TY - JOUR A1 - Dörk, Thilo A1 - Peterlongo, Peter A1 - Mannermaa, Arto A1 - Bolla, Manjeet K. A1 - Wang, Qin A1 - Dennis, Joe A1 - Ahearn, Thomas A1 - Andrulis, Irene L. A1 - Anton-Culver, Hoda A1 - Arndt, Volker A1 - Aronson, Kristan J. A1 - Augustinsson, Annelie A1 - Beane Freeman, Laura E. A1 - Beckmann, Matthias W. A1 - Beeghly-Fadiel, Alicia A1 - Behrens, Sabine A1 - Bermisheva, Marina A1 - Blomqvist, Carl A1 - Bogdanova, Natalia V. A1 - Bojesen, Stig E. A1 - Brauch, Hiltrud A1 - Brenner, Hermann A1 - Burwinkel, Barbara A1 - Canzian, Federico A1 - Chan, Tsun L. A1 - Chang-Claude, Jenny A1 - Chanock, Stephen J. A1 - Choi, Ji-Yeob A1 - Christiansen, Hans A1 - Clarke, Christine L. A1 - Couch, Fergus J. A1 - Czene, Kamila A1 - Daly, Mary B. A1 - dos-Santos-Silva, Isabel A1 - Dwek, Miriam A1 - Eccles, Diana M. A1 - Ekici, Arif B. A1 - Eriksson, Mikael A1 - Evans, D. Gareth A1 - Fasching, Peter A. A1 - Figueroa, Jonine A1 - Flyger, Henrik A1 - Fritschi, Lin A1 - Gabrielson, Marike A1 - Gago-Dominguez, Manuela A1 - Gao, Chi A1 - Gapstur, Susan M. A1 - García-Closas, Montserrat A1 - García-Sáenz, José A. A1 - Gaudet, Mia M. A1 - Giles, Graham G. A1 - Goldberg, Mark S. A1 - Goldgar, David E. A1 - Guenél, Pascal A1 - Haeberle, Lothar A1 - Haimann, Christopher A. A1 - Håkansson, Niclas A1 - Hall, Per A1 - Hamann, Ute A1 - Hartman, Mikael A1 - Hauke, Jan A1 - Hein, Alexander A1 - Hillemanns, Peter A1 - Hogervorst, Frans B. L. A1 - Hooning, Maartje J. A1 - Hopper, John L. A1 - Howell, Tony A1 - Huo, Dezheng A1 - Ito, Hidemi A1 - Iwasaki, Motoki A1 - Jakubowska, Anna A1 - Janni, Wolfgang A1 - John, Esther M. A1 - Jung, Audrey A1 - Kaaks, Rudolf A1 - Kang, Daehee A1 - Kapoor, Pooja Middha A1 - Khusnutdinova, Elza A1 - Kim, Sung-Won A1 - Kitahara, Cari M. A1 - Koutros, Stella A1 - Kraft, Peter A1 - Kristensen, Vessela N. A1 - Kwong, Ava A1 - Lambrechts, Diether A1 - Le Marchand, Loic A1 - Li, Jingmei A1 - Lindström, Sara A1 - Linet, Martha A1 - Lo, Wing-Yee A1 - Long, Jirong A1 - Lophatananon, Artitaya A1 - Lubiński, Jan A1 - Manoochehri, Mehdi A1 - Manoukian, Siranoush A1 - Margolin, Sara A1 - Martinez, Elena A1 - Matsuo, Keitaro A1 - Mavroudis, Dimitris A1 - Meindl, Alfons A1 - Menon, Usha A1 - Milne, Roger L. A1 - Mohd Taib, Nur Aishah A1 - Muir, Kenneth A1 - Mulligan, Anna Marie A1 - Neuhausen, Susan L. A1 - Nevanlinna, Heli A1 - Neven, Patrick A1 - Newman, William G. A1 - Offit, Kenneth A1 - Olopade, Olufunmilayo I. A1 - Olshan, Andrew F. A1 - Olson, Janet E. A1 - Olsson, Håkan A1 - Park, Sue K. A1 - Park-Simon, Tjoung-Won A1 - Peto, Julian A1 - Plaseska-Karanfilska, Dijana A1 - Pohl-Rescigno, Esther A1 - Presneau, Nadege A1 - Rack, Brigitte A1 - Radice, Paolo A1 - Rashid, Muhammad U. A1 - Rennert, Gad A1 - Rennert, Hedy S. A1 - Romero, Atocha A1 - Ruebner, Matthias A1 - Saloustros, Emmanouil A1 - Schmidt, Marjanka K. A1 - Schmutzler, Rita K. A1 - Schneider, Michael O. A1 - Schoemaker, Minouk J. A1 - Scott, Christopher A1 - Shen, Chen-Yang A1 - Shu, Xiao-Ou A1 - Simard, Jaques A1 - Slager, Susan A1 - Smichkoska, Snezhana A1 - Southey, Melissa C. A1 - Spinelli, John J. A1 - Stone, Jennifer A1 - Surowy, Harald A1 - Swerdlow, Anthony J. A1 - Tamimi, Rulla M. A1 - Tapper, William J. A1 - Teo, Soo H. A1 - Terry, Mary Beth A1 - Toland, Amanda E. A1 - Tollenaar, Rob A. E. M. A1 - Torres, Diana A1 - Torres-Mejía, Gabriela A1 - Troester, Melissa A. A1 - Truong, Thérèse A1 - Tsugane, Shoichiro A1 - Untch, Michael A1 - Vachon, Celine M. A1 - van den Ouweland, Ans M. W. A1 - van Veen, Elke M. A1 - Vijai, Joseph A1 - Wendt, Camilla A1 - Wolk, Alicja A1 - Yu, Jyh-Cherng A1 - Zheng, Wei A1 - Ziogas, Argyrios A1 - Ziv, Elad A1 - Dunnig, Alison A1 - Pharaoh, Paul D. P. A1 - Schindler, Detlev A1 - Devilee, Peter A1 - Easton, Douglas F. T1 - Two truncating variants in FANCC and breast cancer risk JF - Scientific Reports N2 - Fanconi anemia (FA) is a