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The new Volumetric Ejection Fraction monitoring system (VoLEF®), when combined with the Pulse Contour Cardiac Output monitoring system (PiCCO®) system, allows measurement of left and right heart end-diastolic volumes by thermodilution. The aim of this study was to evaluate whether the left heart end-diastolic volume index determined by the VoLEF system (LHEDI) better reflects left ventricular end-diastolic area index (LVEDAI) measured by transoesophageal echocardiography than does global end-diastolic volume index (GEDI) measured by the PiCCO system alone. Following induction of anaesthesia, PiCCO, VoLEF and transoesophageal echocardiography measurements were performed before and after a fluid challenge in 20 patients scheduled for elective cardiac surgery. Both left ventricular end-diastolic area index and global end-diastolic volume index, but not left heart end-diastolic volume index, significantly increased after fluid administration. Mean bias ± 2 SD for ΔLHEDI–ΔLVEDAI was − 2.2 ± 32.0% and for ΔGEDI–ΔLVEDAI − 0.6 ± 16.8%. In contrast to global end-diastolic volume index, the use of left heart end-diastolic volume index determined by the VoLEF system cannot be recommended as an estimate of left ventricular preload. [ABSTRACT FROM AUTHOR]

Objectives: To compare the prevalence of SARS-CoV-2 and other respiratory viruses in saliva and bioaerosols between two winters and to model the probability of virus detection in classroom air for different viruses., Methods: We analysed saliva, air, and air cleaner filter samples from studies conducted in two Swiss secondary schools (students aged 14-17 years) over 7 weeks during the winters of 2021/22 and 2022/23. Two bioaerosol sampling devices and high efficiency particulate air (HEPA) filters from air cleaners were used to collect airborne virus particles in four classrooms. Daily bioaerosol samples were pooled for each sampling device before PCR analysis of a panel of 19 respiratory viruses and viral subtypes. The probability of detection of airborne viruses was modelled using an adjusted Bayesian logistic regression model., Results: Three classes (58 students) participated in 2021/22, and two classes (38 students) in 2022/23. During winter 2021/22, SARS-CoV-2 dominated in saliva (19 of 21 positive samples) and bioaerosols (9 of 10). One year later, there were 50 positive saliva samples, mostly influenza B, rhinovirus, and adenovirus, and two positive bioaerosol samples, one rhinovirus and one adenovirus. The weekly probability of airborne detection was 34% (95% credible interval [CrI] 22-47%) for SARS-CoV-2 and 10% (95% CrI 5-16%) for other respiratory viruses., Discussion: There was a distinct shift in the distribution of respiratory viruses from SARS-CoV-2 during the omicron wave to other respiratory viruses one year later. SARS-CoV-2 is more likely to be detected in the air than other endemic respiratory viruses, possibly reflecting differences in viral characteristics and the composition of virus-carrying particles that facilitate airborne long-range transmission., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Using a multiple-measurement approach, we examined the real-world effectiveness of portable HEPA air filtration devices (air cleaners) in a school setting., Methods: We collected data over 7 weeks during winter 2022/2023 in 2 Swiss secondary school classes: environmental (CO 2 , particle concentrations), epidemiologic (absences related to respiratory infections), audio (coughing), and molecular (bioaerosol and saliva samples). Using a crossover design, we compared particle concentrations, coughing, and risk of infection with and without air cleaners., Results: All 38 students participated (age, 13 - 15 years). With air cleaners, mean particle concentration decreased by 77% (95% credible interval, 63% - 86%). There were no differences in CO 2 levels. Absences related to respiratory infections were 22 without air cleaners vs 13 with them. Bayesian modeling suggested a reduced risk of infection, with a posterior probability of 91% and a relative risk of 0.73 (95% credible interval, 0.44 - 1.18). Coughing also tended to be less frequent (posterior probability, 93%), indicating that fewer symptomatic students were in class. Molecular analysis detected mainly non-SARS-CoV-2 viruses in saliva (50/448 positive) but not in bioaerosols (2/105) or on the HEPA filters of the air cleaners (4/160). The molecular detection rate in saliva was similar with and without air cleaners. Spatiotemporal analysis of positive saliva samples identified several likely transmissions., Conclusions: Air cleaners improved air quality and showed potential benefits in reducing respiratory infections. Airborne detection of non-SARS-CoV-2 viruses was rare, suggesting that these viruses may be more difficult to detect in the air. Future studies should examine the importance of close contact and long-range transmission and the cost-effectiveness of using air cleaners., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Background: Using a multiple-measurement approach, we examined the real-world effectiveness of portable HEPA-air filtration devices (air cleaners) in a school setting., Methods: We collected environmental (CO 2 , particle concentrations), epidemiological (absences related to respiratory infections), audio (coughing), and molecular data (bioaerosol and saliva samples) over seven weeks during winter 2022/2023 in two Swiss secondary school classes. Using a cross-over study design, we compared particle concentrations, coughing, and the risk of infection with vs without air cleaners., Results: All 38 students (age 13-15 years) participated. With air cleaners, mean particle concentration decreased by 77% (95% credible interval 63%-86%). There were no differences in CO 2 levels. Absences related to respiratory infections were 22 without vs 13 with air cleaners. Bayesian modeling suggested a reduced risk of infection, with a posterior probability of 91% and a relative risk of 0.73 (95% credible interval 0.44-1.18). Coughing also tended to be less frequent (posterior probability 93%). Molecular analysis detected mainly non-SARS-CoV-2 viruses in saliva (50/448 positive), but not in bioaerosols (2/105 positive) or HEPA-filters (4/160). The detection rate was similar with vs without air cleaners. Spatiotemporal analysis of positive saliva samples identified several likely transmissions., Conclusions: Air cleaners improved air quality, showed a potential benefit in reducing respiratory infections, and were associated with less coughing. Airborne detection of non-SARS-CoV-2 viruses was rare, suggesting that these viruses may be more difficult to detect in the air. Future studies should examine the importance of close contact and long-range transmission, and the cost-effectiveness of using air cleaners.

