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Background Patients with coronary heart disease (CHD) with and without diabetes mellitus have an increased risk of recurrent events requiring multifactorial secondary prevention of cardiovascular risk factors. We compared prevalences of cardiovascular risk factors and its determinants including lifestyle, pharmacotherapy and diabetes mellitus among patients with chronic CHD examined within the fourth and fifth EUROASPIRE surveys (EA-IV, 2012–13; and EA-V, 2016–17) in Germany. Methods The EA initiative iteratively conducts European-wide multicenter surveys investigating the quality of secondary prevention in chronic CHD patients aged 18 to 79 years. The data collection in Germany was performed during a comprehensive baseline visit at study centers in Würzburg (EA-IV, EA-V), Halle (EA-V), and Tübingen (EA-V). Results 384 EA-V participants (median age 69.0 years, 81.3% male) and 536 EA-IV participants (median age 68.7 years, 82.3% male) were examined. Comparing EA-IV and EA-V, no relevant differences in risk factor prevalence and lifestyle changes were observed with the exception of lower LDL cholesterol levels in EA-V. Prevalence of unrecognized diabetes was significantly lower in EA-V as compared to EA-IV (11.8% vs. 19.6%) while the proportion of prediabetes was similarly high in the remaining population (62.1% vs. 61.0%). Conclusion Between 2012 and 2017, a modest decrease in LDL cholesterol levels was observed, while no differences in blood pressure control and body weight were apparent in chronic CHD patients in Germany. Although the prevalence of unrecognized diabetes decreased in the later study period, the proportion of normoglycemic patients was low. As pharmacotherapy appeared fairly well implemented, stronger efforts towards lifestyle interventions, mental health programs and cardiac rehabilitation might help to improve risk factor profiles in chronic CHD patients.

Patienten nach herzchirurgischen Operationen haben ein erhohtes Risiko fur postoperative Blutungskomplikationen und thrombembolische Komplikationen. Insbesondere nach Herzklappenoperationen tragen thrombembolische Ereignisse zu erhohter postoperativer Morbiditat und Mortalitat bei. Nach Einfuhrung der „neuen oralen Antikoagulanzien“ (NOAK) und Thrombozytenaggregationshemmer, den P2Y12-Inhibitoren, ist eine Vielfalt an Medikamenten verfugbar, die nach chirurgischen und interventionellen kardialen Eingriffen, z. T. kombiniert, eingesetzt werden konnen. Zusatzlich spielen patientenassoziierte Faktoren fur das postoperative Blutungs- und das Thromboembolierisiko wichtige Rollen. Die Entscheidung fur eine gerinnungshemmende Therapie ist individuell abzuwagen. Der vorliegende Beitrag fasst die derzeit gultigen Empfehlungen zu Antikoagulation und Thrombozytenaggregationshemmung beim herzchirurgischen Patienten auf der Grundlage aktueller Leitlinien und Studien zusammen.

Objectives: The aim of this study was to assess whether age >=75 years impairs surgical, functional, and oncological outcomes after robot-assisted radical prostatectomy (RARP). Materials and methods: Patients with prostate cancer (PCa) were stratified in >=75(n 1/4 669) vs. =75 vs., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Due to the small buffering, soilless systems are prone to salinity. Strict requirements for the quality of irrigation water have therefore been set, in particular if drainage water is being recycled. Since water qualities of resources do not always meet these requirements, a certain rate of leaching or discharge of the drainage is inevitable. The question is how this rate can be limited to avoid the loss of valuable water and nutrients. Evidently Na is the bottle-neck element, therefore we explored for various crops the very limits for the Na concentration in the root environment. The approach was to make use of the gap in the EC-value between the maximum recommended EC and the minimum required EC needed for the nutrients, and make use of this for Na accumulation. We also tried to increase the tolerance to high Na by adjusting the ratios of nutrients. The results for sweet pepper trial with increasing Na concentration up to 10 mmol L-1 in six treatments combined with a low and a high K/Ca ratio is worked out in this paper. No significant effects on yield or blossom end rot (BER) were found. The Na uptake concentration increased linearly with the Na in the root environment, though on a very low level. The K/Ca ratio did not affect the results, although at low K/Ca the K depletion in the root environment became serious. The results showed that the tolerance for Na worked out to be much higher than has been believed up till now and will make crop growing with zero liquid discharge possible. It also opens perspectives for soilless culture with water of lesser quality.

