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Safety and efficacy of interventional treatment of acute limb ischemia in Germany 2021
No full textInterventional procedures have become a mainstay in the therapy of acute limb ischemia caused by embolism or arterial thrombosis. Treatment options include pharmacological thrombolysis (PT) and mechanical thrombectomy (MT). The aim of this study was to evaluate success and major complication rates of interventional radiological treatments of arterial embolism and thrombosis in Germany in 2021 and to compare their results with accepted international quality standards.
Data for PT and MT for 2021 was obtained from the quality management system of the German interventional radiological society (DeGIR). 2431 PT and 1582 MT procedures were documented for 2021, with 459 combinations of PT and MT. Data was analysed for technical and clinical success rates, as well as major complication rates such as intracranial bleeding, major bleeding, distal embolization, aneurysm formation, organ-failure and cardiac-decompensation.
PT alone had technical and clinical success rate of 90.21% and 81.08%, respectively. MT alone had technical and clinical success rates of 97.41% and 95.39%, respectively. MT&PT had technical and clinical success rates of 91.07% and 84.75%, respectively. Major complications were: distal embolization (PT:2.02%; MT:1.74%; PT&MT:2.61%), major bleeding (PT:0.94%; MT:1.14%; PT&MT:0.87%), aneurysm formation (PT:0.33%;MT: 1.14%;PT&MT: 0%), intracranial bleeding (PT:0.16%;MT:0%;PT&MT:0.22%), cardiac-decompensation (PT:0.21%;MT: 0.06%;PT&MT:0%) and organ-failure (PT:0%;MT:0.06%;PT&MT:0.22%).
Technical and clinical success rates were higher, while complication rates were lower than the corresponding threshold recommended by the Society of Interventional Radiology for percutaneous management of acute lower-extremity ischemia.
Treatment of arterial embolism and thrombosis performed by interventional radiologists in Germany is effective and safe with outcomes exceeding internationally accepted standards.Gefördert durch den Open-Access-Publikationsfonds der UB Marburg
An Empirical Analysis of Business Cycles in a New Keynesian Model with Inventories
No full textThis paper introduces inventories in an otherwise standard dynamic stochastic general equilibrium model. Firms accumulate inventories to facilitate sales, but face a cost of doing so in terms of costly storage of intermediate goods. Based on U.S. data we estimate the parameters of our model using Bayesian methods. The results show that accounting for inventory dynamics has a significant impact on parameter estimates and the following analyses. We find that inventories enter the New Keynesian Phillips curve as an additional and significant driving variable and make the inflation process less backward-looking. Moreover, impulse responses can change in terms of magnitude and persistence. The variance decomposition reveals substantial changes regarding the driving forces of inflation and the nominal interest rate when we consider inventory holding
Performing Best When It Matters the Most: Evidence from Professional Handball
No full textWe analyze the impact of psychological pressure on individual performance with handball penalties thrown in the decisive stage vs. the rest of the game. Contrary to the phenomenon of choking under pressure, we observe that most of the analyzed players perform best when it matters the most. The positive effect of pressure on performance is especially pronounced when the score is level or when the thrower’s team is lagging. We control for gender and psychological traits assessed with a survey. Female players score with a higher probability than male players in our sample. The positive impact of pressure is not significantly higher for female players
Natural Selection, Technological Progress, and the Origin of Human Longevity
No full textThis paper suggests that feedback effects between technological progress and human longevity lie at the heart of their common emergence in human history. It connects two major research questions. First, the long life span
after menopause is a unique but puzzling feature of humans among primates.
Second, the shift in human behavior at least 50,000 years ago, which led to
an unprecedented pace of technological progress, is still not well understood.
