Deutsche Leitlinie zur Rehabilitation von Patienten mit Herz-Kreislauferkrankungen (DLL-KardReha)

Ohne Zusammenfassung Deutsche Gesellschaft für Pr?vention und Rehabilitation von Herz-Kreislauferkrankungen e.V. (DGPR) in Zusammenarbeit mit der Deutschen Gesellschaft für Rehabilitationswissenschaften e.V. (DGRW) und der Deutschen Gesellschaft für Sportmedizin und Pr?vention e.V. (DGSP) Unter Mitarbeit von: Stephan B?hmen Kardiologische Abteilung, Reha-Zentrum Oldenburg, Oldenburg Gerd B?nner · Christian Holubarsch MEDIAN Kliniken Bad Krozingen, Klinik Lazariterhof/Klinik Baden – Privatklinik, Bad Krozingen Curt Diehm Innere Medizin, Klinikum Karlsbad-Langensteinbach, Karlsbad Hermann Faller Institut für Psychotherapie und medizinische Psychologie, Universit?t Würzburg Helmut Gohlke · Christa Gohlke-B?rwolf Wolfgang Langosch Herzzentrum Bad Krozingen, Bad Krozingen Gesine Grande Hochschule für Technik, Wirtschaft und Kultur (HTWK), Leipzig Klaus G?tzmann Postfach 468, Waldkirch bei Freiburg Harry Hahmann Klinik Schwabenland, Isny-Neutrauchburg Rainer Hambrecht Klinik für Kardiologie, Klinikum Links der Weser, Bremen Christoph Herrmann-Lingen Klinik für Psychosomatische Medizin und Psychotherapie, Universit?t Marburg Stephan Jacob Forum für Vaskul?re Medizin, Brombeerweg 6, Villingen-Schwenningen Ulrich Keil Institut für Epidemiologie und Sozialmedizin, Universit?tsklinikum Münster Ellen Kuhlmann Zentrum für Sozialpolitik, Abt. Geschlechterpolitik im Wohlfahrtsstaat, Uni Bremen Wolfgang Mayer-Berger Klinik Roderbirken der Deutschen Rentenversicherung Rheinland, Leichlingen Olaf Schulz Kardiologische Praxisgemeinschaft am Klinikum Spandau, Berlin Joachim Thiery Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Universit?tsklinikum Leipzig, Leipzig Diethelm Tsch?pe Herz- und Diabeteszentrum NRW, Bad Oeynhausen Helmut Teschler Abt. Pneumologie, Ruhrlandklinik – Universit?tsklinik, Essen Claudia Wilhelm Klinik Falkenburg, Bad Herrenalb Alfred Wirth Teutoburger-Wald-Klinik, Bad Rothenfelde Horst Zebe Am Unterscheid 2, Bad Wildungen Redaktionelle Assistenz: Kristina Korinth · Erika Winterhalter Deutsche Gesellschaft für Pr?vention und Rehabilitation von Herz-Kreislauferkrankungen e.V., DGPR     

Segmentation of wall and plaque in in vitro vascular MR images

Atherosclerosis leads to heart attack and stroke, which are major killers in the western world. These cardiovascular events frequently result from local rupture of vulnerable atherosclerotic plaque. Non-invasive assessment of plaque vulnerability would dramatically change the way in which atherosclerotic disease is diagnosed, monitored, and treated. In this paper, we report a computerized method for segmentation of arterial wall layers and plaque from high-resolution volumetric MR images. The method uses dynamic programming to detect optimal borders in each MRI frame. The accuracy of the results was tested in 62 T1-weighted MR images from six vessel specimens in comparison to borders manually determined by an expert observer. The mean signed border positioning errors for the lumen, internal elastic lamina, and external elastic lamina borders were –0.1 ± 0.1, 0.0 ± 0.1, and –0.1 ± 0.1 mm, respectively. The presented wall layer segmentation approach is one of the first steps towards non-invasive assessment of plaque vulnerability in atherosclerotic subjects.     

Resolution of cannabis hyperemesis syndrome with topical capsaicin in the emergency department: a case series

Background: Cannabinoid hyperemesis syndrome (CHS) is characterized by symptoms of cyclic abdominal pain, nausea, and vomiting in the setting of prolonged cannabis use. The transient receptor potential vanilloid 1 (TRPV1) receptor may be involved in this syndrome. Topical capsaicin is a proposed treatment for CHS; it binds TRPV1 with high specificity, impairing substance P signaling in the area postrema and nucleus tractus solitarius via overstimulation of TRPV1. This may explain its apparent antiemetic effect in this syndrome.

