Der Nutzen von GKV-Routinedaten für die Versorgungsforschung

Ohne Zusammenfassung     

Better performance with two eyes than with one in stereo-blind subjects' judgments of motion in depth

Visual tasks that involve judging distance or depth obviously benefit from considering retinal disparities and ocular convergence, but various simple visual thresholds are also lower when looking with two eyes. This is also true for stereo-blind subjects. One benefit of using two eyes is that looking with two eyes provides two chances of making the critical distinction. From the literature it would appear that using two eyes might only be an advantage for low contrast stimuli and simple tasks. We here demonstrate that stereo-blind subjects can benefit from using two eyes when making judgments about clearly visible complex stimuli. The task was to judge the direction of rotation of a simulated transparent cylinder. Stereo-blind subjects performed better when looking with two eyes than when looking with their preferred eye. It did not matter for their performance whether the images in their two eyes were correlated or not. Various control experiments ascertained that they judged the direction of rotation from the images in each eye separately and then combined these judgments, rather than relying on differences between the images in the two eyes. These findings raise doubts about the validity of using monocular vision as a control for quantitative studies of the use of binocular disparity.     

Pulmonary complaints and lung function after pediatric kidney transplantation

Abstract:  Recently four of 38 children with a kidney transplant were diagnosed with bronchiectasis. The aim of the current study was to identify patients with increased risk for pulmonary damage. In this cross-sectional observational study, children with a functioning kidney graft in the Netherlands and Antwerp, Belgium, were screened with the use of a symptom checklist and spirometry. Maximum score for upper airway complaints was 21 (normal: <8), for lower airway complaints 28 (<10). Results of FVC, FEV₁ and MEF₂₅ were expressed as percentage predicted for height and sex. One hundred and thirty-five patients completed the interview (122) and/or spirometry (103); 91 did both. Lower airways symptoms were above acceptable levels in 18 (14%) patients. Forty-nine patients (48%) had an abnormal lung function test: in 12 concerning FVC%, in 11 FEV₁%, in 24 MEF₂₅% and in 36 FEV₁/FVC. Of correlations between symptomatology or spirometry data, and clinical parameters, only that between GFR and MEF₂₅% was statistically significant. Children with a kidney transplant are at increased risk for obstructive lung disease. We recommend to monitor lung function during the follow-up after renal transplantation.     

Advances in the use of surgery and multimodality treatment for N2 non-small cell lung cancer

Introduction: Stage IIIA-N2 non-small cell lung cancer (NSCLC) represents a heterogeneous group of bronchogenic carcinomas with locoregional involvement. Different categories of N2 disease exist, ranging from unexpectedly encountered N2 involvement after detailed preoperative staging or ‘surprise’ N2, to potentially resectable disease treated within a combined modality setting, and finally, bulky N2 involvement treated by chemoradiation.

Areas covered: Large randomised controlled trials and meta-analyses on stage IIIA-N2 NSCLC have been published but their implications for treatment remain a matter of debate. No definite recommendations can be provided as diagnostic and therapeutic algorithms vary according to local, national or international guidelines.

Expert commentary: From the literature, it is clear that patients with stage IIIA-N2 NSCLC should be treated by combined modality therapy including chemotherapy, radiotherapy and surgery. The relative contribution of each modality has not been firmly established. For patients undergoing induction therapy, adequate restaging is important as only down-staged patients will clearly benefit from surgical resection. Each patient should be discussed within a multidisciplinary team to determine the best diagnostic and therapeutic approach according to the specific local expertise. In the near future, it might be expected that targeted therapies and immunotherapy will be incorporated as possible therapeutic options.     

Prognostic value of stress 99mTc-tetrofosmin myocardial perfusion imaging in predicting all-cause mortality: a 6-year follow-up study

Purpose The aim of this study was to ascertain whether stress myocardial perfusion imaging can independently predict long-term mortality.Methods We studied 1,386 patients with known or suspected coronary artery disease by means of stress ^99mTc-tetrofosmin myocardial perfusion tomography. The end point during follow-up was death from any cause. Mortality rates were compared with that in a reference population using calculated age- and gender-specific data in the general population.Results Mean age was 60±11 years. There were 608 (44%) women. Perfusion abnormalities were fixed in 416 (30%) patients and reversible in 445 (32%) patients. During a mean follow-up of 6±1.9 years, 290 (21%) patients died. The annual mortality was 1.7% in patients with normal perfusion and 5.2% in patients with abnormal perfusion. Patients with multivessel distribution of perfusion abnormalities had the highest annual mortality (6.2%). The annual mortality in the reference population was 3.2%. In a multivariate analysis model, predictors of death were age [risk ratio (RR)=1.06, 95% CI 1.04–1.07], male gender (RR=2, CI 1.6–2.6), history of heart failure (RR=2.3, CI 1.8–3.1), diabetes mellitus (RR=2.1, CI 1.6–2.7), smoking (RR=1.8, CI 1.4–2.3), reversible perfusion defects (RR=1.8, CI 1.4–2.5) and fixed perfusion defects (RR=1.7, CI 1.3–2.1).Conclusion Myocardial perfusion abnormalities on stress ^99mTc-tetrofosmin tomography are independently associated with long-term risk of death. The extent of perfusion abnormalities is a major determinant of mortality. The presence of normal perfusion is associated with a lower mortality compared with the general population.