Stamm- und progenitorzellbasierte Therapieansätze: Aktuelle Entwicklungen zur Behandlung des akuten Myokardinfarkts und der chronischen ischämischen Kardiomyopathie

Zusammenfassung: Die perkutane koronare Revaskularisation sowie eine optimierte medikamentöse Therapie können bei Patienten mit akutem Myokardinfarkt das linksventrikuläre (LV) Remodeling und die LV-Dysfunktion reduzieren. Trotz dieser modernen Therapiestrategien entwickelt ein nicht unerheblicher Teil dieser Patienten ein ungünstiges kardiales Remodeling, das mit einer schlechten Prognose einhergeht. Stamm- und progenitorzellbasierte Ansätze für die Behandlung des akuten Myokardinfarkts und der chronischen ischämischen Kardiomyopathie werden als potenzielle neue therapeutische Optionen intensiv untersucht. Diese Übersicht fasst die aktuellen Entwicklungen in der stamm- und progenitorzellbasierten Therapie bei ischämischer Herzerkrankung zusammen. Dabei erfolgt eine Einschätzung der Reparatur- und Regenerationsfähigkeit verschiedener Stamm- und Progenitorzellpopulationen. Darüber hinaus werden die Vor- und Nachteile der verschiedenen kardialen Applikationsformen der Zellen und mögliche neue Strategien zur Funktionsverbesserung von Stamm- und Progenitorzellen für den Einsatz der zellbasierten kardiovaskulären Therapie dargestell

Qualität und Integrität bei der Erstellung und Veröffentlichung wissenschaftlicher Ergebnisse: Daten-Trimming, -manipulation, und (Auto-)Plagiate

Zusammenfassung: Das Publizieren wissenschaflticher Manuskripte ist ein entscheidender Schritt im Forschungprozess und zur Gewinnung neuer Erkenntnisse - nur was veröffentlicht wird, existiert. Das Ziel der Forschung ist die anhaltende und nachhaltige Produktion überprüfbaren Wissens. Überprüfbares Wissen muss sich auf eine genaue Beobachtung, nachvollziehbare Methoden der Datengewinnung, das Prinzip der Wiederholbarkeit und auf eine angemessene statistische Analyse stützen. Entsprechend muss es das Anliegen jedes Forschers sein, die Wahrheit und nichts als die Wahrheit zu suchen und zu berichten. Dieses Prinzip erfordert Genauigkeit und Ehrlichkeit. Abweichungen von diesem Vorgehen werden als wissenschaftliches Fehlverhalten bezeichnet: Es umfasst die Verwendung falscher Methoden und statistischer Analysen, Doppelpublikationen eigener Resultate, nachlässige Datendarstellung und -erhebung, Datenunterdrückung bis zum Massaging, Manipulation, Datenklau und das freie Erfinden von Befunden. Bekannte Beispiele finden sich in der gesamten Forschungsgeschichte; es scheint aber, dass Fehlverhalten bis zum Betrug in den letzten Jahrzehnten möglicherweise aufgrund des hohen Konkurrenzdrucks sowie der teilweise existenziellen Bedeutung wissenschaftlicher Produktivität für Forschungs-Grants, den eigenen Lohn und das berufliche Weiterkommen zugenommen haben. Entsprechend ist es in der Aus- und Weiterbildung von Forschern entscheidend, auf die Bedeutung reproduzierbaren Wissens und die Wichtigkeit einer genauen Datenerhebung, -analyse und -darstellung hinzuweisen. Ebenso gilt es sicherzustellen, dass Daten nur einmal veröffentlicht werden, Autoren einen technischen oder intellektuellen Beitrag geleistet haben und die Ergebnisse anderer Forscher angemessen zitiert werden. Herausgeber und Gutachter haben die Qualität wissenschaftlicher Manuskripte entsprechend zu beurteilen. Es ist der Sinn des "Peer-review"-Prozesses, so weit wie möglich sicherzustellen, dass die Qualität wissenschaftlicher Manuskripte modernen methodischen und ethischen Ansprüchen genügt