Die mediane Sternotomie ist in der Herzchirurgie der am haufigsten durchgefuhrte chirurgische Zugang. Gleichwohl treten postoperative Komplikationen dieses Zugangsweges auf. Diese sind teils nichtinfiziert (z. B. mechanische Sternuminstabilitat) bzw. teils infiziert (prasternale oder tief sternale Wundinfektion [„deep sternal wound infection“, DSWI]) und treten mit einer Pravalenz zwischen 2 und 5 % auf. „Deep sternal wound infections“ werden von einer erheblichen Morbiditat und Mortalitat zwischen 10 und 40 % begleitet. Die besten Ergebnisse der Behandlung und des Managements der DSWI lassen sich durch fruhzeitige Revision mit Debridement und kurzweilige offene Wundbehandlung mit Anwendung der Unterdrucktherapie („negative pressure wound therapy“, NPWT) erzielen. Die chirurgische Therapie der DSWI mithilfe der NPWT bietet einige Vorteile: Forderung der Granulation und der lokalen Durchblutung, Reduktion des vorhandenen Gewebsodems sowie Unterstutzung des Abtransports von Wundexsudat. Ziel ist die Uberfuhrung der Wunde aus der Reinigungs- (exsudative Phase) in die Granulationsphase. Ist die Wunde makroskopisch nekrose- und infektionsfrei, wird die Art des Sekundarverschlusses festgelegt. Bezuglich des Therapieerfolgs spielen neben der chirurgischen Sanierung mikrobiologische Aspekte, wie die Materialgewinnung und die Antibiotikatherapie, eine signifikante Rolle. Die meistgefurchtete Komplikation der NPWT ist die akute kardiale oder vaskulare Blutung.

Additional file 2. EuroAspire IV Germany I Follow-up interview I Questionnaire.

Additional file 1: Supplemental Table 1. Current smokers at index event* (n = 124) stratified by their participation at telephone-based follow-up interview. Supplemental Table 2. Clinical data of current smokers at index event* (n = 104) stratified by their smoking status reported 3.5 years later. Supplemental Table 3. Factors associated with smoking cessation (block-wise multivariable logistic regression).

Die retrosternale Infektion des vorderen Mediastinums nach herzchirurgischem Eingriff mit Sternotomie (Poststernotomie-Mediastinitis, PSM) ist eine lebensbedrohliche Komplikation. Sie stellt ein multifaktorielles und komplexes Krankheitsbild dar, an deren Diagnostik und Therapie viele Disziplinen beteiligt sind. Da verschiedene Behandlungskonzepte existieren, die oft auf Erfahrungen einzelner Kliniken beruhen, hat es sich die Deutsche Gesellschaft fur Thorax-, Herz- und Gefaschirurgie (DGTHG) in Kooperation mit der Schweizerischen Gesellschaft fur Herz- und Thorakale Gefaschirurgie (SGHC) zum Ziel gesetzt, eine evidenz- und konsensbasierte Leitlinie zum „Management der Mediastinitis nach herzchirurgischem Eingriff“ zu entwickeln. Unter Einbeziehung aller an Diagnostik und Therapie der PSM beteiligten Berufsgruppen wird eine S3-Leitlinie gemas dem Regelwerk der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) erarbeitet, um die medizinische Versorgung von Patienten mit PSM zu verbessern. Hier werden die Ziele und die methodischen Verfahren dieser Leitlinie beschrieben.

WOS: 000468732700018, PubMed ID: 31054483, Background and aims: One of the objectives of the ESC-EORP EUROASPIRE V survey is to determine how well European guidelines on the management of dyslipidaemias are implemented in coronary patients. Methods: Standardized methods were used by trained technicians to collect information on 7824 patients from 130 centers in 27 countries, from the medical records and at a visit at least 6 months after hospitalization for a coronary event. All lipid measurements were performed in one central laboratory. Patients were divided into three groups: on high-intensity LDL-C-lowering-drug therapy (LLT), on low or moderate-intensity LLT and on no LLT. Results: At the time of the visit, almost half of the patients were on a high-intensity LLT. Between hospital discharge and the visit, LLT had been reduced in intensity or interrupted in 20.8% of the patients and had been started or increased in intensity in 11.7%. In those who had interrupted LLT or had reduced the intensity, intolerance to LLT and the advice of their physician were reported as the reason why in 15.8 and 36.8% of the cases, respectively. LDL-C control was better in those on a high-intensity LLT compared to those on low or moderate intensity LLT. LDL-C control was better in men than women and in patients with self-reported diabetes. Conclusions: The results of the EUROASPIRE V survey show that most coronary patients have a less than optimal management of LDL-C. More professional strategies are needed, aiming at lifestyle changes and LLT adapted to the need of the individual patient., ESC - EORP; AmgenAmgen; Eli LillyEli Lilly; PfizerPfizer; SanofiSanofi-Aventis; Ferrer; Novo NordiskNovo Nordisk, The EUROASPIRE V survey was carried out under the auspices of the ESC - EORP. Since the start of EORP, the following companies have supported the programme: Amgen, Eli Lilly, Pfizer, Sanofi, Ferrer and Novo Nordisk. The sponsors of the EUROASPIRE surveys had no role in the design, data collection, data analysis, data interpretation, decision to publish, or writing the manuscript.

