevaskularisation bei hochgradig eingeschränkter linksventrikulärer Funktion

Faktoren, die die funktionelle Erholung von hibernating myocardium nach aortokoronarem Venen Bypass (ACVB) beeinflussen, werden gegenwärtig untersucht. Von 3/2000 bis 3/2003 untersuchten wir prospektiv 41 Patienten mit einer linksventrikulären Ejektionsfraktion (LVEF)Objectives: Factors that influence functional recovery of hibernating myocardium after coronary artery bypass grafting are at present under investigation. Methods: From 3/2000 to 3/2003 we prospectively analyzed 41 patients with ejection fraction (EF) 15% during DE in group I preoperatively; the increase was < 15% in group II. MRI hyperenhancement was measured with a mean of 16,7±11,6% of the left ventricle in group I compared to a mean of 27,4±14,4% in group II (p 19µm) in group I than in group II (< 17µm). Gene expression of pro-apoptotic genes such as BAK and BAX was lowered (0.5±0.1/0.8±0.1) compared to "normal" myocardium (1.0±0.1) (

Towards a formal semantics of UML 2.0 activities

Abstract: The new version 2.0 of the Unified Modeling Language (UML) was targeted at improving expressiveness and semantic precision. These developments are particularly evident in activity diagrams which have not only acquired many new features, but a completely new metamodel and semantic foundation. The UML contains some hints that Petri-nets are the inspirational source for the new semantics. In this paper we will investigate how strong the alignment of UML’s activity diagrams to Petri-nets really is. We start by providing a mapping of the basic elements of activity diagrams to Petri-nets and discuss the problems arising when trying to extend this approach to some of the advanced features of activity diagrams, namely exceptions, traverse-to-completion, and streaming. This examination raises several syntactic and semantic questions concerning activities. We conclude that for basic activities, the analogy works pretty well, but for higher-level constructs, no such intuitive connection exists.

Evaluation of Hemodynamic and Regional Tissue Perfusion Effects of Minimized Extracorporeal Circulation (MECC®)

Minimized extracorporeal circulation (MECC®, Maquet, Cardiopulmonary AG, Hirrlingen, Germany) is an established procedure to perform coronary revascularization. Studies showed positive effects of MECC compared to conventional cardiopulmonary bypass (CCPB) procedures in terms of transfusion requirements, less inflammation reactions, and neurological impairments. Recent retrospective studies showed higher mean arterial pressure (MAP) and a lower frequency of vasoactive drug use. We addressed this issue in this study. The hypothesis was to find a higher MAP during coronary bypass grafting surgery in patients treated with MECC systems. We performed a prospective, controlled, randomized trial with 40 patients either assigned to MECC (n = 18) or CCPB (n = 22) undergoing coronary bypass grafting. Primary endpoints were the perioperative course of mean arterial pressure, and the consumption of norepinephrine. Secondary endpoints were the regional cerebral and renal oxygen saturation (rSO2) as an indicator of area perfusion and the course of hematocrit. Clinical and demographic characteristics did not significantly differ between both groups. Thirty-day mortality was 0%. At four of five time points during extracorporeal circulation (ECC) MAP values were significantly higher in the MECC group compared to CCPB patients (after starting the ECC 60 ± 11 mmHg vs. 49 ± 10 mmHg, p = .002). MECC patients received significantly less norepinephrine (MECC 22.5 ± 35 μg vs. CCPB 60.5 ± 75 μg, p = .045). The rSO2 measured at right and left forehead and the renal area was similar for both groups during ECC and significantly higher at CCPB group 1 and 4 hours after termination of CPB. Minimized extracorporeal circulation provides a higher mean arterial pressure during ECC and we found a lower consumption of vasoactive drugs in the MECC group. There was a decrease in regional tissue saturation at 1 and 4 hours post bypass in the MECC group possibly due to increased systemic inflammation and extravascular fluid shift in the CCPB group