Prognostic importance of anaemia in HIV type-1-infected patients starting antiretroviral therapy: collaborative analysis of prospective cohort studies

BACKGROUND: In HIV type-1-infected patients starting highly active antiretroviral therapy (HAART), the prognostic value of haemoglobin when starting HAART, and of changes in haemoglobin levels, are not well defined. METHODS: We combined data from 10 prospective studies of 12,100 previously untreated individuals (25% women). A total of 4,222 patients (35%) were anaemic: 131 patients (1.1%) had severe (<8.0 g/dl), 1,120 (9%) had moderate (male 8.0-<11.0 g/dl and female 8.0- < 10.0 g/dl) and 2,971 (25%) had mild (male 11.0- < 13.0 g/ dl and female 10.0- < 12.0 g/dl) anaemia. We separately analysed progression to AIDS or death from baseline and from 6 months using Weibull models, adjusting for CD4+ T-cell count, age, sex and other variables. RESULTS: During 48,420 person-years of follow-up 1,448 patients developed at least one AIDS event and 857 patients died. Anaemia at baseline was independently associated with higher mortality: the adjusted hazard ratio (95% confidence interval) for mild anaemia was 1.42 (1.17-1.73), for moderate anaemia 2.56 (2.07-3.18) and for severe anaemia 5.26 (3.55-7.81). Corresponding figures for progression to AIDS were 1.60 (1.37-1.86), 2.00 (1.66-2.40) and 2.24 (1.46-3.42). At 6 months the prevalence of anaemia declined to 26%. Baseline anaemia continued to predict mortality (and to a lesser extent progression to AIDS) in patients with normal haemoglobin or mild anaemia at 6 months. CONCLUSIONS: Anaemia at the start of HAART is an important factor for short- and long-term prognosis, including in patients whose haemoglobin levels improved or normalized during the first 6 months of HAART.

Ischemia-induced up-regulation of heme oxygenase-1 protects from apoptotic cell death and tissue necrosis

BACKGROUND: Tissues are endowed with protective mechanisms to counteract chronic ischemia. Previous studies have demonstrated that endogenous heme oxygenase (HO)-1 may protect parenchymal tissue from inflammation- and reoxygenation-induced injury. Nothing is known, however, on whether endogenous HO-1 also plays a role in chronic ischemia to protect from development of tissue necrosis. The aim of this study is, therefore, to evaluate in vivo whether endogenous HO-1 exerts protection on chronically ischemic musculocutaneous tissue, and whether this protection is mediated by an attenuation of the microcirculatory dysfunction. MATERIALS AND METHODS: In C57BL/6-mice, a chronically ischemic flap was elevated and fixed into a dorsal skinfold chamber. In a second group, tin-protoporphyrin-IX was administrated to competitively block the action of HO-1. Animals without flap elevation served as controls. With the use of intravital fluorescence microscopy, microcirculation, apoptotic cell death, and tissue necrosis were analyzed over a 10-day observation period. The time course of HO-1 expression was determined by Western blotting. RESULTS: Chronic ischemia induced an increase of HO-1 expression, particularly at day 1 and 3. This was associated with arteriolar dilation and hyperperfusion, which was capable of maintaining an adequate capillary perfusion density in the critically perfused central part of the flap, demarcating the distal necrosis. Inhibition of endogenous HO-1 by tin-protoporphyrin-IX completely abrogated arteriolar dilation (44.6 +/- 6.2 microm versus untreated flaps: 71.3 +/- 7.3 microm; P < 0.05) and hyperperfusion (3.13 +/- 1.29 nL/s versus 8.55 +/- 3.56 nL/s; P < 0.05). This resulted in a dramatic decrease of functional capillary density (16 +/- 16 cm/cm(2)versus 84 +/- 31 cm/cm(2); P < 0.05) and a significant increase of apoptotic cell death (585 +/- 51 cells/mm(2)versus 365 +/- 53 cells/mm(2); P < 0.05), and tissue necrosis (73% +/- 5% versus 51% +/- 5%; P < 0.001). CONCLUSION: Thus, our results suggest that chronic ischemia-induced endogenous HO-1 protects ischemically endangered tissue, probably by the vasodilatory action of the HO-1-associated carbon monoxide.