Accuracy of a New Wrist Cuff Oscillometric Blood Pressure Device: Comparisons with Intraarterial and Mercury Manometer Measurements

Accurate measurement of arterial blood pressure is of great importance for the diagnosis and treatment of hypertension. Because of the chronic nature of antihypertensive drug therapy, the involvement of the patient in blood pressure control is desirable. Such an involvement, however, is only feasible if simple, user-friendly, and precise blood pressure measurement devices are available. In this study we tested a new wrist cuff oscillometric blood pressure measurement device in 100 consecutive patients undergoing cardiac catheterization. Blood pressures were simultaneously taken intraarterially (axillary artery) and with a mercury manometer and stethoscope or noninvasive measurement device (OMRON R3). Intraarterial measurements were directly compared with two measurements taken in random order with either an arm cuff mercury manometer or the wrist cuff device. Systolic and diastolic blood pressure as assessed with the mercury manometer was higher, especially when compared with the intraarterial and the wrist cuff values, which were comparable. Correlations of blood pressure values with intraarterial measurement were 0.86 systolic and 0.75 diastolic (P < .01) for the wrist cuff and 0.84 systolic (P < .01) and 0.59 diastolic (P < .05) for the mercury manometer measurements. Reproducibility of both measurements was good for the wrist cuff device ([systolic/diastolic]: r = 0.94/0.92; P < .01) and the mercury manometer (r = 0.97/0.88; P < .01). Both methods overestimated high diastolic values, whereas only the wrist cuff underestimated high systolic values. Thus, the new oscillometric wrist cuff blood pressure measurement device measures arterial blood pressure with great accuracy and reproducibility. As compared with intraarterial values, the wrist cuff device overestimated high diastolic and underestimated high systolic blood pressure values. Blood pressure values as measured by the mercury manometer were higher than intraarterial values and those of the wrist cuff. Both noninvasive devices overestimated high diastolic value

Takotsubo cardiomyopathy associated with opiate withdrawal

DIT SCI 1105 Operating Syste

Detection of coronary artery disease by magnetic resonance myocardial perfusion imaging with various contrast medium doses: first european multi-centre experience

Aims Magnetic resonance (MR) first-pass myocardial perfusion imaging during hyperaemia detects coronary artery stenoses in humans with test sensitivity depending on contrast medium (CM)-induced signal change in myocardium. In this prospective multi-centre study, the effect of CM dose on myocardial signal change and on diagnostic performance was evaluated using a stress-only approach. Methods and results Ninety-four patients with known or suspected coronary artery disease (CAD) were randomised to 0.05,0.10, or 0.15 mmol/kg body weight of an extravascular CM (Gd-DTPA) and X-ray coronary angiography was performed within 30 days prior/after the MR examination. A multi-slice MR technique with identical hardware and software in all centres was used during hyperaemia (adenosine 0.14 mg/kg/min) to monitor myocardial CM wash-in kinetics and data were analysed semi-automatically in a core laboratory. Protocol violations resulted in 80 complete studies with CAD (defined as ⩾1 vessel with diameter stenosis ⩾50% on quantitative coronary angiography) present in 19/29, 13/24, and 20/27 patients for doses 1, 2, and 3, respectively. In normal myocardium, the upslope increased with CM dose (overall-p<0.0001, ANOVA). For CAD detection the area under the receiver operator characteristics curve for subendocardial data (3 slices with quality score<4 representing 86% of cases) was 0.91±0.07 and 0.86±0.08 for doses 2 and 3, respectively, and was lower for dose 1 (0.53±0.13, p<0.01 and p<0.02 vs. doses 2 and 3, respectively). Corresponding sensitivities/specificities (95% confidence intervals) for pooled doses 2/3 were 93% (77-99%; ns vs. dose 1) and 75% (48-92%;p<0.05 vs. dose 1), respectively. Conclusions With increasing doses of CM, a higher signal response in the myocardium was achieved and consequently this stress-only protocol, with CM doses of 0.10-0.15 mmol/kg combined with a semi-automatic analysis, yielded a high diagnostic performance for the detection of CA

Uptake and efficacy of a systematic intensive smoking cessation intervention using motivational interviewing for smokers hospitalised for an acute coronary syndrome: a multicentre before-after study with parallel group comparisons.