Objectives: The diagnosis of larval cestodiases in humans primarily depends on using imaging techniques in combination with serological tests. However, in case of atypical imaging results, negative serology results due to immunosuppression, or infection with rare taeniid species, traditional diagnostic tools may not provide a definitive species-level diagnosis. We aimed to validate a rapid, reliable, and cost-effective single-step real-time PCR method that can identify and differentiate larval cestodiases from biopsy material., Methods: We validated a real-time PCR technique able to distinguish Echinococcus multilocularis, E. granulosus sensu lato (s.l.), and Taenia spp. from biopsy or cytology material in a single-step analysis. Further Sanger sequencing of E. granulosus s.l. and Taenia spp. amplicons enables differentiation of various Echinococcus and Taenia species. The assay was validated on (a) a reference sample collection of 69 clinical and veterinary cases confirmed by imaging, serology, and morphological analysis, (b) 38 routine human patient samples confirmed for aforementioned pathogens by a conventional end-point PCR, and (c) 127 samples from patients with suspected echinococcosis that were submitted to our laboratory for diagnostic analysis., Results: Compared to a conventional reference end-point PCR approach, the quadruplex real-time PCR exhibited a lower limit of detection in a serial dilution with 5-log dilutions for all three targets (2 log for E. multilocularis, 1 log for E. granulosus s.s., and 1 log for T. saginata). We were able to detect DNA from E. multilocularis, E. granulosus s.l. (E. granulosus s.s., E. canadensis, E. ortleppi, and E. felidis), a wide range of Taenia spp., as well as from non-echinococcal metacestodes such as Hydatigera taeniaformis, Hymenolepis spp., Versteria sp., and Spirometra erinaceieuropaei., Discussion: We suggest that the presented real-time PCR method is a suitable tool to be routinely used in a clinical microbiology laboratory to rapidly detect and identify larval cestodiases in human tissue., (Copyright © 2023 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Background: Growing evidence suggests an important contribution of airborne transmission to the overall spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), in particular via smaller particles called aerosols. However, the contribution of school children to SARS-CoV-2 transmission remains uncertain. The aim of this study was to assess transmission of airborne respiratory infections and the association with infection control measures in schools using a multiple-measurement approach., Methods and Findings: We collected epidemiological (cases of Coronavirus Disease 2019 (COVID-19)), environmental (CO2, aerosol and particle concentrations), and molecular data (bioaerosol and saliva samples) over 7 weeks from January to March 2022 (Omicron wave) in 2 secondary schools (n = 90, average 18 students/classroom) in Switzerland. We analyzed changes in environmental and molecular characteristics between different study conditions (no intervention, mask wearing, air cleaners). Analyses of environmental changes were adjusted for different ventilation, the number of students in class, school and weekday effects. We modeled disease transmission using a semi-mechanistic Bayesian hierarchical model, adjusting for absent students and community transmission. Molecular analysis of saliva (21/262 positive) and airborne samples (10/130) detected SARS-CoV-2 throughout the study (weekly average viral concentration 0.6 copies/L) and occasionally other respiratory viruses. Overall daily average CO2 levels were 1,064 ± 232 ppm (± standard deviation). Daily average aerosol number concentrations without interventions were 177 ± 109 1/cm3 and decreased by 69% (95% CrI 42% to 86%) with mask mandates and 39% (95% CrI 4% to 69%) with air cleaners. Compared to no intervention, the transmission risk was lower with mask mandates (adjusted odds ratio 0.19, 95% CrI 0.09 to 0.38) and comparable with air cleaners (1.00, 95% CrI 0.15 to 6.51). Study limitations include possible confounding by period as the number of susceptible students declined over time. Furthermore, airborne detection of pathogens document exposure but not necessarily transmission., Conclusions: Molecular detection of airborne and human SARS-CoV-2 indicated sustained transmission in schools. Mask mandates were associated with greater reductions in aerosol concentrations than air cleaners and with lower transmission. Our multiple-measurement approach could be used to continuously monitor transmission risk of respiratory infections and the effectiveness of infection control measures in schools and other congregate settings., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: ME serves on PLOS Medicine’s editorial board. All authors have declared that no competing interests exist., (Copyright: © 2023 Banholzer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Microbes unculturable in vitro remain diagnostically challenging, dependent historically on clinical findings, histology, or targeted molecular detection. We applied whole-genome sequencing directly from tissue to diagnose infections with mycobacteria (leprosy) and parasites (coenurosis). Direct pathogen DNA sequencing provides flexible solutions to diagnosis of difficult pathogens in diverse contexts., (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