Integriertes Informationsmanagement für Bildungseinrichtungen

Der CampusSource Workshop fand vom 10. bis 12. Oktober 2006 an der Westfälischen Wilhelms Universität (WWU) in Münster statt. Kernpunkte der Veranstaltung waren die Entwicklung einer Engine zur Verknüpfung von e-Learning Anwendungen mit Systemen der HIS GmbH und die Erstellung von Lehr- und Lerninhalten mit dem Ziel der Wiederverwendung. Im zweiten Kapitel sind Vorträge der Veranstaltung im Adobe Flash Format zusammengetragen. Zur Betrachtung der Vorträge ist der Adobe Flash Player, mindestens in der Version 6 erforderlich

Impact of Switching From Zidovudine to Tenofovir Disoproxil Fumarate on Bone Mineral Density and Markers of Bone Metabolism in Virologically Suppressed HIV-1 Infected Patients; A Substudy of the PREPARE Study

Context: In virologically suppressed, antiretroviral-treated patients, the effect of switching to tenofovir (TDF) on bone biomarkers compared to patients remaining on stable antiretroviral therapy is unknown. Methods: We examined bone biomarkers (osteocalcin [OC], procollagen type 1 amino-terminal propeptide, and C-terminal cross-linking telopeptide of type 1 collagen) and bone mineral density (BMD) over 48 weeks in virologically suppressed patients (HIV RNA < 50 copies/ml) randomized to switch to TDF/emtricitabine (FTC) or remain on first-line zidovudine (AZT)/lamivudine (3TC). PTH was also measured. Between-group differences in bone biomarkers and associations between change in bone biomarkers and BMD measures were assessed by Student's t tests, Pearson correlation, and multivariable linear regression, respectively. All data are expressed as mean (SD), unless otherwise specified. Results: Of 53 subjects (aged 46.0 y; 84.9% male; 75.5% Caucasian), 29 switched to TDF/FTC. There were reductions in total hip and lumbar spine BMD in those switching to TDF/FTC (total hip, TDF/FTC, −1.73 (2.76)% vs AZT/3TC, −0.39 (2.41)%; between-group P = .07; lumbar spine, TDF/FTC, −1.50 (3.49)% vs AZT/3TC, +0.25 (2.82)%; between-group P = .06), but they did not reach statistical significance. Greater declines in lumbar spine BMD correlated with greater increases in OC (r = −0.28; P = .05). The effect of TDF/FTC on bone biomarkers remained significant when adjusted for baseline biomarker levels, gender, and ethnicity. There was no difference in change in PTH levels over 48 weeks between treatment groups (between-group P = .23). All biomarkers increased significantly from weeks 0 to 48 in the switch group, with no significant change in those remaining on AZT/3TC (between-group, all biomarkers, P < .0001). Conclusion: A switch to TDF/FTC compared to remaining on a stable regimen is associated with increases in bone turnover that correlate with reductions in BMD, suggesting that TDF exposure directly affects bone metabolism in vivo.

Is a 3-mm intrafractional margin sufficient for daily image-guided intensity-modulated radiation therapy of prostate cancer?

PURPOSE: To determine whether a 3-mm isotropic target margin adequately covers the prostate and seminal vesicles (SVs) during administration of an intensity-modulated radiation therapy (IMRT) treatment fraction, assuming that daily image-guided setup is performed just before each fraction. MATERIALS AND METHODS: In-room computed tomographic (CT) scans were acquired immediately before and after a daily treatment fraction in 46 patients with prostate cancer. An eight-field IMRT plan was designed using the pre-fraction CT with a 3-mm margin and subsequently recalculated on the post-fraction CT. For convenience of comparison, dose plans were scaled to full course of treatment (75.6 Gy). Dose coverage was assessed on the post-treatment CT image set. RESULTS: During one treatment fraction (21.4+/-5.5 min), there were reductions in the volumes of the prostate and SVs receiving the prescribed dose (median reduction 0.1% and 1.0%, respectively, p<0.001) and in the minimum dose to 0.1 cm(3) of their volumes (median reduction 0.5 and 1.5 Gy, p<0.001). Of the 46 patients, three patients' prostates and eight patients' SVs did not maintain dose coverage above 70 Gy. Rectal filling correlated with decreased percentage-volume of SV receiving 75.6, 70, and 60 Gy (p<0.02). CONCLUSIONS: The 3-mm intrafractional margin was adequate for prostate dose coverage. However, a significant subset of patients lost SV dose coverage. The rectal volume change significantly affected SV dose coverage. For advanced-stage prostate cancers, we recommend to use larger margins or improve organ immobilization (such as with a rectal balloon) to ensure SV coverage.

