Perinatal care at the limit of viability between 22 and 26 completed weeks of gestation in Switzerland. 2011 revision of the Swiss recommendations

Perinatal care of pregnant women at high risk for preterm delivery and of preterm infants born at the limit of viability (22-26 completed weeks of gestation) requires a multidisciplinary approach by an experienced perinatal team. Limited precision in the determination of both gestational age and foetal weight, as well as biological variability may significantly affect the course of action chosen in individual cases. The decisions that must be taken with the pregnant women and on behalf of the preterm infant in this context are complex and have far-reaching consequences. When counselling pregnant women and their partners, neonatologists and obstetricians should provide them with comprehensive information in a sensitive and supportive way to build a basis of trust. The decisions are developed in a continuing dialogue between all parties involved (physicians, midwives, nursing staff and parents) with the principal aim to find solutions that are in the infant's and pregnant woman's best interest. Knowledge of current gestational age-specific mortality and morbidity rates and how they are modified by prenatally known prognostic factors (estimated foetal weight, sex, exposure or nonexposure to antenatal corticosteroids, single or multiple births) as well as the application of accepted ethical principles form the basis for responsible decision-making. Communication between all parties involved plays a central role. The members of the interdisciplinary working group suggest that the care of preterm infants with a gestational age between 22 0/7 and 23 6/7 weeks should generally be limited to palliative care. Obstetric interventions for foetal indications such as Caesarean section delivery are usually not indicated. In selected cases, for example, after 23 weeks of pregnancy have been completed and several of the above mentioned prenatally known prognostic factors are favourable or well informed parents insist on the initiation of life-sustaining therapies, active obstetric interventions for foetal indications and provisional intensive care of the neonate may be reasonable. In preterm infants with a gestational age between 24 0/7 and 24 6/7 weeks, it can be difficult to determine whether the burden of obstetric interventions and neonatal intensive care is justified given the limited chances of success of such a therapy. In such cases, the individual constellation of prenatally known factors which impact on prognosis can be helpful in the decision making process with the parents. In preterm infants with a gestational age between 25 0/7 and 25 6/7 weeks, foetal surveillance, obstetric interventions for foetal indications and neonatal intensive care measures are generally indicated. However, if several prenatally known prognostic factors are unfavourable and the parents agree, primary non-intervention and neonatal palliative care can be considered. All pregnant women with threatening preterm delivery or premature rupture of membranes at the limit of viability must be transferred to a perinatal centre with a level III neonatal intensive care unit no later than 23 0/7 weeks of gestation, unless emergency delivery is indicated. An experienced neonatology team should be involved in all deliveries that take place after 23 0/7 weeks of gestation to help to decide together with the parents if the initiation of intensive care measures appears to be appropriate or if preference should be given to palliative care (i.e., primary non-intervention). In doubtful situations, it can be reasonable to initiate intensive care and to admit the preterm infant to a neonatal intensive care unit (i.e., provisional intensive care). The infant's clinical evolution and additional discussions with the parents will help to clarify whether the life-sustaining therapies should be continued or withdrawn. Life support is continued as long as there is reasonable hope for survival and the infant's burden of intensive care is acceptable. If, on the other hand, the health car...

Liraglutide once a day versus exenatide twice a day for type 2 diabetes: a 26-week randomised, parallel-group, multinational, open-label trial (LEAD-6)

BACKGROUND: Unlike most antihyperglycaemic drugs, glucagon-like peptide-1 (GLP-1) receptor agonists have a glucose-dependent action and promote weight loss. We compared the efficacy and safety of liraglutide, a human GLP-1 analogue, with exenatide, an exendin-based GLP-1 receptor agonist. METHODS: Adults with inadequately controlled type 2 diabetes on maximally tolerated doses of metformin, sulphonylurea, or both, were stratified by previous oral antidiabetic therapy and randomly assigned to receive additional liraglutide 1.8 mg once a day (n=233) or exenatide 10 microg twice a day (n=231) in a 26-week open-label, parallel-group, multinational (15 countries) study. The primary outcome was change in glycosylated haemoglobin (HbA(1c)). Efficacy analyses were by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00518882. FINDINGS: Mean baseline HbA(1c) for the study population was 8.2%. Liraglutide reduced mean HbA(1c) significantly more than did exenatide (-1.12% [SE 0.08] vs -0.79% [0.08]; estimated treatment difference -0.33; 95% CI -0.47 to -0.18; p<0.0001) and more patients achieved a HbA(1c) value of less than 7% (54%vs 43%, respectively; odds ratio 2.02; 95% CI 1.31 to 3.11; p=0.0015). Liraglutide reduced mean fasting plasma glucose more than did exenatide (-1.61 mmol/L [SE 0.20] vs -0.60 mmol/L [0.20]; estimated treatment difference -1.01 mmol/L; 95% CI -1.37 to -0.65; p<0.0001) but postprandial glucose control was less effective after breakfast and dinner. Both drugs promoted similar weight losses (liraglutide -3.24 kg vs exenatide -2.87 kg). Both drugs were well tolerated, but nausea was less persistent (estimated treatment rate ratio 0.448, p<0.0001) and minor hypoglycaemia less frequent with liraglutide than with exenatide (1.93 vs 2.60 events per patient per year; rate ratio 0.55; 95% CI 0.34 to 0.88; p=0.0131; 25.5%vs 33.6% had minor hypoglycaemia). Two patients taking both exenatide and a sulphonylurea had a major hypoglycaemic episode. INTERPRETATION: Liraglutide once a day provided significantly greater improvements in glycaemic control than did exenatide twice a day, and was generally better tolerated. The results suggest that liraglutide might be a treatment option for type 2 diabetes, especially when weight loss and risk of hypoglycaemia are major considerations.

