Aging is associated with increased collagen type IV accumulation in the basal lamina of human cerebral microvessels

BACKGROUND: Microvascular alterations contribute to the development of stroke and vascular dementia. The goal of this study was to evaluate age and hypertension related changes of the basal lamina in cerebral microvessels of individuals, who died from non-cerebral causes. RESULTS: We examined 27 human brains: 11 young and 16 old patients. Old patients were divided into two subgroups, those with hypertension (n = 8) and those without hypertension (n = 8). Basal lamina changes of the cerebral microvessels were determined in the putamen using antibodies against collagen type IV and by quantitative analysis of vessel number, total stained area of collagen, thickness of the vessel wall and lumen, and relative staining intensity using immunofluorescence. The total number of collagen positive vessels per microscopic field was reduced in old compared to young subjects (12.0+/-0.6 vs. 15.1+/-1.2, p = 0.02). The relative collagen content per vessel (1.01+/-0.06 vs. 0.76+/-0.05, p = 0.01) and the relative collagen intensity (233.1+/-4.5 vs. 167.8+/-10.6, p < 0.0001) shown by immunofluorescence were higher in the older compared to the younger patients with a consecutive reduction of the lumen / wall ratio (1.29+/-0.05 vs. 3.29+/-0.15, p < 0.0001). No differences were observed for these parameters between old hypertensive and non-hypertensive patients. CONCLUSIONS: The present data show age-related changes of the cerebral microvessels in sections of human putamen for the first time. Due to the accumulation of collagen, microvessels thicken and show a reduction in their lumen. Besides this, the number of vessels decreases. These findings might represent a precondition for the development of vascular cognitive impairment. However, hypertension was not proven to modulate these changes

Early discharge using single cardiac troponin and copeptin testing in patients with suspected acute coronary syndrome (ACS): a randomized, controlled clinical process study

Aims This randomized controlled trial (RCT) evaluated whether a process with single combined testing of copeptin and troponin at admission in patients with low-to-intermediate risk and suspected acute coronary syndrome (ACS) does not lead to a higher proportion of major adverse cardiac events (MACE) than the current standard process (non-inferiority design). Methods and results A total of 902 patients were randomly assigned to either standard care or the copeptin group where patients with negative troponin and copeptin values at admission were eligible for discharge after final clinical assessment. The proportion of MACE (death, survived sudden cardiac death, acute myocardial infarction (AMI), re-hospitalization for ACS, acute unplanned percutaneous coronary intervention, coronary artery bypass grafting, or documented life threatening arrhythmias) was assessed after 30 days. Intention to treat analysis showed a MACE proportion of 5.17% [95% confidence intervals (CI) 3.30-7.65%; 23/445] in the standard group and 5.19% (95% CI 3.32-7.69%; 23/443) in the copeptin group. In the per protocol analysis, the MACE proportion was 5.34% (95% CI 3.38-7.97%) in the standard group, and 3.01% (95% CI 1.51-5.33%) in the copeptin group. These results were also corroborated by sensitivity analyses. In the copeptin group, discharged copeptin negative patients had an event rate of 0.6% (2/362). Conclusion After clinical work-up and single combined testing of troponin and copeptin to rule-out AMI, early discharge of low- to intermediate risk patients with suspected ACS seems to be safe and has the potential to shorten length of stay in the ED. However, our results need to be confirmed in larger clinical trials or registries, before a clinical directive can be propagate

Auswirkungen der gegenwärtig diskutierten Novellierungsvorschläge für das EEG-2014: Hintergrundpapier – überarbeitet am 31.03.2014

