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Background: Neurohumoral activation is present in COPD and might provide a link between pulmonary and systemic effects, especially cardiovascular disease. Because long acting inhaled β-agonists reduce hyperinflation, they could reduce sympathoexcitation by improving the inflation reflex. We aimed to evaluate if inhaled therapy with salmeterol reduces muscle sympathetic nerve activity (MSNA) evaluated by microneurography., Methods: MSNA, heart rate, blood pressure, and respiration were continually measured. After baseline recording of 20 minutes, placebo was administered; after further 45 minutes salmeterol (50 μg) was administered which was followed by a further 45 minutes of data recording. Additionally, lung function, plasma catecholamine levels, arterial pulse wave velocity, heart rate variability, and baroreflex sensitivity were evaluated. Following 4 weeks of treatment with salmeterol 50 μg twice daily, measurements were repeated without placebo administration., Results: A total of 32 COPD patients were included. Valid MSNA signals were obtained from 18 patients. Change in MSNA (bursts/100 heart beats) following acute administration of salmeterol did not differ significantly from the change following placebo (-1.96 ± 9.81 vs. -0.65 ± 9.07; p = 0.51) although hyperinflation was significantly reduced. Likewise, no changes in MSNA or catecholamines were observed after 4 weeks. Heart rate increased significantly by 3.8 ± 4.2 (p < 0.01) acutely and 3.9 ± 4.3 bpm (p < 0.01) after 4 weeks. Salmeterol treatment was safe and well tolerated., Conclusions: By using microneurography as a gold standard to evaluate sympathetic activity we found no change in MSNA following salmeterol inhalation. Thus, despite an attenuation of hyperinflation, the long acting β-agonist salmeterol does not appear to reduce nor incite sympathoexcitation., Trial Registration: This study was registered with the European Clinical Trials Database (EudraCT No. 2011-001581-18) and ClinicalTrials.gov ( NCT01536587 ).

Aims: MitraClip implantation is evolving as a potential alternative treatment to conventional surgery in high-risk patients with significant mitral regurgitation (MR). However, outcome predictors are under-investigated. The aim of this study was to identify predictors of midterm mortality and heart failure rehospitalisation after percutaneous mitral valve repair with MitraClip., Methods and Results: A total of 150 consecutive patients were followed for a median of 463 days. Survival analyses were performed for baseline characteristics, risk scores and failure of acute procedural success (APS) defined as persisting MR grade 3+ or 4+. Univariate significant risk stratifiers were tested in multivariate analyses using a Cox proportional hazards model. Overall survival was 96% at 30 days, 79.5% at 12 months, and 62% at two years. Multivariate analysis identified APS failure (HR 2.13, p=0.02), NYHA Class IV at baseline (HR 2.11, p=0.01) and STS score ≥12 (HR 2.20, p<0.0001) as significant independent predictors of all-cause mortality, and APS failure (HR 2.31, p=0.01) and NYHA Class IV at baseline (HR 1.89, p=0.03) as significant independent predictors of heart failure rehospitalisation. Furthermore, a post-procedural significant decrease in hospitalisation rate could only be observed after successful interventions (0.89±1.07 per year before vs. 0.54±0.96 after implantation, p=0.01). Patients with severely dilated and overloaded ventricles who did not meet EVEREST II eligibility criteria were at higher risk of APS failure., Conclusions: The failure of acute procedural success proved to have the most important impact on outcome after MitraClip implantation.

Unlabelled: This study was designed to show the feasibility, safety, and efficacy of venous access-site closure with a single 6 Fr suture-mediated Proglide (Abbott Vascular) during MitraClip procedures., Methods: Preclosure of the right femoral vein with Proglide used for access with the 24 Fr guiding catheter was performed. A total of 72 patients undergoing MitraClip were enrolled in this study (28 patients retrospectively and 44 patients prospectively), of whom 42 patients underwent a groin examination with ultrasound 2 days after the procedure., Results: Only 1 patient (1.4%) needed transfusion of packed cells because of bleeding and hematoma in the groin due to Proglide failure. None of the patients that were examined with ultrasound revealed an arteriovenous fistula or a spurious aneurysm, a local thrombosis, or a local stenosis related to the Proglide device., Conclusion: This study demonstrates that vascular closure with the suture-mediated Proglide system is feasible, safe, and efficacious in large venous sites of 24 Fr as needed in patients undergoing MitraClip implantation despite the necessity of anticoagulation or platelet inhibition.