genetically heterogeneous disorder with 22 disease-causing genes reported to date. In some FA genes, monoallelic mutations have been found to be associated with breast cancer risk, while the risk associations of others remain unknown. The gene for FA type C, FANCC, has been proposed as a breast cancer susceptibility gene based on epidemiological and sequencing studies. We used the Oncoarray project to genotype two truncating FANCC variants (p.R185X and p.R548X) in 64,760 breast cancer cases and 49,793 controls of European descent. FANCC mutations were observed in 25 cases (14 with p.R185X, 11 with p.R548X) and 26 controls (18 with p.R185X, 8 with p.R548X). There was no evidence of an association with the risk of breast cancer, neither overall (odds ratio 0.77, 95%CI 0.44–1.33, p = 0.4) nor by histology, hormone receptor status, age or family history. We conclude that the breast cancer risk association of these two FANCC variants, if any, is much smaller than for BRCA1, BRCA2 or PALB2 mutations. If this applies to all truncating variants in FANCC it would suggest there are differences between FA genes in their roles on breast cancer risk and demonstrates the merit of large consortia for clarifying risk associations of rare variants. KW - oncology KW - risk factors Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-222838 VL - 9 ER - TY - THES A1 - Zoran, Tamara T1 - Multilevel analysis of the human immune response to \(Aspergillus\) \(fumigatus\) infection: Characteristic molecular signatures and individual risk factors T1 - Analysen der humanen Immunantwort auf eine Infektion mit \(Aspergillus\) \(fumigatus\): Charakteristische molekulare Signaturen und individuelle Risikofaktoren N2 - Although the field of fungal infections advanced tremendously, diagnosis of invasive pulmonary aspergillosis (IPA) in immunocompromised patients continues to be a challenge. Since IPA is a multifactorial disease, investigation from different aspects may provide new insights, helpful for improving IPA diagnosis. This work aimed to characterize the human immune response to Aspergillus fumigatus in a multilevel manner to identify characteristic molecular candidates and risk factors indicating IPA, which may in the future support already established diagnostic assays. We combined in vitro studies using myeloid cells infected with A. fumigatus and longitudinal case-control studies investigating patients post allogeneic stem cell transplantation (alloSCT) suffering from IPA and their match controls. Characteristic miRNA and mRNA signatures indicating A. fumigatus-infected monocyte-derived dendritic cells (moDCs) demonstrated the potential to differentiate between A. fumigatus and Escherichia coli infection. Transcriptome and protein profiling of alloSCT patients suffering from IPA and their matched controls revealed a distinctive IPA signature consisting of MMP1 induction and LGAL2 repression in combination with elevated IL-8 and caspase-3 levels. Both, in vitro and case-control studies, suggested cytokines, matrix-metallopeptidases and galectins are important in the immune response to A. fumigatus. Identified IPA characteristic molecular candidates are involved in numerous processes, thus a combination of these in a distinctive signature may increase the specificity. Finally, low monocyte counts, severe GvHD of the gut (grade ≥ 2) and etanercept administration were significantly associated with IPA diagnosis post alloSCT. Etanercept in monocyte-derived macrophages (MDM) infected with A. fumigatus downregulates genes involved in the NF-κB and TNF-α pathway and affects the secretion of CXCL10. Taken together, identified characteristic molecular signatures and risk factors indicating IPA may in the future in combination with established fungal biomarkers overcome current diagnostic challenges and help to establish tailored antifungal therapy. Therefore, further