Mit der geplanten Novellierung im Sommer 2014 läuft die Politik Gefahr, den moderaten Ausbau der Stromerzeugung aus Biomasse weitgehend zu beenden. Für die in den letzten Jahren so erfolgreich etablierten Technologielinien besteht das Risiko eines kompletten Ausbau- und damit auch Entwicklungsstopps. Für den bereits existierenden umfangreichen Anlagenbestand zeigt der aktuelle Entwurf keine Perspektive auf und setzt die bisher geleistete Entwicklung aufs Spiel. Auf diesen Sachverhalt wurde bereits von 65 Forschungsnehmern des Förderprogrammes Energetische Biomassenutzung des BMUB hingewiesen. Das vorliegende Hintergrundpapier spricht die Schwachpunkte der geplanten Novellierung an, skizziert deren Auswirkungen und gibt Empfehlungen zur Anpassung der gegenwärtig vorliegenden Vorschläge

Early discharge using single cardiac troponin and copeptin testing in patients with suspected acute coronary syndrome (ACS): a randomized, controlled clinical process study

Aims: This randomized controlled trial (RCT) evaluated whether a process with single combined testing of copeptin and troponin at admission in patients with low-to-intermediate risk and suspected acute coronary syndrome (ACS) does not lead to a higher proportion of major adverse cardiac events (MACE) than the current standard process (non-inferiority design). Methods and results: A total of 902 patients were randomly assigned to either standard care or the copeptin group where patients with negative troponin and copeptin values at admission were eligible for discharge after final clinical assessment. The proportion of MACE (death, survived sudden cardiac death, acute myocardial infarction (AMI), re-hospitalization for ACS, acute unplanned percutaneous coronary intervention, coronary artery bypass grafting, or documented life threatening arrhythmias) was assessed after 30 days. Intention to treat analysis showed a MACE proportion of 5.17% [95% confidence intervals (CI) 3.30–7.65%; 23/445] in the standard group and 5.19% (95% CI 3.32–7.69%; 23/443) in the copeptin group. In the per protocol analysis, the MACE proportion was 5.34% (95% CI 3.38–7.97%) in the standard group, and 3.01% (95% CI 1.51–5.33%) in the copeptin group. These results were also corroborated by sensitivity analyses. In the copeptin group, discharged copeptin negative patients had an event rate of 0.6% (2/362). Conclusion: After clinical work-up and single combined testing of troponin and copeptin to rule-out AMI, early discharge of low- to intermediate risk patients with suspected ACS seems to be safe and has the potential to shorten length of stay in the ED. However, our results need to be confirmed in larger clinical trials or registries, before a clinical directive can be propagated

Multicentre cross-sectional observational registry to monitor the safety of early discharge after rule-out of acute myocardial infarction by copeptin and troponin: the Pro-Core registry

Objectives: There is sparse information on the safety of early primary discharge from the emergency department (ED) after rule-out of myocardial infarction in suspected acute coronary syndrome (ACS). This prospective registry aimed to confirm randomised study results in patients at low-to-intermediate risk, with a broader spectrum of symptoms, across different institutional standards and with a range of local troponin assays including high-sensitivity cTn (hs-cTn), cardiac troponin (cTn) and point-of-care troponin (POC Tn). Design Prospective, multicentre European registry. Setting 18 emergency departments in nine European countries (Germany, Austria, Switzerland, France, Spain, UK, Turkey, Lithuania and Hungary) Participants: The final study cohort consisted of 2294 patients (57.2% males, median age 57 years) with suspected ACS. Interventions: Using the new dual markers strategy, 1477 patients were eligible for direct discharge, which was realised in 974 (42.5%) of patients. Main outcome measures: The primary endpoint was allcause mortality at 30 days. Results: Compared with conventional workup after dual marker measurement, the median length of ED stay was 60 min shorter (228 min, 95% CI: 219 to 239 min vs 288 min, 95% CI: 279 to 300 min) in the primary dual marker strategy (DMS) discharge group. All-cause mortality was 0.1% (95% CI: 0% to 0.6%) in the primary DMS discharge group versus 1.1% (95% CI: 0.6% to 1.8%) in the conventional workup group after dual marker measurement. Conventional workup instead of discharge despite negative DMS biomarkers was observed in 503 patients (21.9%) and associated with higher prevalence of ACS (17.1% vs 0.9%, p<0.001), cardiac diagnoses (55.2% vs 23.5%, p<0.001) and risk factors (p<0.01), but with a similar all-cause mortality of 0.2% (95% CI: 0% to 1.1%) versus primary DMS discharge (p=0.64). Conclusions Copeptin on top of cardiac troponin supports safe discharge in patients with chest pain or other symptoms suggestive of ACS under routine conditions with the use of a broad spectrum of local standard POC, conventional and high-sensitivity troponin assays. Trial registration number NCT02490969