The paper develops an evolutionary growth theory that builds on the trade-off
between the quantity and the quality of offspring. It suggests that early tech-
nological advances gradually increased the importance of intergenerational
transfers of knowledge. Eventually, the fertility advantage shifted towards
individuals that were characterized by higher parental investment in offspring
and a significant post{reproductive life span. Subsequently, the rise in human
longevity reinforced the process of development and laid the foundations for
sustained technological progress. As a key feature, the theory resolves the debate about a \revolution" in human behavior in an entirely new way. It shows
that a gradual emergence of modern behavior is sufficient to trigger a demo-
graphic shift that appears as a \behavioral revolution" in the archeological
record
Trump Pressuring the Fed
No full textAfter appointing Federal Reserve Chairman Powell, President Trump steadily
put pressure on the Fed to cut interest rates. We show that, on average, a
statement from Trump led to lower long-term interest rates, consistent with
expectations of lower expected future short rates. However, the impact of
Trump's statements declined over time
Temporal dynamics in mental health symptoms and loneliness during the COVID-19 pandemic in a longitudinal probability sample: a network analysis
No full textFiguring out which symptoms are central for symptom escalation during the COVID-19 pandemic is important for targeting
prevention and intervention. Previous studies have contributed to the understanding of the course of psychological distress during
the pandemic, but less is known about key symptoms of psychological distress over time. Going beyond a pathogenetic pathway
perspective, we applied the network approach to psychopathology to examine how psychological distress unfolds in a period of
maximum stress (pre-pandemic to pandemic onset) and a period of repeated stress (pandemic peak to pandemic peak). We
conducted secondary data analyses with the Understanding Society data (N = 17,761), a longitudinal probability study in the UK
with data before (2019), at the onset of (April 2020), and during the COVID-19 pandemic (November 2020 & January 2021). Using
the General Health Questionnaire and one loneliness item, we computed three temporal cross-lagged panel network models to
analyze psychological distress over time. Specifically, we computed (1) a pre-COVID to first incidence peak network, (2) a first incidence
peak to second incidence peak network, and (3) a second incidence peak to third incidence peak network. All networks were highly
consistent over time. Loneliness and thinking of self as worthless displayed a high influence on other symptoms. Feeling depressed
and not overcoming difficulties had many incoming connections, thus constituting an end-product of symptom cascades. Our
findings highlight the importance of loneliness and self-worth for psychological distress during COVID-19, which may have
important implications in therapy and prevention. Prevention and intervention measures are discussed, as single session
interventions are available that specifically target loneliness and worthlessness to alleviate mental health problems.Gefördert durch den Open-Access-Publikationsfonds der UB Marburg
NAD+ metabolism is a key modulator of bacterial respiratory epithelial infections
No full textLower respiratory tract infections caused by Streptococcus pneumoniae (Spn)
are a leading cause of death globally. Here we investigate the bronchial epithelial
cellular response to Spn infection on a transcriptomic, proteomic and
metabolic level. We found the NAD+ salvage pathway to be dysregulated upon
infection in a cell line model, primary human lung tissue and in vivo in rodents,
leading to a reduced production of NAD+. Knockdown of NAD+ salvage
enzymes (NAMPT, NMNAT1) increased bacterial replication. NAD+ treatment
of Spn inhibited its growth while growth of other respiratory pathogens
improved. Boosting NAD+ production increased NAD+ levels in immortalized
and primary cells and decreased bacterial replication upon infection. NAD+
treatment of Spn dysregulated the bacterial metabolism and reduced intrabacterial
ATP. Enhancing the bacterial ATP metabolism abolished the antibacterial
effect of NAD+. Thus, we identified the NAD+ salvage pathway as an
antibacterial pathway in Spn infections, predicting an antibacterial mechanism
of NAD+.Gefördert durch den Open-Access-Publikationsfonds der UB Marburg