Ms. Ff. Mus. 1246 - Am Neu-Jahrs-Tag : Lobet den Herrn p ; C. A. T. B., 2 violini, viola, 2 oboe, 3 clarini, tympano, violoncello, organo

del S. Telemann

Mus Hs 750/7 - No. 1

[Carl Oestreich]

Outcome study of real-time MR-guided cervical periradicular injection therapy in an open 1.0 Tesla MRI system

PURPOSE To evaluate the accuracy, safety, and efficacy of cervical nerve root injection therapy using magnetic resonance guidance in an open 1.0 T MRI system. METHODS Between September 2009 and April 2012, a total of 21 patients (9 men, 12 women; mean age 47.1 ± 11.1 years) underwent MR-guided cervical periradicular injection for cervical radicular pain in an open 1.0 T system. An interactive proton density-weighted turbo spin echo (PDw TSE) sequence was used for real-time guidance of the MR-compatible 20-gauge injection needle. Clinical outcome was evaluated on a verbal numeric rating scale (VNRS) before injection therapy (baseline) and at 1 week and 1, 3, and 6 months during follow-up. RESULTS All procedures were technically successful and there were no major complications. The mean preinterventional VNRS score was 7.42 and exhibited a statistically significant decrease (P < 0.001) at all follow-up time points: 3.86 ± 1.53 at 1 week, 3.21 ± 2.19 at 1 month, 2.58 ± 2.54 at 3 months, and 2.76 ± 2.63 at 6 months. At 6 months, 14.3 % of the patients reported complete resolution of radicular pain and 38.1 % each had either significant (4-8 VNRS score points) or mild (1-3 VNRS score points) relief of pain; 9.5 % experienced no pain relief. CONCLUSION Magnetic resonance fluoroscopy-guided periradicular cervical spine injection is an accurate, safe, and efficacious treatment option for patients with cervical radicular pain. The technique may be a promising alternative to fluoroscopy- or CT-guided injections of the cervical spine, especially in young patients and in patients requiring repeat injections.

Intravitreal ranibizumab monotherapy to treat retinopathy of prematurity zone II, stage 3 with plus disease.

BACKGROUND Treatment of retinopathy of prematurity (ROP) stage 3 plus with bevacizumab is still very controversial. We report the outcome of 6 eyes of 4 premature infants with ROP stage 3 plus disease treated with ranibizumab monotherapy. METHODS Six eyes of 4 premature infants with threshold ROP 3 plus disease in zone II, were treated with one intravitreal injection of 0.03 ml ranibizumab. No prior laser or other intravitreal therapy was done. Fundus examination was performed prior to the intervention and at each follow-up visit. Changes in various mean vital parameters one week post intervention compared to one week pre-intervention were assessed. RESULTS The gestational age (GA) of patient 1, 2, 3, and 4 at birth was 24 5/7, 24 5/7, 24 4/7, and 26 1/7 weeks, respectively. The birth weight was 500 grams, 450 grams, 665 grams, and 745 grams, respectively. The GA at the date of treatment ranged from 34 3/7 to 38 6/7 weeks. In one infant, upper air way infection was observed 2 days post injection of the second eye. Three eyes required paracentesis to reduce the intraocular pressure after injection and to restore central artery perfusion. After six months, all eyes showed complete retinal vascularisation without any signs of disease recurrence. CONCLUSIONS Treatment of ROP 3 plus disease with intravitreal ranibizumab was effective in all cases and should be considered for treatment. One infant developed an upper air way infection suspicious for nasopharyngitis, which might be a possible side effect of ranibizumab. Another frequent complication was intraocular pressure rise after injection. More patients with longer follow-up duration are mandatory to confirm the safety and efficacy of this treatment. TRIAL REGISTRATION NUMBER NCT02164604 ; Date of registration: 13.06.2014.

Hepatic and intramyocellular glycogen stores in adults with type 1 diabetes and healthy controls.

Glycogen levels in liver and skeletal muscle assessed non-invasively using magnetic resonance spectroscopy after a 48-h pre-study period including a standardized diet and withdrawal from exercise did not differ between individuals with well-controlled Type 1 DM and matched healthy controls.