To compare the efficacy of a proactive approach with a reactive approach to offer intensive smoking cessation intervention using motivational interviewing (MI). Before-after comparison in 2 academic hospitals with parallel comparisons in 2 control hospitals. Academic hospitals in Switzerland. Smokers hospitalised for an acute coronary syndrome (ACS). In the intervention hospitals during the intervention phase, a resident physician trained in MI systematically offered counselling to all smokers admitted for ACS, followed by 4 telephone counselling sessions over 2 months by a nurse trained in MI. In the observation phase, the in-hospital intervention was offered only to patients whose clinicians requested a smoking cessation intervention. In the control hospitals, no intensive smoking cessation intervention was offered. The primary outcome was 1 week smoking abstinence (point prevalence) at 12 months. Secondary outcomes were the number of smokers who received the in-hospital smoking cessation intervention and the duration of the intervention. In the intervention centres during the intervention phase, 87% of smokers (N=193/225) received a smoking cessation intervention compared to 22% in the observational phase (p&lt;0.001). Median duration of counselling was 50 min. During the intervention phase, 78% received a phone follow-up for a median total duration of 42 min in 4 sessions. Prescription of nicotine replacement therapy at discharge increased from 18% to 58% in the intervention phase (risk ratio (RR): 3.3 (95% CI 2.4 to 4.3; p≤0.001). Smoking cessation at 12-month increased from 43% to 51% comparing the observation and intervention phases (RR=1.20, 95% CI 0.98 to 1.46; p=0.08; 97% with outcome assessment). In the control hospitals, the RR for quitting was 1.02 (95% CI 0.84 to 1.25; p=0.8, 92% with outcome assessment). A proactive strategy offering intensive smoking cessation intervention based on MI to all smokers hospitalised for ACS significantly increases the uptake of smoking cessation counselling and might increase smoking abstinence at 12 months

Health utility indexes in patients with acute coronary syndromes.

BACKGROUND: Acute coronary syndromes (ACS) have been associated with lower health utilities (HUs) compared with the general population. Given the prognostic improvements after ACS with the implementation of coronary angiography (eg, percutaneous coronary intervention (PCI)), contemporary HU values derived from patient-reported outcomes are needed. METHODS: We analysed data of 1882 patients with ACS 1 year after coronary angiography in a Swiss prospective cohort. We used the EuroQol five-dimensional questionnaire (EQ-5D) and visual analogue scale (VAS) to derive HU indexes. We estimated the effects of clinical factors on HU using a linear regression model and compared the observed HU with the average values of individuals of the same sex and age in the general population. RESULTS: Mean EQ-5D HU 1-year after coronary angiography for ACS was 0.82 (±0.16) and mean VAS was 0.77 (±0.18); 40.9% of participants exhibited the highest utility values. Compared with population controls, the mean EQ-5D HU was similar (expected mean 0.82, p=0.58) in patients with ACS, but the mean VAS was slightly lower (expected mean 0.79, p&lt;0.001). Patients with ACS who are younger than 60 years had lower HU than the general population (&lt;0.001). In patients with ACS, significant differences were found according to the gender, education and employment status, diabetes, obesity, heart failure, recurrent ischaemic or incident bleeding event and participation in cardiac rehabilitation (p&lt;0.01). CONCLUSIONS: At 1 year, patients with ACS with coronary angiography had HU indexes similar to a control population. Subgroup analyses based on patients' characteristics and further disease-specific instruments could provide better sensitivity for detecting smaller variations in health-related quality of life