Analysis of Evolutionary Conservation, Expression Level, and Genetic Association at a Genome-wide Scale Reveals Heterogeneity Across Polygenic Phenotypes
No full textUnderstanding the expression level and evolutionary rate of associated genes with human polygenic diseases provides crucial insights into their disease-contributing roles. In this work, we leveraged genome-wide association studies (GWASs) to investigate the relationship between the genetic association and both the evolutionary rate (dN/dS) and expression level of human genes associated with the two polygenic diseases of schizophrenia and coronary artery disease. Our findings highlight a distinct variation in these relationships between the two diseases. Genes associated with both diseases exhibit a significantly greater variance in evolutionary rate compared to those implicated in monogenic diseases. Expanding our analyses to 4,756 complex traits in the GWAS atlas database, we unraveled distinct trait categories with a unique interplay among the evolutionary rate, expression level, and genetic association of human genes. In most polygenic traits, highly expressed genes were more associated with the polygenic phenotypes compared to lowly expressed genes. About 69% of polygenic traits displayed a negative correlation between genetic association and evolutionary rate, while approximately 30% of these traits showed a positive correlation between genetic association and evolutionary rate. Our results demonstrate the presence of a spectrum among complex traits, shaped by natural selection. Notably, at opposite ends of this spectrum, we find metabolic traits being more likely influenced by purifying selection, and immunological traits that are more likely shaped by positive selection. We further established the polygenic evolution portal (evopolygen.de) as a resource for investigating relationships and generating hypotheses in the field of human polygenic trait evolution.Gefördert durch den Open-Access-Publikationsfonds der UB Marburg
Political Institutions and Government Spending Behavior in Iran
No full textThis study examines how quality of political institutions affects the distribution of government budget and how development of government spending in major sections shapes the political institutions in Iran. This question has become especially important due to recent international sanctions, aiming to change the political behavior of Iran. We use the impulse response functions (IRF) and variance decomposition analysis (VDC) on the basis of Vector Autoregressive (VAR) model with annual data from 1960 to 2006. Our results show the importance of political institutions in patronage and public goods provision spending in Iran. The results imply that a shock in positive changes of democratic quality of institutions leads to negative and statistically significant response of military spending and positive and statistically significant response of education expenditures in short term. If sanctions are successful to change the political behavior of Iran in short run (Dizaji and Bergeijk, 2013), then one can also expect to see a reduction in allocated budget for military in Iran
Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis
No full textEINLEITUNG. Die operative Behandlung der Spondylodiszitis wird zunehmend als Erstlinien-
Therapie der Erkrankung eingesetzt. In dieser Studie beschreiben wir unsere Therapieergebnisse
mit den aktuellen operativen Techniken, sowie Parameter, die für das Behandlungsoutcome der
Patienten Bedeutung haben, um den klinischen Trend zur Operation zu validieren und die
Therapie zu verbessern.
METHODEN. Im Zeitraum zwischen Januar 2010 und Dezember 2018 wurden in unserer Klinik
237 Patienten mit einer Spondylodiszitis operativ behandelt, deren Daten retrospektiv
ausgewertet wurden.
ERGEBNISSE. In diese Studie wurden 237 Patienten, darunter 87 Frauen (36,7%) und 150
Männer (63,3%), mit einem mittleren Alter von 71,4 Jahren eingeschlossen. Die
durchschnittliche Beobachtungsdauer betrug 31,62 Monate mit einer mittleren Dauer des
Krankenhausaufenthaltes von 14,1 Tagen (SD 16,3). Insgesamt starben 26 Patienten (11%) im
Zeitraum der Beobachtung. Die Halswirbelsäule war bei 45 Patienten (19%), die
Brustwirbelsäule bei 73 Patienten (30,8%) und die lumbosakrale Wirbelsäule bei 119 Patienten
(50,2%) betroffen. Postoperativ trat die Erkrankung bei 62 Patienten (26,2%) auf. Keine weiteren
Infektionsfoki fanden sich bei 148 Patienten (62,4 %), während 89 Patienten (37,6%) zusätzliche