Ability to Work and Employment Rates in Human Immunodeficiency Virus (HIV)-1-Infected Individuals Receiving Combination Antiretroviral Therapy: The Swiss HIV Cohort Study

Background.  Limited data exist on human immunodeficiency virus (HIV)-infected individuals' ability to work after receiving combination antiretroviral therapy (cART). We aimed to investigate predictors of regaining full ability to work at 1 year after starting cART. Methods.  Antiretroviral-naive HIV-infected individuals <60 years who started cART from January 1998 through December 2012 within the framework of the Swiss HIV Cohort Study were analyzed. Inability to work was defined as a medical judgment of the patient's ability to work as 0%. Results.  Of 5800 subjects, 4382 (75.6%) were fully able to work, 471 (8.1%) able to work part time, and 947 (16.3%) were unable to work at baseline. Of the 947 patients unable to work, 439 (46.3%) were able to work either full time or part time at 1 year of treatment. Predictors of recovering full ability to work were non-white ethnicity (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.20-3.54), higher education (OR, 4.03; 95% CI, 2.47-7.48), and achieving HIV-ribonucleic acid <50 copies/mL (OR, 1.83; 95% CI, 1.20-2.80). Older age (OR, 0.55; 95% CI, .42-.72, per 10 years older) and psychiatric disorders (OR, 0.24; 95% CI, .13-.47) were associated with lower odds of ability to work. Recovering full ability to work at 1 year increased from 24.0% in 1998-2001 to 41.2% in 2009-2012, but the employment rates did not increase. Conclusions.  Regaining full ability to work depends primarily on achieving viral suppression, absence of psychiatric comorbidity, and favorable psychosocial factors. The discrepancy between patients' ability to work and employment rates indicates barriers to reintegration of persons infected with HIV.

Mus Hs 750/11 - No. 1

[Carl Oestreich]

Ms. Ff. Mus. 1492 - Dom: XXIII. post: Trin: : Werthes Zion sey getrost pp ; â. C. A. T. B., violino primo, violino secundo, hautbois primo, hautbois secundo, clarino primo, clarino secundo, clarino tertio, tympani, viola 1, viola 2, violoncello, chalcedon e. organo

di Telemann

Na 1 Nachlass Max Horkheimer, 643 - Korrekturen zur Neupublikation der Aufsätze Max Horkheimers aus der Zeitschrift für Sozialforschung und Vorwort zur Neupublikation 1968 (p. IX 23.1-20-IX 24.1-9)

1. Friedrich Pollock: Verzeichnis der Änderungen in den Essays nach der Bearbeitung durch Alfred Schmidt, 4 Blatt; 2. Derselbe: Eigenhändige Korrekturnotiz zum Manuskript Schmidt, 1 Blatt; 3. Derselbe: Eigenhändige Notiz über Verteilung von Korrekturen, 1 Blatt; 4. Derselbe: Ergänzungen zu den Korrekturen vom 15. und 20.03.1968. a) 8 Blatt b) 8 Blatt; 5. Korrekturen, 2 Blatt; 6. Friedrich Pollock [?]: Verzeichnis der Essays von Max Horkheimer und der Korrekturen. a) 8 Blatt b) Teilstücke, 2 Blatt; 7. Derselbe [?]: Verzeichnis der Korrekturen, 3 Blatt; 8. Derselbe: Eigenhändige Gesprächsnotiz, 1 Blatt; 9. Derselbe: Eigenhändige Gesprächsnotiz, 1 Blatt; 10. Derselbe: "Sprachregeln", eigenhändige Notiz, 1 Blatt; 11. Derselbe: "Bedenkliche Stellen", eigenhändiges Verzeichnis, 1 Blatt; 12. Derselbe: "Vorschlag für den Inhalt von Max Horkheimers Essays I", eigenhändiges Verzeichnis, 1 Blatt; 13. Derselbe: Eigenhändige Gesprächsnotiz Friedrich Pollocks - Max Horkheimers über Pro und Contra, Neuveröffentlichung, 1 Blatt; 14. S. Fischer Verlaf: Schätzung des Umfangs der Essys, 1 Blatt; 15. Friedrich Pollock: Verzeichnis der Essays von Max Horkheimer, 3 Blatt; 16. Handschriftliches Verzeichnis der Aufsätze, Reden und Schriften Max Horkheimers, 4 Blatt; 17. "Max Horkheimer Essays" Verzeichnis, 1 Blatt; 18. Schönbach, Peter: 1 Brief mit Unterschrift an Max Horkheimer Frankfurt, 11.09.1964, 7 Blatt; 19. Liste der Anmerkungen Frau Dr. Adornos zu den Aufsätzen Prof. Horkheimers in der Zeitschrift für Sozialforschung, 2 Blatt; 20. Adorno, Gretel: 4 Briefe mit Unterschrift an Max Horkheimer, Korrekturvorschläge Frankfurt am Main 1962-1963, 5 Blatt; Vowort zur Neupublikation 1968 der Aufsätze aus der Zeitschrift für Sozialforschung (GS 3, S. 14-19); 1964-1968; Veröffentlicht in: Max Horkheimer "Kritische Theorie", Frankfurt am Main 1968, Seite IX- IXV; 1. Entwürfe Juli- September 1968; 2. Kalb, Peter E.: 1 Brief an Max Horkheimer und Beilage, Frankfurt am Main, 02.08.1968, 2 Blatt; 3. Klappentext der Buchausgabe, Korrekturfahne mit handschriftlichen Korrekturen; 4. Adorno, Theodor W.: 1 Brief mit Unterschrift an Max Horkheimer, Frankfurt, 17.07.1968, 1 Blatt; 5. Horkheimer, Max: "Der neuste Angriff auf die Metaphysik". Sonderdruck der Zeitschrift für Sozialforschung VI, 1937, mit eigenhändigen Korrekturen; 6. Derselbe: "Autoritärer Staat" Teilstücke aus der Gedenkschrift für Walter Benjamin, 1942. Als Typoskript vervielfältigt, 21 Blatt; 7. "Zitate aus 'Autoritärer Staat' heute", 4 Blatt; 8. Schmidt, Alfred: "Zur Idee der kritischen Theorie" = Nachwort zur Buchausgabe. Typoskript mit handschriftlichen Korrekturen von Max Horkheimer, 38 Blatt; 9. N.N.: Ergänzungsvorschläge zu dem Nachwort von Dr. Schmidt, 3 Blatt;