Social comparisons influence self-evaluations in multiple ways. Sometimes self-evaluations are assimilated toward a given standard. At other times, they are contrasted away from the standard. On the basis of the selective accessibility model (T. Mussweiler, 2003a), the authors hypothesized that assimilation results if judges engage in the comparison process of similarity testing and selectively focus on similarities to the standard, whereas contrast occurs if judges engage in dissimilarity testing and selectively focus on differences. If these alternative comparison mechanisms are indeed at play, then assimilative and contrastive social comparisons should be accompanied by diverging informational foci on similarities versus differences. Results of 5 studies support this reasoning, demonstrating that assimilation results under conditions that foster similarity testing, whereas contrast occurs under conditions that foster dissimilarity testing. Furthermore, assimilative social comparisons are accompanied by a general informational focus on similarities, whereas contrastive comparisons are accompanied by a focus on differences., (((c) 2004 APA, all rights reserved).)

Social comparisons are frequently used for self-evaluation. As a consequence, judges have to be efficient in each comparison step. Standard selection, however, is traditionally seen as an elaborate process in which judges deliberately select similar standards. We propose that often judges do not engage in such deliberate selection processes. Instead, they use routine standards--standards that have frequently been used for self-evaluation. Consistent with this assumption, Studies 1-3 demonstrate that student participants activate knowledge about their best friend--a likely routine standard--during self-evaluation. In Study 1, lexical decisions for the best friend's name are facilitated after self-evaluation. In Study 2, participants judge their best friend faster after evaluating themselves on the same dimension. In Study 3, this is even the case if the best friend is dissimilar and consequently undiagnostic. Finally, in Study 4, self-evaluations are primarily influenced by comparison information about an experimentally created routine standard.

Timing for the evaluation and listing of patients with cystic fibrosis who are candidates for lung transplantation is still uncertain. Our study goal was to determine the value of the 12-min walk test as a simple and easy-to-use adjunctive assessment tool for pre-transplant evaluation. A total of 34 cystic fibrosis patients (17 male, mean age 22 years) with end-stage lung disease were evaluated in this retrospective analysis. The 12-min walk test was carried out according to an established protocol. Before walking, body plethysmography was performed and a capillary sample was taken for blood gas analysis. Walking distance and SaO(2) via continuous pulse oximetry were recorded online. There was a strong correlation between survival time and walking distance (r=0.7, P=0.003). No other single parameter, such as FEV(1), SaO(2,) pCO(2) or BMI, showed a statistically significant correlation with survival time. Subjects who walked < or =700 m had a lower cumulative survival (P=0.02). There was a statistically significant positive correlation between walking distance and SaO(2) at rest and after 12 min of walking (r=0.5, P=0.001; and r=0.5, P=0.04, respectively). There was no correlation between walking distance and pCO(2) at rest, BMI, FEV(1), or degree of change in SaO(2) during the walk test. This study demonstrates that in CF patients with end-stage lung disease, walking distance during a 12-min walk test is more informative with respect to survival than single parameters such as SaO(2,) pCO(2), FEV(1) or BMI.

Vertical concentration profiles of soluble reactive phosphorus (SRP) in the upper sedimentary zone of freshwater lakes are an important means for studying internal phosphorus (P) loading and to gain insight into early diagenetic processes. The interpretation of such pore water profiles generally neglects the occurrence of horizontal variability at a specific sampling site. To further examine this variability, we have designed a novel two-dimensional sampler (2D peeper) consisting of 2280 chambers at a spatial resolution of 9 mm providing a sampling area of 43 x 44 cm. This new device was deployed in three eutrophic lakes in north-eastern Germany. The resulting 2D images of the SRP concentrations, diffusive fluxes, and turnover rates revealed systematic vertical and horizontal structures with local niches of increased phosphorus release. Thus, the extrapolation of P flux calculations based on one-dimensional pore water profiles may lead to a considerable error. The observed small-scale horizontal heterogeneity, probably mainly caused by organisms, was larger in the biologically more active Lake Müllrose and Süsser See than in the deeper Arendsee where meio- and macrozoobenthos were missing. In all cases, the variability was highest at the sediment-water interface and diminished with sediment depth.