Myeloid-related protein 8/14 complex is released by monocytes and granulocytes at the site of coronary occlusion: a novel, early, and sensitive marker of acute coronary syndromes

AIMS: We investigated whether myeloid-related protein 8/14 complex (MRP8/14) expressed by infiltrating monocytes and granulocytes may represent a mediator and early biomarker of acute coronary syndromes (ACS). METHODS AND RESULTS: Immunohistochemistry of coronary thrombi was done in 41 ACS patients. Subsequently, levels of MRP8/14 were assessed systemically in 75 patients with ACS and culprit lesions, with stable coronary artery disease (CAD), or with normal coronary arteries. In a subset of patients, MRP8/14 was measured systemically and at the site of coronary occlusion. Macrophages and granulocytes, but not platelets stained positive for MRP8/14 in 76% of 41 thrombi patients. In ACS, local MRP8/14 levels [22.0 (16.2-41.5) mg/L] were increased when compared with systemic levels [13.4 (8.1-14.7) mg/L, P = 0.03]. Systemic levels of MRP8/14 were markedly elevated [15.1 (12.1-21.8) mg/L, P = 0.001] in ACS when compared with stable CAD [4.6 (3.5-7.1) mg/L] or normals [4.8 (4.0-6.3) mg/L]. Using a cut-off level of 8 mg/L, MRP8/14 but not myoglobin or troponin, identified ACS presenting within 3 h from symptom onset. CONCLUSION: In ACS, MRP8/14 is markedly expressed at the site of coronary occlusion by invading phagocytes. The occurrence of elevated MRP8/14 in the systemic circulation prior to markers of myocardial necrosis makes it a prime candidate for the detection of unstable plaques and management of ACS.

Ethik und Erzählung. Theologische und philosophische Beiträge zur narrativen Ethik

Menschen haben eine Geschichte und leben in Geschichten. Wenn wir sagen sollen, warum wir so und nicht anders handeln, erzählen wir in der Regel die «story» unseres Verstricktseins in bestimmte Lebenszusammenhänge. Ohne diese Verortung in Geschichten können wir unser Handeln nicht erklären. Erzählungen formen unsere Identität und liefern unserem Handeln Orientierungspunkte. Zu fragen ist freilich, in welcher Weise dies geschieht. Narrative Ethik reflektiert darüber in kontroverser Weise. Dieser Diskussion widmet sich der vorliegende Band aus theologischer und philosophischer Perspektive mit Beiträgen von Céline Ehrwein Nihan, Antje Fetzer, Hille Haker, Marco Hofheinz, Hans P. Lichtenberger, Frank Mathwig, Willibald Sandler, Wolfgang Schoberth, Heiko Schulz, Werner Schwartz, Hans G. Ulrich, Bernd Wannenwetsch, William Werpehowski und Matthias Zeindler.

"EDV gestützte Fahrzeugdisposition und -abrechung im Baubereich zur Optimierung der Prozesskette"

Die deutsche Bauindustrie sieht sich in der jüngeren Vergangenheit mit starkem Konkurrenzdruck von den neuen EU Mitgliedern konfrontiert, in dem sie sich nur durch technologischen Vorsprung behaupten kann, da einer reiner Preiskampf mit den Billiglohnländern mittelfristig durch die hohen Arbeitskosten in Deutschland nicht gewonnen werden kann. Der erforderliche technologische Vorsprung ist nicht nur auf die eigentlichen Bauprozesse beschränkt, sondern betrifft vor allen auch Prozesse wie die Baustellenlogistik, die mit der eigentlichen Wertschöpfung am Bauprojekt nichts zu tun haben. Durch den Einsatz von mobilen Datenerfassungsgeräten (Onboard Units) können die Prozesse zur Versorgung von Baustellen transparenter gestaltet und so ein automatisiertes Controlling zur Kostenssenkung eingeführt werden. Betriebsmittel können so effektiver eingesetzt werden, aber auch Lieferprozesse durch die höhere Planungssicherheit durch eine EDV Unterstützung schlanker gestaltet und besser mit dem Bauablauf synchronisiert werden. Im Rahmen eines AiF Forschungsprojektes wurde am Lehrstuhl für Fördertechnik Materialfluss Logistik (fml) der TU München in Zusammenarbeit mit Industriepartnern ein Flottentelematiksystem für die Baubranche unter Berücksichtigung der besonderen Randbedingungen entwickelt und in einem langfristigen Pilotversuch getestet.