Serum concentrations of 25-hydroxyvitamin D and immunoglobulins in an older Swiss cohort: results of the Senior Labor Study.

BACKGROUND Vitamin D and the components of humoral immunity play important roles in human health. Older people have lower 25-hydroxyvitamin D (25(OH)D) serum levels than younger adults. We aimed to determine the levels of 25(OH)D serum concentrations in healthy senior citizens and to study their relationship to the levels of components of humoral immunity. METHODS A total of 1,470 healthy Swiss men and women, 60 years or older, were recruited for this study. A total of 179 subjects dropped out of the study because of elevated serum concentrations of C-reactive protein. Fasting blood sera were analyzed for 25(OH)D with the high-performance liquid chromatography (HPLC) and for parathyroid hormone (PTH), immunoglobulins and complement C4 and C3 concentrations with immunoassays. The percentage of participants in each of the four 25(OH)D deficiency groups--severely deficient (<10 ng/ml), deficient (10 to 20), insufficient (21 to 29 ng/ml) and normal (>=30 ng/ml)--were statistically compared. The relationship of the major components of the humoral system and age with 25(OH)D levels was also assessed. RESULTS About 66% of the subjects had insufficient levels of 25(OH)D. Normal levels of 25(OH)D were found in 26.1% of the subjects of which 21% were males and 30.5% were females (total study population). Severely deficient levels of 25(OH)D were found in 7.98% of the total study population. Low levels of 25(OH)D were positively associated with IgG2 (P = 0.01) and with C4 (P = 0.02), yet were inversely related to levels of IgG1 and IgA (P < 0.05) and C3 (P = 0.01). Serum levels of total IgA, IgG, IgG2 and IgG4 peaked together with 25(OH)D during late summer. CONCLUSIONS Approximately two-thirds of the healthy, older Swiss population presented with Vitamin D insufficiency. The incremental shift in IgA and C3 levels might not necessarily reflect a deranged humoral immune defense; however, given the high prevalence of vitamin D deficiency, the importance of this condition in humoral immunity will be worth looking at more closely. This study supports the role of vitamin D in the competent immune system.

Na 1 Nachlass Max Horkheimer, 56 - Korrespondenzen u.a. mit Felix Weil (p. I 26, 131-348)

12 Briefe zwischen Anna Weil und Max Horkheimer, 1935-1936; 82 Briefe und Beilage zwischen Felix Weil, Margot de Weil und Max Horkheimer, 1934-1941; 1 Brief von D. Charnass an Felix Weil, 25.04.1936; 4 Briefe zwischen Dolson Wood Company und Max Horkheimer, 16.05.1941, 19.05.1941; 1 Brief von Max Horkheimer an das American Consul General Havana, 21.03.1941; 1 Brief von Max Horkheimer an Byron H. Uhl, 07.01.1941; 2 Brief zwischen Dorothy B. Padwa und Max Horkheimer, 01.03.1940, 05.03.1940; 1 Brief von Max Horkheimer an Collector of Customs, 08.10.1938; 1 Brief von D. Charnass an Felix Weil, 25.04.1936; 2 Briefe zwischen D. Charnass und Charles Rosenheck, 25.04.1936; 1 Zeugnis von The State Education Department an Charles Rosenheck, 25.04.1936; 1 Zeugniskopie, 24.04.1936; 1 Brief von Charles Rosenheck über Felix Weil, 23.04.1936; 1 Bescheinigung von Albert Marinelli, 24.04.1936; 3 Briefe zwischen George Weil und Max Horkheimer, 22.02.1937, 1937; 2 Briefe zwischen Georg Weil und Max Horkheimer, 06.04.1942, 08.04.1942; 1 Brief von Hans Weil an Max Horkheimer, 01.01.1939; 2 Briefe von Max Horkheimer an Duggan; 1 Brief und Beilage von Hans Weil an Paul Tillich, 11.10.1940; 1 Brief von Max Horkheimer an Hilde Frankel, 12.10.1940; 3 Briefe und 1 Beilage Juliana Weil, 06.06.1936, 1936; 1 Brief von Weinbaum an Max Horkheimer; 2 Briefe zwischen Jacob Weinberger und Max Horkheimer, 20.02.1946, 28.02.1946; 2 Briefe zwischen Ria Weinig, Margit Weinig und Max Horkheimer, 20.07.1949, 29.07.1949; 1 Brief und Beilage von B. Weinryb an Max Horkheimer, 04.03.1941; 1 Brief von Philipp Weintraub an Max Horkheimer, 20.11.1937;

