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Objectives: To switch patients with severe pulmonary hypertension and previous life-threatening catheter-related complications from long-term IV epoprostenol therapy to aerosolized iloprost therapy.Design: Open, uncontrolled trial.Setting: Medical ICU of a university hospital.Patients: Two patients with primary pulmonary hypertension and one patient with pulmonary hypertension after surgical closure of atrial septal defect (mean pulmonary artery pressure > or =50 mm Hg). All were classified as New York Heart Association class II under treatment with continuous IV epoprostenol for 4 years.Interventions: Stepwise reduction of IV epoprostenol (1 ng/kg/min steps every 3 to 10 h) during repeated inhalations of aerosolized iloprost (150 to 300 microg/d with 6 to 18 inhalations/d). Continuous pulmonary and systemic arterial monitoring were performed.Results: Aerosolized iloprost reduced pulmonary artery pressure by 49%, 49%, and 45%, respectively, and increased cardiac output by 70%, 75%, and 41% in the three patients. The effect lasted for 20 min and was similar at different doses of IV epoprostenol. Persistent treatment change to inhaled iloprost could not be achieved because all patients developed signs of right heart failure. After termination of iloprost inhalations, return to standard epoprostenol therapy led to clinical and hemodynamic restoration.Conclusions: Although aerosolized iloprost demonstrated short-term hemodynamic effects, it could not be utilized as alternative chronic vasodilator in patients with severe pulmonary hypertension. [ABSTRACT FROM AUTHOR]

We have studied the evolution of magnetic flux pinning behavior in the Meissner phase and the mixed state for the high-Tc single-crystal La2-xSrxCuO4 (x=0.09) superconductor using the polarized neutron imaging method with varying magnetic field and temperature. In the Meissner state expulsion of magnetic field (switched on during the measurements) is visualized, and the signatures of a mixed state with increasing temperature are observed. However, for flux pinning behavior in the range 5K≤T≤15K and Hext=63.5mT (switched off during the measurements), the evolution of the fringe pattern indicates magnetic flux pinning inside the bulk of the sample. At 25K≤T≤32K, a continuous decrease in inhomogeneously distributed pinned magnetic flux is observed, with the sample reaching a normal conducting state at Tc (≈32 K). The flux pinning behavior is also explored as a function of Hext at T=5K. As expected, with increasing Hext an increase in fringe density is observed, indicating an increase in magnetic flux pinning in the bulk of the sample. A comparison between calculated and experimentally visualized pinned magnetic fluxes shows good agreement. This implies quantification of pinned magnetic flux inside the sample, which is not possible with any other technique for bulk samples. [ABSTRACT FROM AUTHOR]

Background: Patients with idiopathic pulmonary fibrosis have progressive scarring of the lung and usually die within four to five years after symptoms develop. Treatment with oral glucocorticoids is often ineffective. We conducted an open, randomized trial of treatment with a combination of interferon gamma-1b, which has antifibrotic properties, and an oral glucocorticoid. Methods: We studied 18 patients with idiopathic pulmonary fibrosis who had not had responses to glucocorticoids or other immunosuppressive agents. Nine patients were treated for 12 months with oral prednisolone alone (7.5 mg daily, which could be increased to 25 to 50 mg daily), and nine with a combination of 200 μg of interferon gamma-1b (given three times per week subcutaneously) and 7.5 mg of prednisolone (given once a day). Results: All the patients completed the study. Lung function deteriorated in all nine patients in the group given prednisolone alone: total lung capacity decreased from a mean (±SD) of 66±8 percent of the predicted value at base line to 62±6 percent at 12 months. In contrast, in the group receiving interferon gamma-1b plus prednisolone, total lung capacity increased (from 70±6 percent of the predicted value at base line to 79±12 percent at 12 months, P<0.001 for the difference between the groups). In the group that received interferon gamma-1b plus prednisolone, the partial pressure of arterial oxygen at rest increased from 65±9 mm Hg at base line to 76±8 mm Hg at 12 months, whereas in the group that received prednisolone alone it decreased from 65±6 to 62±4 mm Hg (P<0.001 for the difference in the change from base-line values between the two groups); on maximal exertion, the value increased from 55±6 to 65±8 mm Hg in the group that received combined treatment and decreased from 55±6 mm Hg to 52±5 mm Hg in the group given prednisolone alone (P<0.001). The side effects of interferon gamma-1b, such as fever, chills, and muscle pain, subsided within the first 9 to 12 weeks. Conclusions: In a preliminary study, 12 months of treatment with interferon gamma-1b plus prednisolone was associated with substantial improvements in the condition of patients with idiopathic pulmonary fibrosis who had had no response to glucocorticoids alone. (N Engl J Med 1999;341:1264-9.) [ABSTRACT FROM AUTHOR]

Background: Symptoms of mental stress are a hallmark of the COVID-19 pandemic. We hypothesized that just testing for COVID-19 could act as an effective stressor for persisting symptoms of mental distress including posttraumatic stress disorder. Our study aimed to determine whether personal beliefs on individual control and competence (locus of control, LoC) correlate with symptoms of mental distress and positive screening for post-traumatic stress disorder during a 9-month observational period., Methods: Between March and December 2021, we applied online versions of the Questionnaire on Competence and Control Expectations (FKK), the Depression, Anxiety, and Stress Score (DASS), the Short Screening Scale for DSM-IV Posttraumatic Stress Disorder (PTSD), and a medical history questionnaire for COVID-19 symptoms (visit 1). 48 hours after negative COVID-19 testing, DASS was repeated to address relief effects on mental distress (visit 2). Following 90 days (visit 3), development of mental distress was addressed by a combination of DASS and PTSD, while the possible long-term manifestation of PTSD was evaluated 9 months later (visit 4)., Results: At visit 1, 7.4 percent of the total sample ( n = 867) demonstrated a positive screening for PTSD, while after nine months (at visit 4), 8.9 percent of the remaining sample ( n = 204) had positive screening results. The mean age was 36.2 years; 60.8% were women, 39.2% men. In contrast to individuals with negative PTSD screening, these participants demonstrated a significantly different LoC personality profile. This was confirmed by the results of both DASS and the COVID-19 medical history questionnaire., Conclusion: Following testing for COVID-19, individuals with positive long-term PTSD screening present with significantly different personality traits than those w/o suggesting that self-confidence and effective control over one's own actions serve as a protective function against mental distress., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Guttmann-Ducke, Klinger, Ziesche, Otzelberger, Idzko, Ponocny, Prantl and Ponocny-Seliger.)