313 research outputs found
Facets of lupus erythematosus: panniculitis responding to thalidomide
No full textLupus erythematosus profundus or lupus panniculitis is a rare clinical variant of lupus erythematosus, which involves the deep dermis and subcutaneous fat. Diagnosis may be difficult in cases with isolated involvement. Further manifestations of lupus erythematosus may thus be essential for diagnosis, which depends on the clinical picture, histopathology and a positive lesional lupus band test. We report a severe, mutilating case of lupus panniculitis, which responded well to thalidomide
Frequency comb-based microwave transfer over fiber with 7x10(-19) instability using fiber-loop optical-microwave phase detectors
No full textWe demonstrate a remote microwave/radio frequency (RF) transfer technique based on the stabilization of a fiber link using a fiber-loop optical-microwave phase detector (FLOM-PD). This method compensates for the excess phase fluctuations introduced in fiber transfer by direct phase comparison between the optical pulse train reflected from the remote site and the local microwave/RF signal using the FLOM-PD. This enables sub-fs resolution and long-term stable link stabilization while having a wide timing detection range and less of a demand in fiber dispersion compensation. The demonstrated fractional frequency instability between 2.856 GHz RF oscillators separated by a 2.3 km fiber link is 7.6 x 10(-18) and 6.5 x 10(-19) at 1000 and 82,500 s averaging times, respectively. (C) 2014 Optical Society of Americ
punktum. März 2009
No full textAeschlimann, Heidi: Delegierte Urteilskraft;
Möllering, Guido: Soziologie, Vertrauen als Aufheben von Ungewissheit;
Messerli, Beat: Treu und Glauben - ein Rechtsgrundsatz;
Hunziker-Ebneter, Antoinette: Vertrauen in Systeme;
Eugster, Stephan: Ökonomische Risiken, Vertrauen/Misstrauen - eine Frage von Moral und Kosten?;
Krampen, Günter: Forschung. Von der Bedeutung des Vertrauens-Trias;
Heinrichs, Markus: Psychobiologie "Oxytocin ist ein Glücksfall";
Marty, Heinz: Ohnmächtig. Psychologisch-psychotherapeutische Sicht aufs Vertrauen;
Riekku Hochstrasser, Rosmarie: Vertrauen schaffen;
Moro, Claudio: Peter Gugger "Ich schenke Vertrauen à fonds perdu";
Kainz, Martina: Psychotherapie mit Krebspatienten
External validity of the "all-comers" design: insights from the BIOSCIENCE trial.
No full textOBJECTIVES
We sought to systematically evaluate the external validity of a contemporary randomized controlled stent trial (BIOSCIENCE).
METHODS
Baseline characteristics and clinical outcomes of patients enrolled into the BIOSCIENCE trial at Bern University Hospital (n = 1216) were compared to those of patients included in the CARDIOBASE Bern PCI Registry at the same institution (n = 1045). The primary study endpoint was the rate of target lesion failure (TLF), defined as a composite of cardiac death, target vessel-myocardial infarction (MI) or target lesion revascularization (TLR), at 1 year.
RESULTS
Women were underrepresented in the RCT compared to the registry (25 vs. 29.4 %, p = 0.020). Non-participants were older compared to study participants (69.2 ± 12.4 vs. 67.0 ± 11.6, p < 0.001), and had a higher prevalence of previous cerebrovascular events (10.8 vs. 5.2 %, p < 0.001), and chronic renal failure (35.5 vs. 15.6 %, p < 0.001). ST-segment elevation myocardial infarction (STEMI) and Killip class IV at presentation were more common among non-participants than participants (30.7 vs. 21.1 %, p < 0.001 and 7.8 vs. 0.4 %, p < 0.001, respectively). At 1 year, non-participants experienced a significantly higher rate of TLF, (15.0 vs. 6.5 %, p < 0.001), and patient-oriented composite endpoint (POCE), including death, MI or any repeat revascularization (21.6 vs. 11.2 %, p < 0.001). There was a significant interaction between POCE and presence or absence of an acute coronary syndrome in participants versus non-participants, respectively (p = 0.009).
CONCLUSIONS
Non-participants of this all-comers trial had a higher risk profile and adverse prognosis compared to study participants. Further efforts are needed to improve the external validity of contemporary RCTs
The Impact of Left Ventricular Diastolic Dysfunction on Clinical Outcomes After Transcatheter Aortic Valve Replacement
No full textOBJECTIVES
This study sought to determine the impact of left ventricular (LV) diastolic dysfunction (LVDD) on clinical outcomes in patients undergoing transcatheter aortic valve replacement (TAVR).
BACKGROUND
LV hypertrophy in response to afterload increase promotes the development of LVDD and represents an early stage in the progression to valvular heart failure.
METHODS
In a consecutive cohort of 777 aortic stenosis patients undergoing TAVR, LVDD was categorized according to the latest guidelines. The primary endpoint was 1-year all-cause mortality.