multicentre studies are encouraged to evaluate reported findings. N2 - Obwohl im Bereich der Erforschung invasiver Pilzinfektionen aktuell enorme Fortschritte erzielt wurden, stellt die Diagnose der Invasiven Pulmonalen Aspergillose (IPA) bei immunsupprimierten Patienten weiterhin eine grosse Herausforderung dar. Da es sich bei der IPA um eine multifaktorielle Erkrankung handelt, können Untersuchungen unter verschiedenen Fragestellungen neue Erkenntnisse liefern, die zur Verbesserung der IPA Diagnose beitragen. In dieser Arbeit wurde die humane Immunantwort auf Aspergillus fumigatus auf mehreren Ebenen untersucht, um charakteristische molekulare Kandidaten und Risikofaktoren zu identifizieren, die auf eine IPA hinweisen um so in Zukunft bereits etablierte diagnostische Tests unterstützen zu können. Wir kombinierten in vitro Studien mit A. fumigatus infizierten, myeloischen Zellen mit longitudinalen Case-Control-Studien, in denen an IPA erkrankte Patienten und ihre passenden Kontrollpatienten nach allogener Stammzelltransplantation (alloSZT) untersucht wurden. Charakteristische miRNA und mRNA Signaturen von A. fumigatus-infizierten Monozyten-abgeleiteten dendritischen Zellen (moDCs) zeigten das Potenzial, zwischen A. fumigatus und Escherichia coli Infektionen zu unterscheiden. Transkriptom- und Protein- Analysen von alloSZT Patienten, die an einer IPA erkrankten, und den passenden Kontrollpatienten ergaben charakteristische IPA Signaturen, bestehend aus einer MMP1 Induktion und einer LGALS2 Repression, in Kombination mit erhöhten IL-8 und Caspase-3 Konzentrationen. Sowohl die in vitro Daten als auch die Fall-Kontroll- Studien zeigten, dass Zytokine, Matrix-Metallopeptidasen und Galectine eine wichtige Rolle bei der Immunantwort auf A. fumigatus spielen. Die in IPA identifizierten charakteristischen molekularen Kandidaten sind an mehreren Prozessen beteiligt, so dass eine Kombination dieser molekularen Kandidaten die Spezifität mittels charakteristischer Signatur erhöhen könnte. Schließlich waren niedrige Monozytenzahlen, eine schwere GvHD des Darms (Grad ≥ 2) und die Anwendung von Etanercept signifikant mit einer IPA Diagnose nach alloSZT assoziiert. Etanercept in Makrophagen, die mit A. fumigatus ko-kultiviert wurden, reguliert Gene herunter, die am NF-κB- und TNF-α-Signalweg beteiligt sind, und beeinflusst die Sekretion von CXCL10. Zusammenfassend lässt sich festhalten, dass die identifizierten charakteristischen molekularen Signaturen und Risikofaktoren, die auf eine IPA hinweisen, in Zukunft in Kombination mit etablierten Pilz-Biomarkern die derzeitigen diagnostischen Limitationen überwinden könnten und dazu beitragen könnten, eine patientenindividuelle antimykotische Therapie zu etablieren. Es werden jedoch weitere multizentrische Studien notwendig sein, um diese Ergebnisse umfassend zu bewerten. KW - Aspergillus fumigatus KW - Immunantwort KW - Risikofaktoren KW - invasive pulmonary aspergillosis KW - immune response KW - risk factors KW - transcriptome profiling Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-298512 ER - TY - JOUR A1 - Meintrup, David A1 - Borgmann, Stefan A1 - Seidl, Karlheinz A1 - Stecher, Melanie A1 - Jakob, Carolin E. M. A1 - Pilgram, Lisa A1 - Spinner, Christoph D. A1 - Rieg, Siegbert A1 - Isberner, Nora A1 - Hower, Martin A1 - Vehreschild, Maria A1 - Göpel, Siri A1 - Hanses, Frank A1 - Nowak-Machen, Martina T1 - Specific risk factors for fatal outcome in critically ill COVID-19 patients: results from a European multicenter study JF - Journal of Clinical Medicine N2 - (1) Background: The aim of our study was to identify specific risk factors for fatal outcome in critically ill COVID-19 patients. (2) Methods: Our data set consisted of 840 patients enclosed in the LEOSS registry. Using lasso regression for variable selection, a multifactorial logistic regression model was fitted