Outcome Prediction in Patients with Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation—A Retrospective International Multicenter Study

The role of veno-venous extracorporeal membrane oxygenation therapy (V-V ECMO) in severe COVID-19 acute respiratory distress syndrome (ARDS) is still under debate and conclusive data from large cohorts are scarce. Furthermore, criteria for the selection of patients that benefit most from this highly invasive and resource-demanding therapy are yet to be defined. In this study, we assess survival in an international multicenter cohort of COVID-19 patients treated with V-V ECMO and evaluate the performance of several clinical scores to predict 30-day survival. Methods: This is an investigator-initiated retrospective non-interventional international multicenter registry study (NCT04405973, first registered 28 May 2020). In 127 patients treated with V-V ECMO at 15 centers in Germany, Switzerland, Italy, Belgium, and the United States, we calculated the Sequential Organ Failure Assessment (SOFA) Score, Simplified Acute Physiology Score II (SAPS II), Acute Physiology And Chronic Health Evaluation II (APACHE II) Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score, Predicting Death for Severe ARDS on V-V ECMO (PRESERVE) Score, and 30-day survival. Results: In our study cohort which enrolled 127 patients, overall 30-day survival was 54%. Median SOFA, SAPS II, APACHE II, RESP, and PRESERVE were 9, 36, 17, 1, and 4, respectively. The prognostic accuracy for all these scores (area under the receiver operating characteristic—AUROC) ranged between 0.548 and 0.605. Conclusions: The use of scores for the prediction of mortality cannot be recommended for treatment decisions in severe COVID-19 ARDS undergoing V-V ECMO; nevertheless, scoring results below or above a specific cut-off value may be considered as an additional tool in the evaluation of prognosis. Survival rates in this cohort of COVID-19 patients treated with V-V ECMO were slightly lower than those reported in non-COVID-19 ARDS patients treated with V-V ECMO

Historische Hilfswissenschaften und Medienkunde: Archivar des Germanischen Nationalmuseums übernimmt Lehrauftrag an der Universität Erlangen

Sicherheit im Umgang mit schriftlichen und materiellen Quellen wie archivalischen Texten, Wappen, Siegeln, Münzen, Medaillen u. ä. gehört zum unverzichtbaren Handwerkszeug in den historischen Fächern. Doch der Erwerb solcher Kenntnisse und Fertigkeiten spielt in den einschlägigen Studiengängen vielerorts nur noch eine nachgeordnete Rolle. Um diesem Mangel wenigstens punktuell abzuhelfen, bietet das Historische Archiv des Germanischen Nationalmuseums im laufenden Wintersemester 2019/20 am Inst..

Illuminierte Urkunden aus Nürnberger Archiven und Sammlungen: Ausstellungskatalog jetzt auch IM OPEN ACCESS Verfügbar

In Nürnberg besteht ein erfreulich dichtes Netz archivischer Einrichtungen. Sie bewahren zusammen eine historische Überlieferung, die an Umfang und Qualität nicht leicht zu übertreffen ist. Die fünf größten dieser Häuser – das Stadtarchiv Nürnberg, die Stadtbibliothek im Bildungscampus Nürnberg, das Staatsarchiv Nürnberg, das Landeskirchliche Archiv der Evangelisch-Lutherischen Landeskirche in Bayern und das Germanische Nationalmuseum – zeigten vom 13. Februar bis zum 4. Mai 2019 in der Nürnb..

Arbeitskreistreffen wegen Corona-Krise abgesagt

Der Arbeitskreis Archive in der Leibniz-Gemeinschaft trifft sich normalerweise zweimal jährlich zum Erfahrungsaustausch und zur Besprechung gemeinsamer Vorhaben. In dem Gremium sind die Archivarinnen und Archivare von etwa zwei Dutzend Leibniz-Instituten vertreten. Viele von ihnen geben in diesem Blog immer wieder aktuelle Einblicke in ihre Arbeit. Für heute und morgen (16./17.3.2020) war das diesjährige Frühjahrstreffen des Arbeitskreises geplant. Die beteiligten Häuser richten ihre Zusamm..