The COVID-19 pandemic resulted in shortages of personal protective equipment and medical devices in the initial phase. Agile small and medium-sized enterprises from regional textile industries reacted quickly. They delivered alternative products such as textile-based community masks in collaboration with industrial partners and research institutes from various sectors. The current mask materials and designs were further improved by integrating textiles with antiviral and antimicrobial properties and enhanced protection and comfort by novel textile/membrane combinations, key factors to increase the acceptance and compliance of mask wearing. The innocuity and sustainability of masks, as well as taking into account particular needs of vulnerable persons in our society, are new fields for textile-based innovations. These innovations developed for the next generation of facemasks have a high adaptability to other product segments, which make textiles an attractive material for hygienic applications and beyond., (Copyright 2022 Till Batt, Gordon Herwig, Simon Annaheim, Pietro Clement, Lea Furrer, Cordula Hirsch, Vincent Varanges, Baris Caglar, Veronique Michaud, Jing Wang, Gilles Richner, Peter Wick, René Rossi. License: This work is licensed under a Creative Commons Attribution 4.0 International License.)

Background: Named Entity Recognition (NER) and Normalisation (NEN) are core components of any text-mining system for biomedical texts. In a traditional concept-recognition pipeline, these tasks are combined in a serial way, which is inherently prone to error propagation from NER to NEN. We propose a parallel architecture, where both NER and NEN are modeled as a sequence-labeling task, operating directly on the source text. We examine different harmonisation strategies for merging the predictions of the two classifiers into a single output sequence., Results: We test our approach on the recent Version 4 of the CRAFT corpus. In all 20 annotation sets of the concept-annotation task, our system outperforms the pipeline system reported as a baseline in the CRAFT shared task, a competition of the BioNLP Open Shared Tasks 2019. We further refine the systems from the shared task by optimising the harmonisation strategy separately for each annotation set., Conclusions: Our analysis shows that the strengths of the two classifiers can be combined in a fruitful way. However, prediction harmonisation requires individual calibration on a development set for each annotation set. This allows achieving a good trade-off between established knowledge (training set) and novel information (unseen concepts)., (© 2022. The Author(s).)