to the response variable survival. Specific risk factors and their odds ratios were derived. A nomogram was developed as a graphical representation of the model. (3) Results: 14 variables were identified as independent factors contributing to the risk of death for critically ill COVID-19 patients: age (OR 1.08, CI 1.06–1.10), cardiovascular disease (OR 1.64, CI 1.06–2.55), pulmonary disease (OR 1.87, CI 1.16–3.03), baseline Statin treatment (0.54, CI 0.33–0.87), oxygen saturation (unit = 1%, OR 0.94, CI 0.92–0.96), leukocytes (unit 1000/μL, OR 1.04, CI 1.01–1.07), lymphocytes (unit 100/μL, OR 0.96, CI 0.94–0.99), platelets (unit 100,000/μL, OR 0.70, CI 0.62–0.80), procalcitonin (unit ng/mL, OR 1.11, CI 1.05–1.18), kidney failure (OR 1.68, CI 1.05–2.70), congestive heart failure (OR 2.62, CI 1.11–6.21), severe liver failure (OR 4.93, CI 1.94–12.52), and a quick SOFA score of 3 (OR 1.78, CI 1.14–2.78). The nomogram graphically displays the importance of these 14 factors for mortality. (4) Conclusions: There are risk factors that are specific to the subpopulation of critically ill COVID-19 patients. KW - COVID-19 KW - SARS-CoV-2 KW - risk factors KW - critically ill patients KW - comorbidities KW - lasso regression KW - nomogram Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-245191 SN - 2077-0383 VL - 10 IS - 17 ER - TY - THES A1 - Fuchs, Katharina T1 - Validierung verschiedener prädisponierender Faktoren für die Entwicklung eines Lagerungsplagiozephalus T1 - Validation of various predisposing factors for developing an deformational plagiocephaly N2 - Bei seiner Geburt und innerhalb der ersten Lebensmonate ist der Säuglingsschädel verhältnismäßig leicht verformbar. Dies birgt die Gefahr einer unphysiologischen Verformung durch externe modellierende Kräfte. Die auf diesem Weg am häufigsten verursachte Deformation ist der Lagerungsplagiozephalus (LP). In der vorliegenden Studie wurden 455 Säuglinge, die zunächst in drei unterschiedliche Gruppen bezüglich ihrer Kopfform unterteilt worden sind, hinsichtlich verschiedener Parameter miteinander verglichen. Anhand des U-Heftes und einem speziell für die craniofaciale Sprechstunde des CFCW Würzburg angefertigten Fragebogen wurden Prädiktoren für die Entwicklung eines LP evaluiert. Die herausgearbeiteten prädisponierenden Faktoren waren das männliche Geschlecht, Frühgeburtlichkeit, eine unphysiologische Geburtslage, Notkaiserschnitt oder geburtshilfliche Maßnahmen, verminderte Geburtsgröße, vermindertes Geburtsgewicht und ein längerer Krankenhausaufenthalt im Anschluss an die Geburt. Als prognostisch günstiger Faktor hinsichtlich der Entwicklung einer physiologischen Schädelform konnte in der vorliegenden Studie eine längere Stilldauer bestätigt werden. Dies galt ebenso für Gabe von Flaschennahrung aus alternierenden Positionen. Hinsichtlich der präventiven Aufklärung von Eltern Neugeborener liefert die vorliegende Studie einige wichtige Ansätze. Sie untermauert jedoch auch den hohen Bedarf an weiterer Forschung bezüglich prädisponierender Faktoren für die Entwicklung des LP. Dies kann dazu beitragen die Prävention und Früherkennung eines LP mittels flächendeckender qualitativ hochwertiger Aufklärung stetig zu verbessern und notwendig gewordene Behandlungen durch standardisierte Therapieempfehlungen zu optimieren. N2 - At birth and within the first months of life, the infant skull is easily deformable. This goes along with the risk of non-physiological deformation by external modelling forces. The most common deformation caused by this pathway is the unilateral deformational plagiocephaly (DP). In the present study, 455 infants, who were initially divided into three different groups according to their head deformity, were compared with each other regarding different parameters. The identified predisposing factors were male sex, premature birth, non-physiological birth status, emergency