RESULTS
There were 545 (70.1%) patients with LVDD. Ninety-eight (18.0%), 198 (36.3%), and 104 (19.1%) patients were classified as LVDD grades I, II, and III, respectively. In 145 (26.6%) patients, LVDD grade could not be determined because of only 1 or 2 discrepant variables. One-year all-cause mortality was higher in patients with LVDD grades I (16.3%; HR: 2.32; 95% CI: 1.15 to 4.66), II (17.9%; HR: 2.58; 95% CI: 1.43 to 4.67), and III (27.6%; HR: 4.21; 95% CI: 2.25 to 7.86) than in those with normal diastolic function (6.9%). The difference in clinical outcome emerged within 30 days, was driven by cardiovascular death, and maintained in a sensitivity analysis of patients with normal systolic LV function. Furthermore, LVDD grades I (HR: 2.36; 95% CI: 1.17 to 4.74), II (HR: 2.58; 95% CI: 1.42 to 4.66), and III (HR: 4.41; 95% CI: 2.37 to 8.20) were independent predictors of 1-year mortality.
CONCLUSIONS
Advancing stages of LVDD are associated with an incremental risk of all-cause mortality after TAVR, driven by cardiovascular death and taking effect as early as 30 days after the intervention
Comparative Outcomes After Percutaneous Coronary Intervention in Unconscious and Conscious Patients With Out-of-Hospital Cardiac Arrest.
No full textBACKGROUND
Up to 70% of out-of-hospital cardiac arrest (OHCA) patients have a relevant coronary stenosis which may need revascularization. The short- and long-term ischemic and bleeding risk of unconscious and conscious OHCA patients undergoing percutaneous coronary intervention (PCI) is largely unknown.
OBJECTIVES
This study sought to compare the occurrence of 1-year outcomes after PCI between OHCA patients, stratified on the basis of state of consciousness, with patients with acute coronary syndrome (ACS) not preceded by OHCA.
METHODS
The study assessed the unadjusted and adjusted risk of cardiovascular events in a prospective single-center cohort of 9,303 consecutive PCI patients.
RESULTS
At 1 year, all-cause mortality was higher in unconscious (49.5%) but not in conscious OHCA (8.9%) patients than in ACS patients (8.0%), and both unconscious and conscious OHCA patients were more likely than ACS patients to experience definite stent thrombosis (4.4% and 3.5% vs 1.3%) and Bleeding Academic Research Consortium 3 or 5 bleeding (17.8% and 9.0% vs 5.1%). The higher hazards were largely determined by events occurring in the first 30 days. After multivariable adjustment, only unconscious OHCA patients remained at increased risk of death (adjusted HR: 3.27; 95% CI: 2.65-4.05), definite stent thrombosis (adjusted HR: 2.40; 95% CI: 1.30-4.43), and Bleeding Academic Research Consortium 3 or 5 bleeding (adjusted HR: 2.51; 95% CI: 1.82-3.47) at 1 year.
CONCLUSIONS
At 1 year after PCI, unconscious OHCA patients were at higher risk of death, definite stent thrombosis, and bleeding, while conscious OHCA patients had similar hazards compared with an all-comer ACS population without OHCA. Dedicated PCI strategies for OHCA patients taking into account their state of consciousness after resuscitation are warranted
Leadership in medical emergencies depends on gender and personality
No full textLeadership is an important predictor of team performance in medical emergencies. There are no data on why some healthcare workers take the lead in emergencies while others do not. Accordingly, the aim of the study was to determine predictors of leadership in a medical emergency
ABC versus CAB for cardiopulmonary resuscitation: a prospective, randomized simulator-based trial
No full textQUESTIONS UNDER STUDY: After years of advocating
ABC (Airway-Breathing-Circulation), current guidelines
of cardiopulmonary resuscitation (CPR) recommend CAB
(Circulation-Airway-Breathing). This trial compared ABC
with CAB as initial approach to CPR from the arrival of
rescuers until the completion of the first resuscitation cycle.
METHODS: 108 teams, consisting of two physicians each,
were randomized to receive a graphical display of either the
ABC algorithm or the CAB algorithm. Subsequently teams
had to treat a simulated cardiac arrest. Data analysis was
performed using video recordings obtained during simulations.
The primary endpoint was the time to completion
of the first resuscitation cycle of 30 compressions and two
ventilations.
RESULTS: The time to execution of the first resuscitation
measure was 32 ± 12 seconds in ABC teams and 25 ±
10 seconds in CAB teams (P = 0.002). 18/53 ABC teams
(34%) and none of the 55 CAB teams (P = 0.006) applied
more than the recommended two initial rescue breaths
which caused a longer duration of the first cycle of 30
compressions and two ventilations in ABC teams (31 ± 13
vs.23 ± 6 sec; P = 0.001). Overall, the time to completion
of the first resuscitation cycle was longer in ABC teams (63
± 17 vs. 48 ± 10 sec; P <0.0001).CONCLUSIONS: This randomized controlled trial found
CAB superior to ABC with an earlier start of CPR and a
shorter time to completion of the first 30:2 resuscitation
cycle. These findings endorse the change from ABC to
CAB in international resuscitation guidelines
Can we use seismic reflection data to infer the interconnectivity of fracture networks?
No full textThis is a pre-copyedited, author-produced PDF of an article published in Geophysical Journal International following peer review. The version of record “Rubino, J. G., Barbosa, N. D., Hunziker, J., & Holliger, K. (2022). Can we use seismic reflection data to infer the interconnectivity of fracture networks?. Geophysical Journal International, 231(2), 996-1010” can be found at: https://doi.org/10.1093/gji/ggac23
- …