Entzündungsherde zeigten. Bei allen Patienten waren die labormedizinischen
Entzündungsparameter (Leukozytenzahl und CRP-Wert) erhöht. Durchschnittlich betrug der
präoperative CRP-Wert 160,8 mg/dL. Neurologische Defizite traten bei 172 Patienten (72,6%)
auf. Das häufigste Symptom stellten Schmerzen dar (94,9%). Der ventrale Zugang wurde in 45
Fällen (21,2%) und dabei immer im Bereich der HWS gewählt. Davon wurde bei 31 Patienten
eine Diskektomie mit PEEK-Cage Implantation und bei 14 Patienten eine Korporektomie mit
Implantation eines expandierbaren Cages, sowie einer Platte durchgeführt. In 23 dieser Fälle
musste zusätzlich von dorsal, im Sinne einer 360◦ Fusion stabilisiert werden. Bei 54 Patienten
konnte die reine Ausräumung des Empyems mit Nukleotomie/ Diskektomie ohne zusätzliche
Stabilisierung verantwortet werden. Diese Patienten waren alle monosegmental in der Brustoder
Lendenwirbelsäule betroffen. Eine dorsale Instrumentierung wurde in 138 Fällen
durchgeführt. Dabei wurden PEEK-Cages in 45 Fällen – hiervon wiederum 22 in lateraler Technik
- und Titan-Cages in 35 Fällen implantiert. Eine vollständige Heilung der Infektion wurde bei
91,5% der überlebenden Patienten erreicht. Im Durchschnitt wurde eine antibiotische Therapie
für 73,9 Tage durchgeführt. Der neurologische Status verbesserte sich bei 101 Patienten (42,6%),
blieb bei 95 Patienten (40%) gleich und verschlechterte sich bei 15 Patienten (6,3%). Patienten
86
mit einer isolierten Spondylodiszitis (n = 148) hatten ein signifikant besseres Outcome im
Vergleich zu Patienten mit weiteren Infektionen (χ2 = 7.948, p = 0.005). Ein erhöhter CRP-Wert
zeigte eine Korrelation mit einem schlechten Outcome (p < 0,05). Patienten, deren CRP sich
normalisierte (n = 96), zeigten ein signifikant besseres Outcome als Patienten, bei denen der
CRP-Wert erhöht blieb (χ2 = 5,410; p = 0.02). Ein signifikant besseres Outcome war außerdem
bei denjenigen Patienten zu beobachten, deren antibiotische Therapie über sechs Wochen
hinaus andauerte (n = 91, 38,4%; Corr = -0.159, χ2 = 5,733 p = 0.017). Patienten mit einer oder
mehreren Voroperationen an der Wirbelsäule, beziehungsweise einer sekundären
Spondylodiszitis, hatten wiederum ein signifikant schlechteres Outcome (corr = -0.155; χ2 =
5,724, p < 0,02), genauso diejenigen Patienten mit einer rezidivierenden Spondylodiszitis (Corr
= -0.184, χ2 = 0,004, p < 0,01) und Patienten mit mehreren Vorerkrankungen (p < 0,01).
SCHLUSSFOLGERUNG. Da der Infektionsfokus vollständig entfernt werden kann, die
mikrobiologische Diagnostik direkt aus dem Präparat ermöglicht wird, betroffene Patienten
früher mobilisiert werden können, eine höhere Lebensqualität und eine bessere
Schmerzkontrolle aufweisen, kann die Operation als Erstlinien-Therapie der Spondylodiszitis
angewandt werden. Die vollständige Abheilung der Infektion, die sich in einem signifikanten
Abfall der Laborparameter des CRP-Wertes und der Leukozytenzahl widerspiegelt, ist für die
erfolgreiche Behandlung der Erkrankung essentiell und kann nur durch eine ausreichend lange
antibiotische Therapie gewährleistet werden. Antibiosen über sechs Wochen hinaus, genauso
wie eine vollständige Normalisierung des CRP korrelierten signifikant mit einem günstigen
Outcome, während zusätzliche Infektionsfoki, vorhergegangene Operationen der Wirbelsäule,
eine ausgeprägte Multimorbidität und initial hohe CRP-Werte signifikant mit einem schlechten
Outcome vergesellschaftet waren. Aufgrund dessen empfehlen wir neben einer primär
operativen und einer ausreichend langen antibiotischen Therapie ein Screening aller Patienten
auf weitere Entzündungsherde mittels CT-Thorax und CT-Abdomen, einer trans-ösophagealen-
Echokardiographie, sowie einer klinischen Untersuchung des Nasen-Rachen-Raumes während
des primären Aufenthaltes, besonders bei Patienten, die Risiken für schlechte Verläufe zeigen.
PUBLIKATION. Unsere Ergebnisse wurden veröffentlicht: Pojskić M, Carl B, Schmöckel V, Völlger
B, Nimsky C, Saβ B. Neurosurgical Management and Outcome Parameters in 237 Patients with
Spondylodiscitis. Brain Sci. 2021 Jul 30;11(8):1019. doi: 10.3390/brainsci11081019. PMID:
34439638; PMCID: PMC8394582. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8394582/).OBJECTIVE. Operative therapy of spondylodiscitis is increasingly evolving to the first line therapy
in the clinical practice. In this study we describe our experience in the treatment of
spondylodiscitis with current operative techniques as well as parameters which show
importance for the outcome to validate the surgical trend and optimize therapy.