caesarean section or obstetric measures, reduced birth size, reduced birth weight and a longer hospitalization after birth. A longer breastfeeding duration was confirmed as a prognostic factor in the development of a physiological skull shape. This also applied to bottle feeding from alternating positions. The study provides some important approaches regarding the preventive education of parents. However, it also underlines the strong need for further research considering predisposing factors for the development of an DP. This can help to continuously improve the prevention and early detection of DP and to optimize necessary treatments by standardized therapy recommendations. KW - Lagerungsplagiozephalus KW - Risikofaktoren KW - risk factors KW - deformational plagiocephaly Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-251471 ER - TY - JOUR A1 - Dannewitz, Bettina A1 - Sommerer, Claudia A1 - Stölzel, Peggy A1 - Baid‐Agrawal, Seema A1 - Nadal, Jennifer A1 - Bärthlein, Barbara A1 - Wanner, Christoph A1 - Eckardt, Kai‐Uwe A1 - Zeier, Martin A1 - Schlagenhauf, Ulrich A1 - Krane, Vera A1 - Jockel‐Schneider, Yvonne T1 - Status of periodontal health in German patients suffering from chronic kidney disease—Data from the GCKD study JF - Journal of Clinical Periodontology N2 - Aim To assess the prevalence and severity of periodontitis in patients with moderate chronic kidney disease (CKD) and comparing the results with the self‐reported periodontitis awareness of the study subjects. Material and methods The periodontal status of 270 patients with moderate CKD randomly selected from a cohort of 5,217 subjects participating in the prospective observational German Chronic Kidney Disease (GCKD) project was analysed by recording bleeding on probing (BOP), probing pocket depth (PPD) and clinical attachment level (CAL). Furthermore, the awareness of the study subjects of their periodontal conditions was evaluated by a self‐reported questionnaire. Results 24.4% of the CKD study patients showed no or only mild signs of periodontal disease, 47.6% displayed moderate and 27% severe periodontitis. Questionnaire data revealed that 62.3% of the study subjects with severe periodontitis were not aware of the presence of the disease, 44.4% denied having received any systematic periodontal therapy so far, although 50% of them indicated to visit their dentist regularly for professional tooth cleanings. Conclusion While the clinical study data confirm an increased prevalence of periodontitis in CKD patients, their self‐reported awareness of periodontitis was low. KW - chronic kidney disease KW - observational cohort study KW - periodontitis KW - risk factors Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-217821 VL - 47 IS - 1 SP - 19 EP - 29 ER - TY - JOUR A1 - Barbieri, Flavia L. A1 - Gardon, Jacques A1 - Ruiz-Castell, María A1 - Paco V., Pamela A1 - Muckelbauer, Rebecca A1 - Casiot, Corinne A1 - Freydier, Rémi A1 - Duprey, Jean-Louis A1 - Chen, Chih-Mei A1 - Müller-Nordhorn, Jacqueline A1 - Keil, Thomas T1 - Toxic trace elements in maternal and cord blood and social determinants in a Bolivian mining city JF - International Journal of Environmental Health Research N2 - This study assessed lead, arsenic, and antimony in maternal and cord blood, and associations between maternal concentrations and social determinants in the Bolivian mining city of Oruro using the baseline assessment of the ToxBol/Mine-Nino birth cohort. We recruited 467 pregnant women, collecting venous blood and sociodemographic information as well as placental cord blood at birth. Metallic/semimetallic trace elements were measured using inductively coupled plasma mass spectrometry. Lead medians in maternal and cord blood were significantly correlated (Spearman coefficient=0.59; p<0.001; 19.35 and 13.50 μg/L, respectively). Arsenic concentrations were above detection limit (3.30 μg/L) in 17.9% of maternal and 34.6% of cord blood samples. They were not associated (Fischer's p=0.72). Antimony medians in maternal and cord blood were weakly correlated (Spearman coefficient=0.15; p<0.03; 9.00 and 8.62 μg/L, respectively). Higher concentrations of toxic elements in maternal blood were associated with maternal smoking, low educational level, and partner involved in mining. KW - environmental exposure KW - metallic trace elements KW - maternal exposure KW - prenatal exposure KW - risk factors Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-190703 VL - 26 IS - 2 ER - TY - JOUR A1 - Gehrke, Thomas A1 - Scherzad, Agmal A1 - Hagen, Rudolf A1 - Hackenberg, Stephan T1 - Risk factors for children requiring adenotonsillectomy and their impact on postoperative complications: a retrospective analysis of 2000 patients JF - Anaesthesia N2 - Adenotonsillectomies are commonly performed procedures and sleep‐disordered breathing is becoming increasingly important as an indication for surgery. Because of the higher risks in patients with obstructive sleep apnoea, the required level of postoperative care for these patients is currently under discussion, and better identification of patients at risk may reduce unnecessary postoperative monitoring. To evaluate the influence of obstructive sleep apnoea, and other risk factors, on peri‐operative complications in children requiring adenotonsillectomy, we performed a retrospective case‐control study that included 1995 patients treated between January 2009 and June 2017. In our analysis, young age (OR 3.8, 95%CI 2.1–7.1), low body weight (OR 2.6, 95%CI 1.5–4.4), obstructive sleep apnoea (OR 2.4, 95%CI 1.5–3.8), pre‐existing craniofacial or syndromal disorders (OR 2.3, 95%CI 1.4–3.8) and adenotonsillectomy, compared with adenoidectomy alone, (OR 7.9, 95%CI 4.7–13.1) were identified as risk factors for complications during or after surgery, p < 0.001. All 13 patients suffering from complications more than 3 h postoperatively had obstructive sleep apnoea plus at least one more of these risk factors. Patients at risk of postoperative complications can therefore be identified by several criteria pre‐operatively, and should be monitored postoperatively using pulse oximetry overnight. For all other patients, postoperative observation on a surgical ward without extra monitoring is sufficient. Admission to paediatric intensive care should be reserved for patients suffering serious intra‐operative complications. KW - adenotonsillectromy KW - monotoring KW - obstructive sleep apnoea KW - paediatrics KW - retrospective KW - risk factors Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-204787 VL - 74 IS - 12 ER - TY - THES A1 - Triebswetter, Susanne T1 - Charakterisierung von Langzeitüberlebenden in einem Kollektiv hämodialysepflichtiger Patienten mit Typ 2 Diabetes T1 - Long-term Survivor Characteristics in Hemodialysis Patients with Type 2 Diabetes N2 - Die Mortalitätsrate von Dialysepatienten ist gegenüber der Allgemeinbevölkerung deutlich erhöht; im Besonderen bei Patienten, die zugleich an einem Diabetes mellitus Typ 2 leiden. Es gibt zahlreiche Studien, die versuchen, Prädiktoren für das Kurz- und Langzeitüberleben von Dialysepatienten zu ermitteln. Studien, die dasselbe für hämodialysepflichtige Patienten mit Typ 2 Diabetes mellitus versuchen, sind jedoch noch selten. Ziel der vorliegenden Arbeit war es, die Überlebenden der Deutschen Diabetes Dialyse Studie (4D Studie) zu charakterisieren und Überlebenszeitanalysen durchzuführen, um Hypothesen für zukünftige Studien zu generieren und mögliche Risikofaktoren für eine erhöhte Mortalität zu ermitteln. In der vorliegenden Arbeit wurden mit Hilfe der Daten der 4D-Studie Überlebenszeitanalysen für 1255 hämodialysepflichtige Patienten mit Diabetes mellitus Typ 2 aus 178 Dialysezentren in Deutschland durchgeführt (mittlere