Lagerverwaltung und Bestandsmanagement in dezentral gesteuerten Systemen

Die Verwaltung von Lagerbeständen in Unternehmen muss erhebliche Anforderungen an die Datenverfügbarkeit, -sicherheit und -konsistenz erfüllen. Dies wird heute durch eine zentrale Datenhaltung in Lagerverwaltungssystemen gewährleistet. Auf der anderen Seite ist in vielen Bereichen (z. B. Materialfluss- und Transportsteuerung, Produktionssteuerung) eine Entwicklungstendenz in Richtung dezentraler Steuerungsstrategien zu beobachten, welche eine erhöhte Flexibilität und reduzierte Komplexität versprechen. Im Rahmen eines von der Deutschen Forschungsgemeinschaft (DFG) geförderten Projekts werden im vorliegenden Beitrag Konzepte zur verteilten Gestaltung von Lagerverwaltungssystemen vorgestellt und diskutiert.

Drug-eluting stents vs. bare metal stents in patients with cardiogenic shock: a comparison by propensity score analysis.

BACKGROUND In patients with cardiogenic shock, data on the comparative safety and efficacy of drug-eluting stents (DESs) vs. bare metal stents (BMSs) are lacking. We sought to assess the performance of DESs compared with BMSs among patients with cardiogenic shock undergoing percutaneous coronary intervention (PCI). METHODS Out of 236 patients with acute coronary syndromes complicated by cardiogenic shock, 203 were included in the final analysis. The primary endpoint included death, and the secondary endpoint of major adverse cardiac and cerebrovascular events (MACCEs) included the composite of death, myocardial infarction, any repeat revascularization and stroke. Patients were followed for a minimum of 30 days and up to 4 years. As stent assignment was not random, we performed a propensity score analysis to minimize potential bias. RESULTS Among patients treated with DESs, there was a lower risk of the primary and secondary endpoints compared with BMSs at 30 days (29 vs. 56%, P < 0.001; 34 vs. 58%, P = 0.001, respectively) and during long-term follow-up [hazard ratio 0.43, 95% confidence interval (CI) 0.29-0.65, P < 0.001; hazard ratio 0.49, 95% CI 0.34-0.71, P < 0.001, respectively]. After propensity score adjustment, all-cause mortality was reduced among patients treated with DESs compared with BMSs both at 30 days [adjusted odds ratio (OR) 0.26, 95% CI 0.11-0.62; P = 0.002] and during long-term follow-up (adjusted hazard ratio 0.40, 95% CI 0.22-0.72; P = 0.002). The rate of MACCE was lower among patients treated with DESs compared with those treated with BMSs at 30 days (adjusted OR 0.42, 95% CI 0.19-0.95; P = 0.036). The difference in MACCEs between devices approached significance during long-term follow-up (adjusted hazard ratio 0.60, 95% CI 0.34-1.01; P = 0.052). CONCLUSION DESs appear to be associated with improved clinical outcomes, including a reduction in all-cause mortality compared with BMSs among patients undergoing PCI for cardiogenic shock, possibly because of a pacification of the infarct-related artery by anti-inflammatory drug. The results of this observational study require confirmation in an appropriately powered randomized trial.

Antioxidant supplementation attenuates oxidative stress in patients undergoing coronary artery bypass graft surgery.