Hintergrund Ethische und medizinische Kriterien der Entscheidungsfindung bezuglich Therapiebegrenzung oder Therapieabbruch von lebenserhaltenden Masnahmen bei kritisch kranken Patienten stellen eine grose Herausforderung in der Intensivmedizin dar.

Die aktuelle Kasuistik berichtet uber die Anwendung der venoarteriellen extrakorporalen Membranoxygenierung (va-ECMO) als „bridge to therapy“ im Fall einer massiven Lungenembolie mit konsekutivem Rechtsherzversagen. Eine 38-jahrige Frau prasentierte sich in einem Krankenhaus der Regelversorgung mit Dyspnoe und zunehmender Kreislaufinsuffizienz. Die Diagnostik zeigte eine massive Lungenembolie. Nach frustraner Thrombolyse und Entwicklung eines kardiogenen Schocks war die Indikation zur Thrombendarteriektomie gegeben. Um einen Transport der hochgradig instabilen Patientin in ein Zentrum der Maximalversorgung zu ermoglichen, wurde ein mobiles ECMO-Team alarmiert. Dies leitete vor Ort eine va-ECMO-Therapie an der wachen Patientin ein. Nach Stabilisierung der kardiopulmonalen Funktion mithilfe der extrakorporalen Unterstutzung erfolgten die sichere Verlegung und anschliesend die erfolgreiche Operation mit Restitutio ad integrum.

Sediment-hosted, Paleoproterozoic low-grade Zn–Pb–Ag and Cu–Au mineralization occurs at the Polygonum, Thunderdome, Hunters Dam, and Benagerie Ridge prospects under a thick sedimentary cover in the Mulyungarie Domain (MD) of the southern Curnamona Province (SCP), Australia. Host rocks and mineralization were metamorphosed to lower greenschist facies at Benagerie Ridge, upper greenschist facies at Hunters Dam, and lower to upper amphibolite facies at Polygonum and Thunderdome. The giant Paleoproterozoic Pb–Zn–Ag Broken Hill deposit, which was metamorphosed to the granulite facies, is hosted in the Broken Hill Domain (BHD). The general lithostratigraphy for each prospect is similar and can be subdivided into four main units. Unit 1, at the base of the stratigraphic section, hosts Cu–Au mineralization and is characterized by the presence of oxidized magnetic metapsammopelites. Unit 2 consists of sulfide-rich, pyritic carbonaceous metapelites, calcareous metashales/siltstones, Mn-bearing sideritic metacarbonates, metacalc-silicates, and carbonate and feldspar lenses and layers. Syn-sedimentary sulfide mineralization occurs as laminations of fine-grained pyrite and sphalerite and resembles that at the HYC deposit, Queensland. Differences in δ 13 C values (δ 13 C VPDB = − 10.2 and − 0.8‰) of calcite in unit 2 from the same area suggest variable amounts of original organic C. The δ 13 C values of carbonates in Broken Hill ore and those obtained here from the Esmeralda deposit near Broken Hill are extremely low (δ 13 C = − 25 to − 21‰) and likely resulted from volatilization and high temperature effects during high-grade metamorphism. Barren laminated carbonaceous metapelites in unit 3 constitute a marker unit throughout the SCP. Unit 4 at the top of the stratigraphic sequence consists of psammopelitic and laminated andalusite or chiastolite phyllites that contain garnet and gahnite, laminated garnetite, quartz garnetite, Mn-bearing banded iron formation, amphibolite, and stratabound hydrothermal Pb–Zn mineralization. This unit, which is present at the Polygonum and Thunderdome prospects, is stratigraphically equivalent to the upper Broken Hill Group, which hosts the Broken Hill deposit. Base metals occur in metacarbonates and metapelites and close to redox boundaries between units 1 and 2, and units 2 and 3. Geochemical indicators of stratabound Pb–Zn mineralization in the northern part of the SCP include whole-rock values of > 4 ppm Tl, > 25 ppm Cd, and > 17 ppm Se in units 2 and 4, (Mn + Fe + Mg)/(Mn + Fe + Mg + Ca) ratios > 0.9 for carbonates, Mn/(Mn + Fe + Mg) ratios > 0.6 for garnet in garnet–quartz rocks, and Mn/(Mn + Ca + Fe) ratios > 0.3 for garnet in metacalc-silicate rocks.