Inflammation and Renal Function after a Four-Year Follow-Up in Subjects with Unimpaired Glomerular Filtration Rate: Results from the Observational, Population-Based CARLA Cohort

<div><p>Background</p><p>There is evidence that chronic inflammation is associated with the progression/development of chronic renal failure; however, relations in subjects with preserved renal function remain insufficiently understood.</p><p>Objective</p><p>To examine the association of inflammation with the development of renal failure in a cohort of the elderly general population.</p><p>Methods</p><p>After excluding subjects with reduced estimated glomerular filtration rate (eGFR<60 mL/min/1.73 m²) and missing data, the cohort incorporated 785 men and 659 women (aged 45–83 years). Follow-up was performed four years after baseline. Covariate adjusted linear and logistic regression models were used to assess the association of plasma/serum concentrations of soluble tumour necrosis factor receptor 1 (sTNF-R1), C-reactive protein (CRP), and interleukin 6 (IL-6) with change in eGFR/creatinine. The areas under the curve (AUCs) from receiver operating characteristics (ROCs) were estimated.</p><p>Results</p><p>In adjusted models sTNF-R1 was distinctively associated with a decline in eGFR in men (0.6 mL/min/1.73 m² per 100 pg/mL sTNF-R1; 95% CI: 0.4–0.8), but not in women. A similar association could not be found for CRP or IL-6. Estimates of sTNF-R1 in the cross-sectional analyses were similar between sexes, while CRP and IL-6 were not relevantly associated with eGFR/creatinine.</p><p>Conclusion</p><p>In the elderly male general population with preserved renal function sTNF-R1 predicts the development of renal failure.</p></div

Association of TILs with clinical parameters, Recurrence Score (R) results, and prognosis in patients with early HER2-negative breast cancer (BC)-a translational analysis of the prospective WSG PlanB trial

Background The presence of tumor-infiltrating lymphocytes has been associated with prognosis and chemotherapy response, particularly in high-risk breast cancer subtypes. There is limited data so far as to (i) how tumor-infiltrating lymphocyte (TIL) measurements correlate with genomic measurements such as the Oncotype DX Recurrence Score (R) and (ii) whether the survival impact of TIL measurements varies according to different adjuvant systemic therapies. Methods The WSG PlanB trial compared an anthracycline-free chemotherapy regimen (6x docetaxel/cyclophosphamide, TC) to an anthracycline-taxane sequence (4xEC followed by 4x docetaxel) in patients with intermediate-risk, HER2-negative early breast cancer (EBC). Patients with HR-positive HER2-negative EBC were further stratified to receive endocrine therapy alone vs. chemotherapy followed by endocrine therapy based on Recurrence Score results and nodal status. In this analysis, three independent observers quantified and categorized the presence of TILs among tumor samples from patients in PlanB. TIL measurements were correlated with clinical/pathological parameters and treatment outcome overall and according to the treatment arm. Results Disease-free survival (DFS) rates were significantly better (p = .04) in HR-negative patients with high vs. intermediate TIL levels and were higher in low vs. intermediate TIL patients, however with borderline significance only (p = .06). There were no significant differences among TIL categories in HR+ patients. High RS categories, HR-negative status, and high KI67 were independently and significantly associated with high TIL categories. There was no significant impact of TIL category on DFS in patients treated by endocrine therapy only; however, in patients receiving chemotherapy, DFS in the intermediate TIL category was lower than that in the other categories. Conclusion Although the presence of high TILs is associated with negative prognostic parameters such as high KI67 and HR-negative status among patients with HR-positive HER2-negative EBC, patients with high TILs show a favorable 5-year DFS in both HR-positive/HER2-negative and triple-negative breast cancer

Cross-sectional and longitudinal regression analyses in women: association of inflammation parameters with GFR/creatinine.

<p>unadj. = unadjusted estimates; CI = confidence limit; adj. = estimates adjusted for age, body mass index (BMI), HbA1c, low-density lipoprotein (LDL), high-density lipoprotein (HDL), baseline diastolic and systolic blood pressure and baseline to follow-up change in the longitudinal analyses, number of cigarettes/cigars/pipes smoked, presence of cardio-vascular diseases, regular intake of anti-diabetic (Anatomical Therapeutic Chemical Classification [ATC]: A10) and anti-hypertensive medication (ATC: C02/C03/C07/C08/C09); users coded as “1”, non-users coded as “0”. GFR estimated by means of CKD-EPI formula¹⁰. Effect estimates with 95% confidence intervals are displayed.</p><p>*Effect estimates refer to an increase of one standard deviation in the log-transformed inflammation parameter.</p><p>Abbreviations: sTNF-R1: Soluble tumour necrosis factor-α receptor 1; hsCRP: High-sensitivity C-reactive protein; IL-6: Interleukin 6; eGFR: estimated glomerular filtration rate.</p><p>Cross-sectional and longitudinal regression analyses in women: association of inflammation parameters with GFR/creatinine.</p