Purpose: We describe a series of thirteen cases of suspected cannabis hyperemesis syndrome treated with capsaicin in the emergency departments of two academic medical centers.

Methods: A query of the electronic health record at both centers identified thirteen patients with documented daily cannabis use and symptoms consistent with CHS who were administered topical capsaicin cream for symptom management.

Results: All 13 patients experienced symptom relief after administration of capsaicin cream.

Conclusion: Topical capsaicin was associated with improvement in symptoms of CHS after other treatments failed.     

The rarity of ALDH+ cells is the key to separation of normal versus leukemia stem cells by ALDH activity in AML patients

To understand the precise disease driving mechanisms in acute myeloid leukemia (AML), comparison of patient matched hematopoietic stem cells (HSC) and leukemia stem cells (LSC) is essential. In this analysis, we have examined the value of aldehyde dehydrogenase (ALDH) activity in combination with CD34 expression for the separation of HSC from LSC in 104 patients with de novo AML. The majority of AML patients (80 out of 104) had low percentages of cells with high ALDH activity (ALDH⁺ cells; <1.9%; ALDH‐rare AML), whereas 24 patients had relatively numerous ALDH⁺ cells (≥1.9%; ALDH‐numerous AML). In patients with ALDH‐rare AML, normal HSC could be separated by their CD34⁺ALDH⁺ phenotype, whereas LSC were exclusively detected among CD34⁺ALDH^? cells. For patients with ALDH‐numerous AML, the CD34⁺ALDH⁺ subset consisted mainly of LSC and separation from HSC was not feasible. Functional analyses further showed that ALDH⁺ cells from ALDH‐numerous AML were quiescent, refractory to ARA‐C treatment and capable of leukemic engraftment in a xenogenic mouse transplantation model. Clinically, resistance to chemotherapy and poor long‐term outcome were also characteristic for patients with ALDH‐numerous AML providing an additional risk‐stratification tool. The difference in spectrum and relevance of ALDH activity in the putative LSC populations demonstrates, in addition to phenotypic and genetic, also functional heterogeneity of leukemic cells and suggests divergent roles for ALDH activity in normal HSC versus LSC. By acknowledging these differences our study provides a new and useful tool for prospective identification of AML cases in which separation of HSC from LSC is possible.     

Reference values for healthy human myocardium using a T1 mapping methodology: results from the International T1 Multicenter cardiovascular magnetic resonance study

Background

T1 mapping is a robust and highly reproducible application to quantify myocardial relaxation of longitudinal magnetisation. Available T1 mapping methods are presently site and vendor specific, with variable accuracy and precision of T1 values between the systems and sequences. We assessed the transferability of a T1 mapping method and determined the reference values of healthy human myocardium in a multicenter setting.

Methods

Healthy subjects (n = 102; mean age 41 years (range 17–83), male, n = 53 (52%)), with no previous medical history, and normotensive low risk subjects (n=113) referred for clinical cardiovascular magnetic resonance (CMR) were examined. Further inclusion criteria for all were absence of regular medication and subsequently normal findings of routine CMR. All subjects underwent T1 mapping using a uniform imaging set-up (modified Look- Locker inversion recovery, MOLLI, using scheme 3(3)3(3)5)) on 1.5 Tesla (T) and 3 T Philips scanners. Native T1-maps were acquired in a single midventricular short axis slice and repeated 20 minutes following gadobutrol. Reference values were obtained for native T1 and gadolinium-based partition coefficients, λ and extracellular volume fraction (ECV) in a core lab using standardized postprocessing.

Results

In healthy controls, mean native T1 values were 950 ± 21 msec at 1.5 T and 1052 ± 23 at 3 T. λ and ECV values were 0.44 ± 0.06 and 0.25 ± 0.04 at 1.5 T, and 0.44 ± 0.07 and 0.26 ± 0.04 at 3 T, respectively. There were no significant differences between healthy controls and low risk subjects in routine CMR parameters and T1 values. The entire cohort showed no correlation between age, gender and native T1. Cross-center comparisons of mean values showed no significant difference for any of the T1 indices at any field strength. There were considerable regional differences in segmental T1 values. λ and ECV were found to be dose dependent. There was excellent inter- and intraobserver reproducibility for measurement of native septal T1.