Neuer Auß Münster vom 25. deß Weinmonats im Jahr 1648 abgefertigter Freud- vnd Friedenbringender Postreuter

Der Postreiter posaunt die Freude über den Westfälischen Frieden in die Welt

Kurtze vnd eigentliche Entwerffung, der schweren Belägerung : so die Stadt Leipzig vnd Vestung Bleissenburg, vom 14. Octobr. biß 26. Novemb. deß 1642. Jahrs außgestanden, neben einem außführlichen Bericht, was sich von Tag zu Tag denckwürdiges dabey zugetragen ...

Bibliograph. Nachweis: Paas P-2129

Na 1 Nachlass Max Horkheimer, 562 - Korrespondenzen u.a. mit Alice H. Maier und Leo Löwenthal (p. VI 26, 170-409)

Briefwechsel zwischen Alice H. Maier und Max Horkheimer; 3 Briefe zwischen Adolf Sturmthal und Alice H. Maier, 1951; 1 Brief von Alice H. Maier an Hattie Ross, 25.09.1951; 1 Brief an Franz Neumann von Alice H. Maier, 20.08.1951; 1 Brief von Alice H. Maier an Friede Fromm-Reichmann, 20.08.1951; 1 Brief an Leo Löwenthal von M. von Medelssohn, 13.08.1951; 1 Brief an The New York Academy of Science von Alice H. Maier, 20.03.1951; 1 Brief von dem Lee Travel Service (New York) an Max Horkheimer, 09.08.1948; 1 Brief an Max Horkheimer von Walter Hallstein, 02.07.1948; 1 Brief von E. Stein an Max Horkheimer, 26.06.1948; 2 Briefe zwischen Alice H. Maier und Gaby Onderwijzer, 1947; 1 Brief an Alfred Haas von Emmy Henne, 01.04.1955; 11 Briefe zwischen Emmy Henne und Alice H. Maier, 1954 - 1955; 2 Briefe zwischen Max Horkheimer und Morris L. Ernst, Oktober 1955; 1 Brief an Alfred Haas und Fritz Moses von Emmy Henne, 01.04.1955; 1 Brief an Alice H. Maier von Alfred Haas und Fritz Moses, 25.10.1954; 1 Brief an das Barbison Plaza Hotel (New York) von Alice H. Maier, 10.02.1955; 4 Briefe von dem Institut für Sozialforshung (Fankfurt am Main) an die Social Studies Association (New York), 1952 - 1954; 2 Briefe und 8 Briefentwürfe von Max Horkheimer an Nicholas Jory, September 1954; 1 Brief und 2 Briefentwürfe an Stroock von Alice H. Maier, [1954]; 1 Brief an Max Horkheimer von L. A. Chamberlin, 16.08.1954; 1 Brief von A. P. Bersohn an Max Horkheimer, 17.08.1954; 1 Brief von Max Horkheimer an Jacob K. Javits, 07.08.1954; 1 Brief an The Ideal Book Shop (New York) von Alice H. Maier, 07.08.1954; 1 Brief von Lothar Wendt (Internist) an Max Horkheimer, 30.07.1954; 1 Brief von Max Horkheimer an Young, 16.07.1954; 1 Brief an R. B. Shipley von Chauncy D. Harris, 16.07.1954; 1 Brief von Chauncy D. Harris an Max Horkheimer, 28.05.1954; 3 Briefe zwischen Max Horkheimer und John J. McCloy, 1954; 1 Brief von John J. McCloy an Ruth Shipley, 12.07.1954; 4 Briefe zwischen Alice H. Maier und Volker von Hagen, 1954; 1 Brief an York Lucci von Alice H. Maier, 13.04.1954; 3 Briefe von Alice H. Maier an H. P. Edelman, 1954; 3 Briefe zwischen Diedrich Osmer und Alice H. Maier, 1953; 1 Brief an die Indiana University (South Bend) von Diedrich Osmer, 26.02.1953; 3 Briefe zwischen Alice H. Maier und Elizabeth C. Krueger, 1953; 2 Briefe zwischen David Melvin Raul und Alice H. Maier, 1952; 1 Brief von Frederick Wild an The American Quaterly (Mineapolis), 25.06.1952; 1 Brief an Alice H. Maier von David Riesman, 19.05.1952; 1 Brief und 1 Briefentwurf an Felix Weil von Alice H. Maier, 23.04.1952;