Stellungnahme zum EEG 2017

Mit dem EEG 2017 wurde die zukünftige Förderung von Biomasseanlagen, zusammen mit Photovoltaikund Windkraftanlagen, auf ein Ausschreibungsverfahren umgestellt. Im Gegensatz zu Wind- und Photovoltaik-Anlagen, können sich bei der Förderung der Stromerzeugung aus Biomasse jedoch auch Bestandsanlagen für einen zweiten Förderzeitraum bewerben. Um einen Förderanspruch für weitere 10 Jahre zu erwerben, müssen die Anlagen verschiedenste Voraussetzungen erfüllen. Dazu gehören unter anderem Vorgaben zur Flexibilisierung und zum Substrateinsatz in Biogasanlagen (sinkender Maisdeckel). Im September 2017 wurde die erste Ausschreibungsrunde für Bioenergieanlagen durchgeführt. Unter anderem aufgrund der langen durchschnittlichen Vergütungs-Restlaufzeit der meisten Bioenergieanlagen war das Interesse noch verhalten. Das Ausschreibungsvolumen betrug ca. 122 MWel installierte Leistung. Von 33 Geboten mit einem Volumen von rund 41 MWel erhielten 24 Gebote mit einem Volumen von rund 28 MWel einen Zuschlag. Obwohl das Volumen in der ersten Ausschreibungsrunde nicht ausgeschöpft wurde, lassen sich aus den ersten Erfahrungen bereits Änderungsvorschläge zur Verbesserung des Ausschreibungsdesigns ableiten. Ziel sollte sein, den Wettbewerb innerhalb der Ausschreibungen für Biomasseanlagen zu erhöhen und Perspektiven für die Entwicklung des Anlagenbestandes aufzuzeigen. Die Änderungsvorschläge werden nachfolgend kurz dargestellt

Cold-water corals in the Bay of Biscay - occurrences and distribution in space and time (TransBiscay) - Cruise No. M84/5, May 31 - June 21, 2011, Vigo (Spain) - Brest (France)

The scientific objectives of METEOR cruise M84/5 focused on the measurement and analysis of the environmental controls of modern and fossil cold-water coral growth along a transect in the Bay of Biscay. In four working areas we successfully deployed lander systems and CTD/Ro’s to document the physical and hydrochemical characteristics of bottom water masses and the water column in general. These are used to shed light on potential linkages to modern cold-water coral growth and distribution. These investigations were flanked by plankton tows in surface waters. The base for all investigations was a thorough hydroacoustic survey to characterize potential cold-water coral bearing areas with living colonies. Based on these maps we deployed all video-guided gear such as the OFOS-video sled, the TV grab, and the lander systems. Benthic assemblages and sedimentary structures have been documented and sampled with the OFOS and a box corer. Simultaneously, genetic samples of the living coral material were taken for additional studies. Furthermore, we have taken gravity cores to investigate the paleoceanographic conditions as well as the timing of cold-water coral colonization in the Bay of Biscay. Along with the coring efforts, a detailed sampling and study of porewater properties was performed. An additional aim of this cruise was to investigate the influence of boundary exchange processes on the Neodymium isotopy in bottom waters along the pathway of the Mediterranean Outflow water (MOW) by taking multiple samples with the CTD/Ro. The new data and samples of this METEOR cruise will provide the framework to investigate the timing of cold-water coral colonization in the Bay of Biscay, as well as its interplay with the ambient hydrography and geochemistry. This successful cruise has provided the basis to investigate the scientific aims of this expedition in great detail