Na 1 Nachlass Max Horkheimer, 654 - "The Aftermath of National Socialism"; "National Socialism and Philosophy"; "The Idea of Philosophy"; "Programm einer Intereuropäischen Akademie" (p. IX 36a.1-4-IX 39.1-2)

"The Aftermath of National Socialism. On the Cultural Aspects of the Collapse of National Socialism". Vorlesungsreihe des Instituts für Sozialforschung, März 1945; 1. Vorlesungsankündigung und Typoskripte der Beiträge von: Theodor W. Adorno, "The Fate of the Arts" (= "What National Socialism Has Done to the Arts"); Frederick Pollock, "Prejudice and the Social Classes"; Leo Löwenthal, "The Aftermath of Totalitarian Terror". Bibliographie, Typoskripte, geheftet, mit eigenhändiger Korrektur von Frederick Pollock, 93 Blatt; 2. Vorlesungsankündigung, als Typoskript vervielfältigt, 1 Blatt; 3. Max Horkheimer: "Totalitarism and the Crisis of European Culture". Eigene Notizen zur Vorlesung, 3 Blatt; 4. Theodor W. Adorno: Notizen zur Vorlesungsreihe. Typoskript, 2 Blatt; Max Horkheimer: "National Socialism and Philosophy". Seminar Frühjahr 1945; 1. Protokolle zu den Sitzungen vom 5.2, 24.4., 1.5. und 8.5.1945. Typoskript mit eigenhändiger Korrektur, 16 Blatt; 2. Dasselbe. Gebunden, 16 Blatt; 3. Eigenhändige Notizen, 8 Blatt; Max Horkheimer: "The Idea of Philosophy". Vorlesung Winter 1945/46; 1. Eigenhändige Notizen, 3 Blatt; 2. Eigenhändige Notizen, 4 Blatt; 3. Eigenhändige Notizen, 2 Blatt; 4. Abschriften aus Werken unter anderem von Friedrich von Bezold, Karl Lamprecht, Richard Pietchman, Leopold von Ranke, Edwin R.A. Seligman. Typoskripte, 8 Blatt; 5. Paul Tillich: "Conscience in Western Thought and the Idea a Transmoral Conscience". Sonderdruck aus: Crozer Quarterly, Vol. XXII, Nr. 4, Oktober 1945, 6 Blatt; Max Horkheimer: Programm einer Intereuropäischen Akademie, 1944/45 (?); 1. Typoskriptfassungen, englisch. a) Typoskript, 18 Blatt b) Typoskript mit handschriftlicher Korrektur von Theodor W. Adorno (GS 12, S.195-213), 18 Blatt c) Typoskript (Kopie) mit handschriftliche Korrektur, 18 Blatt (Kopie 1989 aus der Hoover Institution, Standford, California) d) Typoskript mit eigenhändiger Korrektur, 17 Blatt e) Korrektur-Teilstücke, Typoskripte mit eigenhändiger Korrektur, 2 Blatt; 2. Zeitungsausschnitt 1944, 1 Blatt;