Beobachtungsdauer: 11,5 Jahre). Der primäre Endpunkt war die Gesamtmortalität. Mit dem Cox Proportional Hazards Modell wurden Hazard Ratios für zehn ausgewählte Parameter (Alter, Geschlecht, Pflege, Body Mass Index, Albumin, Diabetesdauer, HbA1c, und kardiovaskuläre, zerebrovaskuläre, periphere vaskuläre Vorerkrankungen) sowohl für das gesamte Kollektiv als auch für nach Geschlecht, Alter und Diabetesdauer aufgeteilte Subgruppen berechnet. Anschließend wurden für alle drei Subgruppen Interaktionsanalysen durchgeführt. Die Überlebenden des gesamten Studienzeitraumes von 11,5 Jahren sind im Durchschnitt jünger und häufiger männlich, haben weniger Vorerkrankungen und sind seltener pflegebedürftig, sind kürzer an Diabetes mellitus erkrankt, das HbA1c ist besser eingestellt und BMI und Serumalbumin liegen höher als bei den Verstorbenen. Pflegebedürftigkeit (HR = 1,199, p = 0,018), ein niedriges Serumalbumin (HR = 0,723, p = 0,002) sowie kardiovaskuläre (HR = 1,423, p < 0,001) und periphere vaskuläre Erkrankungen (HR = 1,549, p < 0,001) erhöhen das Mortalitätsrisiko signifikant. Weibliche Patienten verlieren ihren, in der Gesamtbevölkerung üblichen, Überlebensvorteil (HR = 1,019, p < 0,79). N2 - Data concerning long-term mortality predictors among large, purely diabetic hemodialysis collectives are scarce. With data from a multicenter, prospective, randomized trial among 1255 hemodialysis patients with type 2 diabetes mellitus (T2DM) and its observational follow-up study (the 4D study) the association of ten baseline candidate variables with mortality was assessed by Cox proportional hazards regression. Overall 103 participants survived the median follow-up of 11.5 years. Significant predictors of mortality were age, cardiovascular, and peripheral vascular disease, higher HbA1c and loss of self-dependency. Higher albumin and BMI had protective associations. There was no significant association with sex, diabetes duration and cerebrovascular diseases. Subgroup analyses by age and diabetes duration showed stronger associations of cerebrovascular disease and loss of self-dependency in younger patients. In conclusion long-term mortality risk in patients with T2DM on hemodialysis was associated with higher age, vascular diseases, higher HbA1c, loss of self-dependency and low energy resources, while it does not vary between sexes, diabetes duration and gender. KW - Chronische Niereninsuffizienz KW - Diabetes mellitus KW - Sterblichkeit KW - Risikofaktor KW - Dialyse KW - dialysis KW - diabetes KW - mortality KW - risk factors KW - chronic kidney disease KW - Diabetes Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-189821 ER - TY - JOUR A1 - Barbieri, Flavia L. A1 - Gardon, Jacques A1 - Ruiz-Castell, María A1 - Paco V., Pamela A1 - Muckelbauer, Rebecca A1 - Casiot, Corinne A1 - Freydier, Rémi A1 - Duprey, Jean-Louis A1 - Chen, Chih-Mei A1 - Müller-Nordhorn, Jacqueline A1 - Keil, Thomas T1 - Toxic trace elements in maternal and cord blood and social determinants in a Bolivian mining city JF - International Journal of Environmental Health Research N2 - This study assessed lead, arsenic, and antimony in maternal and cord blood, and associations between maternal concentrations and social determinants in the Bolivian mining city of Oruro using the baseline assessment of the ToxBol/Mine-Niño birth cohort. We recruited 467 pregnant women, collecting venous blood and sociodemographic information as well as placental cord blood at birth. Metallic/semimetallic trace elements were measured using inductively coupled plasma mass spectrometry. Lead medians in maternal and cord blood were significantly correlated (Spearman coefficient = 0.59; p < 0.001; 19.35 and 13.50 μg/L, respectively). Arsenic concentrations were above detection limit (3.30 μg/L) in 17.9 % of maternal and 34.6 % of cord blood samples. They were not associated (Fischer’s p = 0.72). