Regional differences among female patients with heart failure from the Cardiac Insufficiency BIsoprolol Study in ELDerly (CIBIS-ELD)

Background: The aim of our study was to examine regional differences in the demographics, etiology, risk factors, comorbidities and treatment of female patients with heart failure (HF) in the Cardiac Insufficiency BI soprolol Study in ELDerly (CIBIS-ELD) clinical trial.Methods and results: One hundred and fifty-nine female patients from Germany and 169 from Southeastern (SE) Europe (Serbia, Slovenia and Montenegro) were included in this subanalysis of the CIBIS-ELD trial. Women comprised 54% of the study population in Germany and 29% in SE Europe. German patients were significantly older. The leading cause of HF was arterial hypertension in German patients, 71.7% of whom had a preserved ejection fraction. The leading etiology in SE Europe was the coronary artery disease; 67.6% of these patients had a reduced left ventricular ejection fraction (34.64 ± 7.75%). No significant differences were found in the prevalence of traditional cardiovascular risk factors between the two regions (hypertension, diabetes, hypercholesterolemia, smoking and family history of myocardial infarction). Depression, chronic obstructive pulmonary disease and malignancies were the comorbidities that were noted more frequently in the German patients, while the patients from SE Europe had a lower glomerular filtration rate. Compared with the German HF patients, the females in SE Europe received significantly more angiotensin converting enzyme inhibitors, loop diuretics and less frequently angiotensin receptor blockers and mineralocorticoid receptor antagonists.Conclusions: Significant regional differences were noted in the etiology, comorbidities and treatment of female patients with HF despite similar risk factors. Such differences should be considered in the design and implementation of future clinical trials, especially as women remain underrepresented in large trial populations.

Scientometric Analysis and Combined Density-Equalizing Mapping of Environmental Tobacco Smoke (ETS) Research

Background: Passive exposure to environmental tobacco smoke (ETS) is estimated to exert a major burden of disease. Currently, numerous countries have taken legal actions to protect the population against ETS. Numerous studies have been conducted in this field. Therefore, scientometric methods should be used to analyze the accumulated data since there is no such approach available so far. Methods and Results: A combination of scientometric methods and novel visualizing procedures were used, including density-equalizing mapping and radar charting techniques. 6,580 ETS-related studies published between 1900 and 2008 were identified in the ISI database. Using different scientometric approaches, a continuous increase of both quantitative and qualitative parameters was found. The combination with density-equalizing calculations demonstrated a leading position of the United States (2,959 items published) in terms of quantitative research activities. Charting techniques demonstrated that there are numerous bi- and multilateral networks between different countries and institutions in this field. Again, a leading position of American institutions was found. Conclusions: This is the first comprehensive scientometric analysis of data on global scientific activities in the field o

sequelae, quality of life and complementary therapy following brain tumors in childhood and adolescence