Background: We present a text-mining tool for recognizing biomedical entities in scientific literature. OGER++ is a hybrid system for named entity recognition and concept recognition (linking), which combines a dictionary-based annotator with a corpus-based disambiguation component. The annotator uses an efficient look-up strategy combined with a normalization method for matching spelling variants. The disambiguation classifier is implemented as a feed-forward neural network which acts as a postfilter to the previous step., Results: We evaluated the system in terms of processing speed and annotation quality. In the speed benchmarks, the OGER++ web service processes 9.7 abstracts or 0.9 full-text documents per second. On the CRAFT corpus, we achieved 71.4% and 56.7% F1 for named entity recognition and concept recognition, respectively., Conclusions: Combining knowledge-based and data-driven components allows creating a system with competitive performance in biomedical text mining.

Background: Animal health data recorded in free text, such as in necropsy reports, can have valuable information for national surveillance systems. However, these data are rarely utilized because the text format requires labor-intensive classification of records before they can be analyzed with using statistical or other software. In a previous study, we designed a text-mining tool to extract data from text in necropsy reports. In the current study, we used the tool to extract data from the reports from pig and cattle necropsies performed between 2000 and 2011 at the Institute of Animal Pathology (ITPA), University of Bern, Switzerland. We evaluated data quality in terms of credibility, completeness and representativeness of the Swiss pig and cattle populations., Results: Data was easily extracted from necropsy reports. Data quality in terms of completeness and validity varied a lot depending on the type of data reported. Diseases of the gastrointestinal system were reported most frequently (54.6% of pig submissions and 40.8% of cattle submissions). Diseases affecting serous membranes were reported in 16.0% of necropsied pigs and 27.6% of cattle. Respiratory diseases were reported in 18.3% of pigs and 21.6% of cattle submissions., Conclusions: This study suggests that extracting data from necropsy reports can provide information of value for animal health surveillance. This data has potential value for monitoring endemic disease syndromes in different age and production groups, or for early detection of emerging or re-emerging diseases. The study identified data entry and other errors that could be corrected to improve the quality and validity of the data. Submissions to veterinary diagnostic laboratories have selection biases and these should be considered when designing surveillance systems that include necropsy reports.

Background: This article describes a high-recall, high-precision approach for the extraction of biomedical entities from scientific articles., Method: The approach uses a two-stage pipeline, combining a dictionary-based entity recognizer with a machine-learning classifier. First, the OGER entity recognizer, which has a bias towards high recall, annotates the terms that appear in selected domain ontologies. Subsequently, the Distiller framework uses this information as a feature for a machine learning algorithm to select the relevant entities only. For this step, we compare two different supervised machine-learning algorithms: Conditional Random Fields and Neural Networks., Results: In an in-domain evaluation using the CRAFT corpus, we test the performance of the combined systems when recognizing chemicals, cell types, cellular components, biological processes, molecular functions, organisms, proteins, and biological sequences. Our best system combines dictionary-based candidate generation with Neural-Network-based filtering. It achieves an overall precision of 86% at a recall of 60% on the named entity recognition task, and a precision of 51% at a recall of 49% on the concept recognition task., Conclusion: These results are to our knowledge the best reported so far in this particular task.

Spinal Muscular Atrophy is due to the loss of SMN1 gene function. The duplicate gene SMN2 produces some, but not enough, SMN protein because most transcripts lack exon 7. Thus, promoting the inclusion of this exon is a therapeutic option. We show that a somatic gene therapy using the gene for a modified U7 RNA which stimulates this splicing has a profound and persistent therapeutic effect on the phenotype of a severe Spinal Muscular Atrophy mouse model. To this end, the U7 gene and vector and the production of pure, highly concentrated self-complementary (sc) adenovirus-associated virus 9 vector particles were optimized. Introduction of the functional vector into motoneurons of newborn Spinal Muscular Atrophy mice by intracerebroventricular injection led to a highly significant, dose-dependent increase in life span and improvement of muscle functions. Besides the central nervous system, the therapeutic U7 RNA was expressed in the heart and liver which may additionally have contributed to the observed therapeutic efficacy. This approach provides an additional therapeutic option for Spinal Muscular Atrophy and could also be adapted to treat other diseases of the central nervous system with regulatory small RNA genes.