Ischemia-reperfusion has been reported to be associated with augmented oxidative stress in the course of surgery, which might be causally involved in the onset of atrial fibrillation (AF), the most common arrhythmia after cardiac surgery. We hypothesized that supplementation of antioxidants and n-3 polyunsaturated fatty acids (n-3 PUFAs) might lower the incidence of AF following coronary artery bypass graft (CABG) surgery. In the present study, by monitoring oxidative stress in the course of CABG surgery, we analyzed the efficacy of vitamins (ascorbic acid and α-tocopherol) and/or n-3 PUFAs (eicosapentaenoic acid and docosahexaenoic acid). Subjects (n = 75) were divided into 4 subgroups: control, vitamins, n-3 PUFAs, and a combination of vitamins and n-3 PUFAs. Fluorescent techniques were used to measure the antioxidative capacity, i.e. ability to inhibit oxidation. Total peroxides, endogenous peroxidase activity, and antibodies against oxidized LDL (oLAb) were used as serum oxidative stress biomarkers. Post-operative increase in oxidative stress was associated with the consumption of antioxidants and a simultaneous onset of AF. This was confirmed through an increased peroxide level and a decreased oLAb titer in control and n-3 PUFAs groups, indicating the binding of antibodies to oxidative modified epitopes. In both subgroups that were supplemented with vitamins, total peroxides decreased, and the maintenance of a constant IgG antibody titer was facilitated. However, treatment with vitamins or n-3 PUFAs was inefficient with respect to AF onset and its duration. We conclude that the administration of vitamins attenuates post-operative oxidative stress in the course of CABG surgery.

Urkundliche Beiträge zur Geschichte der mähr[ischen] Judenschaft im 17. und 18. Jahrhundert

hrsg. von Willibald Müller

Safety profile of prasugrel and clopidogrel in patients with acute coronary syndromes in Switzerland.

OBJECTIVE To assess safety up to 1 year of follow-up associated with prasugrel and clopidogrel use in a prospective cohort of patients with acute coronary syndromes (ACS). METHODS Between 2009 and 2012, 2286 patients invasively managed for ACS were enrolled in the multicentre Swiss ACS Bleeding Cohort, among whom 2148 patients received either prasugrel or clopidogrel according to current guidelines. Patients with ST-elevation myocardial infarction (STEMI) preferentially received prasugrel, while those with non-STEMI, a history of stroke or transient ischaemic attack, age ≥75 years, or weight <60 kg received clopidogrel or reduced dose of prasugrel to comply with the prasugrel label. RESULTS After adjustment using propensity scores, the primary end point of clinically relevant bleeding events (defined as the composite of Bleeding Academic Research Consortium, BARC, type 3, 4 or 5 bleeding) at 1 year, occurred at a similar rate in both patient groups (prasugrel/clopidogrel: 3.8%/5.5%). Stratified analyses in subgroups including patients with STEMI yielded a similar safety profile. After adjusting for baseline variables, no relevant differences in major adverse cardiovascular and cerebrovascular events were observed at 1 year (prasugrel/clopidogrel: cardiac death 2.6%/4.2%, myocardial infarction 2.7%/3.8%, revascularisation 5.9%/6.7%, stroke 1.0%/1.6%). Of note, this study was not designed to compare efficacy between prasugrel and clopidogrel. CONCLUSIONS In this large prospective ACS cohort, patients treated with prasugrel according to current guidelines (ie, in patients without cerebrovascular disease, old age or underweight) had a similar safety profile compared with patients treated with clopidogrel. CLINICAL TRIAL REGISTRATION NUMBER SPUM-ACS: NCT01000701; COMFORTABLE AMI: NCT00962416.

Der Anfang aller Weisheit ist die Furcht Gottes : ein Gebet- und Erbauungsbuch für die erwachsene katholische Jugend ...

von Renatus Münster [d. i. Sebastian Willibald Schießler

Seraphsklänge : ein Gebet- und Erbauungsbuch für gebildete katholische Christen

von Renatus Münster [d. i. Sebastian Willibald Schießler]