Zielsetzung: Ziel dieser Promotion war die Darstellung der Probleme in der Nachsorge von pädiatrischen Patienten mit Hirntumoren bezüglich Spätfolgen und Lebensqualität einerseits sowie die Betrachtung des komplementären Therapieansatzes Eurythmie andererseits. Methoden: Für die Analysen von Spätfolgen und Lebensqualität nach einem Hirntumor im Kindes- und Jugendalter wurden 24 Medulloblastompatienten bzw. 49 Patienten mit niedrig-gradigen Gliomen, die sich in der Nachsorge der Klinik für Pädiatrie mit Schwerpunkt Onkologie/Hämatologie befanden, rekrutiert. Für die Erfassung der Spätfolgen und der Lebensqualität wurden folgende validierte Assessments angewandt: die Brock-Hörverlust-Skala, die modifizierte Rankin-Skala zur Erfassung des Behinderungsgrades und der KINDL-Fragebogen zur Erfassung der gesundheitsbezogenen Lebensqualität. In einer Studie mit Cross-over-Design zur möglichen Anwendbarkeit der Heileurythmie als komplementäre Therapie nach Hirntumorerkrankung, wurde bei 20 herzgesunden Probanden der Einfluss von Eurythmie auf die Variabilität der Herzfrequenz im Vergleich zu konventionellem Ergometertraining untersucht. Ergebnisse: Das Gesamtüberleben von 24 Medulloblastompatienten, die im Rahmen der Behandlungsprotokolle der Gesellschaft für pädiatrische Onkologie mit dem Ziel der Minderung von ototoxischen Spätfolgen mit Carboplatin statt Cisplatin behandelt wurden, betrug 96%. Lediglich zwei von 19 Patienten, für die ausreichende audiologische Daten vorhanden waren, zeigten eine relevante Hörminderung (Hörschwellenabfall > 20dB, Grad 2 nach Brock). 49 Patienten mit Zustand nach Erkrankung an einem niedrig-gradigen Gliom und deren Eltern nahmen an der Lebensqualitätsstudie teil. Die Patienten schätzten ihre Gesamtlebensqualität im Vergleich zu der gleichaltrigen Referenzbevölkerung signifikant höher ein. Die Perspektive der Eltern bezüglich der Lebensqualität der Überlebenden war im Gegensatz deutlich schlechter. In der Pilotstudie zur Eurythmie zeigte sich bei den Probanden nach den Eurythmieübungen im Gegensatz zum Ergometertraining anhand der Herzfrequenzvariabilität eine sympathovagale Balance, als Zeichen einer tiefen Relaxation. Schlussfolgerung: Der Austausch Carboplatin gegen Cisplatin in den Behandlungsprotokollen für Medulloblastome ist einerseits nicht mit einem Verlust der Überlebenschance und andererseits mit einer geringeren Rate an später Ototoxizität assoziiert. Trotz funktioneller Einschränkungen ist die Kompensation der Patienten so gut, dass sie ihre Lebensqualität im Vergleich zur gleichaltrigen Referenzbevölkerung sogar deutlich besser erleben. Lebensqualität scheint somit eine Messgröße zu sein, die weniger vom Ausmaß des Verlustes von funktionellen Fähigkeiten sondern mehr von der Anpassungsfähigkeit des Patienten im Verlauf bestimmt wird. Komplementäre Therapien, wie Eurythmie, führen im Vergleich zu konventionellem Ergometertraining bei herzgesunden Probanden zu messbaren Veränderungen physiologischer Parameter. Dies untermauert die Rationale, die Wirksamkeit von Eurythmie in Zukunft an einem Kollektiv von pädiatrischen Patienten mit einem Hirntumor im Rahmen der Rehabilitation zu prüfen.Purpose: To highlight the difficulties facing pediatric aftercare following the treatment of brain tumors in childhood and adolescence. In this cumulative thesis three aspects were investigated, treatment- and tumor-related sequelae, patients’ quality of life as well as eurythmy as a possible therapeutic approach. Patients and Methods: For the analysis of sequelae and quality of life following brain tumor treatment in childhood and adolescence, 24 medulloblastoma patients and 49 patients low-grade glioma patients were recruited from the outpatient clinic of the Department of Pediatric Oncology and Hematology at the Charité Virchow Campus in Berlin, Germany. The following assessments were used for the evaluation of late sequelae and patients’ quality of life: the Brock hearing loss scale, the modified Rankin disability scale the KINDL quality of life questionnaire. In a crossover pilot study of 20 healthy volunteers the effect of eurythmy on heart rate variability compared with conventional ergometer training was investigated. Results: 23 of 24 medulloblastoma patients treated with carboplatin instead of cisplatin according to treatment protocols of the German Society for Pediatric Oncology and Hematology were alive at follow-up (mean 30.8 months, range 8.1-111.3 months). Of the 19 for whom audiological data was available, only 2 (10.5%) had developed relevant hearing loss (>20dB, Brocks Grade 2). All of the 49 low-grade glioma patients had some tumor and treatment-associated morbidity; however, these patients rated their total quality of life significantly higher than healthy peers in the reference population. Parents of low-grade glioma patients rated their children’s quality of life significantly lower than the patients themselves. No significant correlations were seen between the degree of disability (modified Rankin) and self-reported total quality of life (KINDL). In the pilot study of eurythmy as a possible therapeutic approach in cancer aftercare, heart rate variability was elevated during the eurythmy exercises compared with conventional ergometer training. Furthermore, a decrease in the LF/HF (low frequency/high frequency) index was observed following the eurythmy exercises as evidence of sympathovagal balance. Conclusion: The substitution of carboplatin for ciplatin in the medulloblastoma protocols led to lower rates of ototoxicity compared with historical controls without compromising overall survival rates. Patients, but not their parents, rate their total quality of life higher than healthy peers, reflecting effective coping mechanisms among survivors of low-grade gliomas. Furthermore, the discrepancies between the self- and proxy-reports underscore the difficulties of quality of life assessment in pediatric populations. The effectiveness of eurythmy in terms of heart rate variability modulation supports the usefulness of complementary therapies in pediatric aftercare