For direct NMR detection and imaging of compounds with very short coherence life times the dead time between radio-frequency (RF) pulse and reception of the free induction decay (FID) is a major limiting factor. It is typically dominated by the transient and recovery times of currently available transmit-receive (T/R) switches and amplification chains. A novel PIN diode-based T/R switch topology is introduced allowing for fast switching by high bias transient currents but nevertheless producing a very low video leakage signal and insertion loss (0.5dB). The low transient spike level in conjunction with the high isolation (75dB) prevent saturation of the preamplifier entirely which consequently does not require time for recovery. Switching between transmission and reception is demonstrated within less than 1μs in bench tests as well as in acquisitions of FIDs and zero echo time (ZTE) images with bandwidths up to 500kHz at 7T. Thereby the 2kW switch exhibited a rise-time of 350ns (10-99%) producing however a total video leakage of below 20mV peak-to-peak and less than -89dBm in-band. The achieved switching time renders the RF pulse itself the dominant contribution to the dead time in which a coherence cannot be observed, thus making pulsed NMR experiments almost time-optimal even for compounds with very short signal life times., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: The benefit of off-pump coronary artery bypass (OPCAB) surgery may be reduced by strokes caused by microemboli produced after aortic side-clamping for proximal bypass anastomoses. The Heartstring device allows constructing proximal bypass anastomoses without side-clamping of the aorta., Methods: This retrospective study describes 260 consecutive patients who underwent OPCAB surgery; 442 proximal anastomoses were performed with the Heartstring device in this series. Ten percent of the patients were randomly sampled before discharge to undergo a coronary angiogram for assessment of graft patency., Results: Intraoperative Doppler measurements confirmed regular bypass function. Early mortality occurred in 4 patients (1.5%), and stroke occurred in 2 patients (0.8%). Device-related bleeding was negligible, and there were no cases of aortic dissection. Perioperative ischemia occurred in 8 patients (3.1%). Predischarge coronary angiography evaluations in 25 of the patients (of 260) showed that all 42 Heartstring-assisted anastomoses (of 442) were patent., Conclusions: Clampless performance of proximal bypass anastomoses combined with OPCAB is associated with a very low incidence of stroke complications. Short-term follow-up has shown excellent results regarding bypass patency and other adverse events. Prospective randomized trials are required to confirm the advantage of this technique.

Background: Neuraxial blockade is used as primary anesthetic technique in one third of surgical procedures. The authors tested whether bisoprolol would protect patients at risk for cardiovascular complications undergoing surgery with spinal block., Methods: The authors performed a double-blinded, placebo-controlled, multicenter trial to compare the effect of bisoprolol with that of placebo on 1-yr composite outcome including cardiovascular mortality, nonfatal myocardial infarction, unstable angina, congestive heart failure, and cerebrovascular insult. Bisoprolol was given orally before and after surgery for a maximum of 10 days. Adrenergic receptor polymorphisms and safety outcome measures of bisoprolol therapy were also determined., Results: A total of 224 patients were enrolled. Spinal block could not be established in 5 patients. One hundred ten patients were assigned to the bisoprolol group, and 109 patients were assigned to the placebo group. The mean duration of treatment was 4.9 days in the bisoprolol group and 5.1 days in the placebo group. Bisoprolol therapy reduced mean heart rate by 10 beats/min. The primary outcome was identical between treatment groups and occurred in 25 patients (22.7%) in the bisoprolol group and 24 patients (22.0%) in the placebo group during the 1-yr follow-up (hazard ratio, 0.97; 95% confidence interval, 0.55-1.69; P = 0.90). However, carriers of at least one Gly allele of the beta1-adrenergic receptor polymorphism Arg389Gly showed a higher number of adverse events than Arg homozygous (32.4% vs. 18.7%; hazard ratio, 1.87; 95% confidence interval, 1.04-3.35; P = 0.04)., Conclusions: Perioperative bisoprolol therapy did not affect cardiovascular outcome in these elderly at-risk patients undergoing surgery with spinal block.