METHODS. Retrospective review identified 237 patients who were operatively treated for
spondylodiscitis at our institution in the period January 2010 - December 2018.
RESULTS. We included 237 patients in the study, 87 females (36.7%) and 150 males (63.3%) with
mean age 71.4 years. Mean follow up was 31.62 months. Average duration of hospital stay was
14.1 days (SD 16.3). Twenty-six patients died during the follow up (11%). 45 patients (19%) had
spondylodiscitis of the cervical spine, 73 or 30,8 % of the thoracic spine and 119 or 50.2 % of the
lumbosacral spine. 62 or 26.2% of patients had postoperative spondylodiscitis. 148 patients or
62.4% had isolated spondylodiscitis, 89 patients or 37.6 % had concomitant infections. All
patients had increased laboratory infection parameters leukocyte count and CRP with mean
preoperative CRP value of 160.8. 172 patients or 72.6% had neurological deficits. Pain was the
most common symptom (94,9%). Ventral approach was performed in 45 or 21.1% of patients
(exclusively cervical spine), 31 patients received a ventral discectomy and PEEK Cage
implantation, 14 patients a corpectomy and vertebral body expandable cage implantation with
plating. Additional dorsal stabilization was performed in 23 cases (360◦ Fusion). In 54 patients
discectomy/ nucleotomy with evacuation of the empyema was performed without additional
stabilization (all with dorsal approach and monosegmental spondylodiscitis in the thoracic or
lumbar spine). The majority of patients (138 or 58,2%) received treatment by dorsal
instrumentation, all of them were affected in thoracic or lumbar spine. Additional PEEK-cages
were implanted in 45 (from this number 22 in lateral approach), additional titan-cages in 35 of
those cases. Complete healing occurred in 91.5% of patients. Mean time of cumulative
application of antibiotic therapy was 73.9 days. Neurological status improved in 101 patients
(42.6%), remained unchanged in 95 (40%) and worsened in 15 patients (6.3%). Patients with
isolated spondylodiscitis, id est without concomitant infections (n = 148), had significantly
favourable outcome compared to patients with concomitant infections (χ2 = 7.948; p = 0.005).
Higher CRP showed correlation to unfavourable outcome (p < 0.05). Patients with completely
normalized CRP value (n=96) had significantly favourable outcome compared to patients
without normalization (χ2 = 5,410; p = 0.02). Patients who received antibiotic therapy for a
period of time more than six weeks (n = 91 or 38.4%) had significantly favourable outcome (Corr
= -0.159; χ2 = 5,733; p = 0.017). Patients who underwent previous surgeries on the spine, id est
88
patients with postoperative spondylodiscitis, had significantly unfavourable outcome (corr = -
0.155; χ2 = 5,724; p < 0,02) as well as patients with recurrent spondylodiscitis (Corr = -0.184; χ2
= 0,004; p < 0,01) and patients with more comorbidities (p < 0.01).
CONCLUSION. Due to the possibility of surgical removal of the infection focus, microbiological
diagnosis from the intraoperative specimen, early mobilization of the patient, higher quality of
life and better pain control, surgery can be used as first line therapy. Complete healing of
infection with significant fall of laboratory infection parameters (leucocyte count and CRP) are
essential for successful treatment and impossible to achieve without appropriate antibiotic
therapy. Application of antibiotic therapy longer than six weeks as well as normalized CRP
showed clear correlation to favourable outcome, while additional infection foci, previous
operations of the spine, a severe multimorbidity and high initial CRP were significantly related
with unfavourable outcome. Therefore, we recommend operative therapy, screening for
concomitant infectious diseases during the primary hospital stay for all patients with CT of
thorax and abdomen, trans esophageal echocardiography, as well as clinical examination of
nasal and dental cavity, especially in patients who carry the risk for unfavourable outcome.
PUBLICATION. Our results have been published: Pojskić M, Carl B, Schmöckel V, Völlger B,
Nimsky C, Saβ B. Neurosurgical Management and Outcome Parameters in 237 Patients with
Spondylodiscitis. Brain Sci. 2021 Jul 30;11(8):1019. doi: 10.3390/brainsci11081019. PMID:
34439638; PMCID: PMC8394582. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8394582/)