Article related bibliometric data.

<p>(A) shows the analysis of total number of published items (B) shows the analysis of total number of citations (C) shows the annual average number of citations per article. (D) shows the average number of authors per article per year.</p

Institutional research network analysis.

<p>Radar chart visualization of cooperation between different institutions. Grayscale shade and width of connecting lines depict the number of cooperative research efforts. Cooperation resulting in fewer than three articles was not depicted.</p

Top 15 journals and authors analysis.

<p>(A): Ranking of most productive journals. (B): Ranking of most productive authors regarding their position on author's list.</p

Average length of articles.

<p>Average number of pages of all in this analysis included articles since 1983 are shown in the diagram below.</p

Tolerability and feasibility of beta-blocker titration in HFpEF versus HFrEF: Insights from the CIBIS-ELD trial

OBJECTIVES: This study evaluated the tolerability and feasibility of titration of 2 distinctly acting beta-blockers (BB) in elderly heart failure patients with preserved (HFpEF) and reduced (HFrEF) left ventricular ejection fraction. BACKGROUND: Broad evidence supports the use of BB in HFrEF, whereas the evidence for beta blockade in HFpEF is uncertain. METHODS: In the CIBIS-ELD (Cardiac Insufficiency Bisoprolol Study in Elderly) trial, patients >65 years of age with HFrEF (n = 626) or HFpEF (n = 250) were randomized to bisoprolol or carvedilol. Both BB were up-titrated to the target or maximum tolerated dose. Follow-up was performed after 12 weeks. HFrEF and HFpEF patients were compared regarding tolerability and clinical effects (heart rate, blood pressure, systolic and diastolic functions, New York Heart Association functional class, 6-minute-walk distance, quality of life, and N-terminal pro-B-type natriuretic peptide). RESULTS: For both of the BBs, tolerability and daily dose at 12 weeks were similar. HFpEF patients demonstrated higher rates of dose escalation delays and treatment-related side effects. Similar HR reductions were observed in both groups (HFpEF: 6.6 beats/min; HFrEF: 6.9 beats/min, p = NS), whereas greater improvement in NYHA functional class was observed in HFrEF (HFpEF: 23% vs. HFrEF: 34%, p < 0.001). Mean E/e' and left atrial volume index did not change in either group, although E/A increased in HFpEF. CONCLUSIONS: BB tolerability was comparable between HFrEF and HFpEF. Relevant reductions of HR and blood pressure occurred in both groups. However, only HFrEF patients experienced considerable improvements in clinical parameters and Left ventricular function. Interestingly, beta-blockade had no effect on established and prognostic markers of diastolic function in either group. Long-term studies using modern diagnostic criteria for HFpEF are urgently needed to establish whether BB therapy exerts significant clinical benefit in HFpEF. (Comparison of Bisoprolol and Carvedilol in Elderly Heart Failure HF] Patients: A Randomised, Double-Blind Multicentre Study CIBIS-ELD]; ISRCTN34827306)