Garnet-rich rocks are locally associated with the giant Paleoproterozoic Broken Hill Pb-Zn-Ag deposit and hundreds of smaller Broken Hill-type occurrences in the southern Curnamona Province, Australia; however, others are present unrelated to sulfides. Mn-bearing garnet-rich rocks are conformable to bedding in metasedimentary rocks of the Paleoproterozoic Willyama Supergroup and, together with sulfide-bearing zones, are spatially related to amphibolite and/or felsic volcanic rocks or shallow granite intrusions. The stratiform garnet-rich rocks can be subdivided into two groups: Mn-rich varieties typical of the stratigraphic hanging wall of the Broken Hill deposit and Mn-poor and Fe-rich varieties that are typical of the footwall and are regionally widespread. These garnet-rich rocks formed on the floor of a rifted basin as a mixture of chemical precipitates and detrital sediments and were subsequently metamorphosed to the amphibolite or granulite facies during the Olarian orogeny. A plot of Fe/Ti versus Al/(Al + Fe + Mn) ratios of these rocks suggests equal proportions of hydrothermal and detrital components in the precursor phases. Low Co + Cu + Ni contents are consistent with the input of a small hydrogenous component. Quartz garnetite and garnet-gahnite rocks in the stratigraphic footwall of the Broken Hill deposit (Zn-rich, Cu-poor B and C lodes), and garnet-rich rocks elsewhere in the southern Curnamona Province that are Mn poor and Fe rich, exhibit chondrite-normalized rare earth element (REE) patterns with negative Eu anomalies, which indicate that the precursor minerals formed from hydrothermal fluids at

Purpose An important rehabilitation aim following coronary artery bypass graft (CABG) surgery is to modify cardiovascular risk factors positively. Among the most potent possibilities for improvement of these factors is a lifestyle change in terms of increasing sports exercise, changing diet patterns, stress reduction, etc. An indispensable condition for these changes is the motivation to implement the necessary changes. In our working group a patient education programme was developed aimed at enhancing the motivation for lifestyle change, which was already applied in a cardiac surgery hospital. In evaluating the programme, we could observe that various cognitive factors of motivation for lifestyle change had dropped in untreated patients and risen in patients participating in the programme. Based on these preliminary findings we examined the motivation for lifestyle change one year after CABG surgery. Method Each patient was evaluated for his/her value in motivation for lifestyle change using a 30-item questionnaire which measures the six factors Vulnerability, Intention, Social Expectations, Outcome Expectation, Self-Efficacy Expectation, and Perceived Severity two days before CABG surgery as well as ten days and one year after CABG surgery. Between January and May 2002 patients in usual care were investigated as control group (n=70). From January to May 2003, n=70 patients had the opportunity to take part in a comprehensive patient education programme that was provided by a specifically trained psychologist. Data from 108 patients could be evaluated one year after CABG surgery (response rate=77.1%). The programme had comprised individualized units, as well as a group lecture. If partners were available they were included in the process. Results One year after CABG surgery no significant differences between the control group and the intervention group could be found. Conclusion The positive effects of the patient education programme measured ten days after surgery were found to have vanished one year after the operation. A possible reason is the short duration of the programme. Long-term, structured aftercare programmes should help stabilize the positive effects obtained in the short term.

The current report highlights the use of venoarterial extracorporeal membrane oxygenation (va-ECMO) in a case of pulmonary embolism complicated by right ventricular failure. A 38-year-old woman was admitted to a secondary care hospital with dyspnea and systemic hypotension. Diagnostic testing revealed a massive pulmonary embolism. Thrombolytic therapy was unsuccessful necessitating thromboendarterectomy in the presence of cardiogenic shock. To allow the necessary transport of the highly unstable patient to a tertiary care center a mobile ECMO team was called in. The team immediately initiated awake va-ECMO as a bridge to therapy. Extracorporeal support subsequently allowed a safe transportation and successful completion of the surgical procedure with complete recovery.