Background: Anesthetic gases modulate gene expression and provide organ protection. This study aimed at identifying myocardial transcriptional phenotypes to predict cardiovascular biomarkers and function in patients undergoing off-pump coronary artery bypass graft surgery., Methods: In a prospective randomized trial, patients undergoing elective off-pump coronary artery bypass graft surgery were allocated to receive either the anesthetic gas sevoflurane (n = 10) or the intravenous anesthetic propofol (n = 10). Blood samples were collected perioperatively to determine cardiac troponin T, N-terminal pro-brain natriuretic peptide, and pregnancy-associated plasma protein A. Cardiac function was measured with transesophageal echocardiography and pulmonary artery thermodilution. Atrial biopsies were collected at the beginning and end of bypass surgery to determine gene expression profiles., Results: N-terminal pro-brain natriuretic peptide and pregnancy-associated plasma protein A blood levels were decreased with sevoflurane treatment. Echocardiography showed preserved postoperative cardiac function in sevoflurane patients, which paralleled higher cardiac index measurements. N-terminal pro-brain natriuretic peptide release was predicted by sevoflurane-induced transcriptional reduction in fatty acid oxidation, whereas changes in cardiac index were predicted by preoperative gene activity of the peroxisome proliferator-activated receptor gamma coactivator-1alpha pathway. Sevoflurane-mediated attenuation of transcripts involved in DNA-damage signaling and activation of the granulocyte colony-stimulating factor survival pathway predicted improved postoperative cardiac index and diastolic heart function, respectively., Conclusions: Anesthetic-induced and constitutive gene regulatory control of myocardial substrate metabolism predicts postoperative cardiac function in patients undergoing off-pump coronary artery bypass graft surgery. The authors' analysis further points to novel cardiac survival pathways as potential therapeutic targets in perioperative cardioprotection.

Study Objectives: Stroke volume variation (SVV) and pulse pressure variation (PPV) determined by the PiCCOplus system (Pulsion Medical Systems; Munich, Germany) may be useful dynamic variables in guiding fluid therapy in patients receiving mechanical ventilation. However, with respect to the prediction of volume responsiveness, conflicting results for SVV have been published in cardiac surgery patients. The goal of this study was to reevaluate SVV in predicting volume responsiveness and to compare it with PPV., Design: Prospective nonrandomized clinical investigation., Setting: University-based cardiac surgery., Patients: Forty patients with preserved left ventricular function undergoing elective off-pump coronary artery bypass grafting., Interventions: Volume replacement therapy before surgery., Measurements and Results: Following induction of anesthesia, before and after volume replacement (6% hydroxyethyl starch solution, 10 mL/kg ideal body weight), hemodynamic measurements of stroke volume index (SVI), SVV, PPV, global end-diastolic volume index (GEDVI), central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) were obtained. Also, left ventricular end-diastolic area index (LVEDAI) was assessed by transesophageal echocardiography. Prediction of ventricular performance was tested by calculating the area under the receiver operating characteristic (ROC) curves and by linear regression analysis; p < 0.05 was considered significant. All measured hemodynamic variables except heart rate changed significantly after fluid loading. GEDVI, CVP, PCWP, and LVEDAI increased, whereas SVV and PPV decreased. The best area under the ROC curve (AUC) was found for SVV (AUC = 0.823) and PPV (AUC = 0.808); the AUC for other preload indexes ranged from 0.493 to 0.636. A significant correlation with changes of SVI was observed for SVV (r = 0.606, p < 0.001) and PPV (r = 0.612, p < 0.001) only. SVV and PPV were closely related (r = 0.861, p < 0.001)., Conclusions: In contrast to standard preload indexes, SVV and PPV, comparably, showed a good performance in predicting fluid responsiveness in patients before off-pump coronary artery bypass grafting.

A judgement on the patient's quality of life cannot be based solely on the information about the clinical severity of a disease. Very often there is no correlation between these parameters. It is necessary to assess the quality of life by a health status questionnaire since non-life threatening diseases common in dermatology influence the quality of life very much. The most frequently used questionnaires are the SF-36 and the Nottingham Health Profile. However, these forms do not evaluate all dermatologic patients adequately. Therefore specific tools such as the DLQI (Dermatology Life Quality Index) and Skindex have been established for dermatology. Further disease-specific questionnaires have been created to measure time related changes in dermatological patients.