Conclusion

We show transferability for a unifying T1 mapping methodology in a multicenter setting. We provide reference ranges for T1 values in healthy human myocardium, which can be applied across participating sites.

Electronic supplementary material

The online version of this article (doi:10.1186/s12968-014-0069-x) contains supplementary material, which is available to authorized users.     

Ewing-Sarkom-Zellen in Gewebekultur: Cytologie und Virusnachweis

Zusammenfassung Immunodiffusionsstudien mit Zellextrakten von in Gewebekultur gehaltenen Ewing-Sarkom-Zellen ließen eine Antigengemeinschaft der Zellextrakte mit dem Burkitt-Antigen erkennen. Dieses Ergebnis machte den morphologischen Nachweis des Epstein-Barr-Virus (EBV) selbst oder eines verwandten Virus in den Ewing-Sarkom-Zellen wahrscheinlich. Virus-Partikel mit der charakteristischen Morphologie der Herpes-Gruppe konnten zahlreich in Kern- und Zellfragmenten nachgewiesen werden. Eine beinahe parakristalline Anordnung eigenartiger Partikel im Cytoplasma der Wirtszelle könnte möglicherweise als sehr dichte Lagerung noch nicht reifer Virus-Partikel gedeutet werden. Der Nachweis von nackten Viren in Zellen oder in Zell- und Kernfragmenten und von umhüllten Virus-Partikeln, die einen größeren Durchmesser haben, an Zelloberflächen, läßt auf eine aktive Virus-Produktion der Ewing-Sarkom-Zelle schließen. Es muß zumindest eine Passagier-Rolle der Viren angenommen werden.

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Ewing sarcoma cells in tissue culture: Cytology and verification of virus particles

Summary Tissue culture cells from a human Ewing sarcoma were studied electron microscopically. Since immunological findings suggested the presence of a virus related to or identical with the virus found in cultured Burkitt lymphoma cells (Epstein-Barr Virus), we expected to find such a virus in the Ewing cells. Many particles with the characteristic morphology of the Herpes type virus were found in fragments of the nucleus or in cellular debris. Particles in the cytoplasm bear resemblance to immature virus particles. The fact that virus particles in different stages of maturation were observed, makes it likely that active virus production takes place in Ewing cells.

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Mit Unterstützung des Landesamtes für Forschung NRW Düsseldorf und der DFG Bad Godesberg.     

Sequential cycles of high-dose chemotherapy with dose escalation of carboplatin with or without paclitaxel supported by G-CSF mobilized peripheral blood progenitor cells: a phase I/II study in advanced ovarian cancer

To assess high-dose carboplatin chemotherapy with or without paclitaxel with filgrastim mobilized peripheral blood progenitor cell (PBPC) support in a phase I/II study, a total of 21 patients with mostly chemonaive disease received four cycles of high-dose chemotherapy. Cycle 1 (cyclophosphamide, 6 g/m2) was followed by two cycles of carboplatin (1600 mg/m2 or 1800 mg/m2). Cycle 4 consisted of carboplatin (1600 mg/m2), etoposide (1600 mg/m2), and melphalan (140 mg/m2). Further chemotherapy intensification was achieved by adding paclitaxel (175 mg/m2) to all cycles with a fixed carboplatin dose (1600 mg/m2). Ototoxicity was dose-limiting for escalation of sequential cycles of carboplatin. Grade 2 and grade 3 ototoxicity, hearing loss not requiring a hearing aid, or hearing loss correctable with a hearing aid, was observed with carboplatin at 1800 mg/m2. The maximum tolerated dose (MTD) of sequential carboplatin, therefore, was identified in this study as 1600 mg/m2. After cycles 1, 2, 3 and 4 the median duration of leukopenia (<1.0x10(9)/l) was 7, 4, 4 and 6 days. Severe grade 3 and 4 infections were seen in only 7% of cycles. Of the 21 patients evaluable for disease response, 57% had complete remissions and 43% experienced partial remissions resulting in an overall response rate of 100%. The median progression-free survival is 25 (15-36) months, the median overall survival 36.5 (15-38) months. Most patients were suboptimally debulked or had bulky residual disease at the start of chemotherapy. Sequential high-dose chemotherapy to a maximum dose of 1600 mg/m2 carboplatin is effective and feasible. A randomized, prospective trial comparing sequential high-dose chemotherapy with optimal standard chemotherapy is now warranted.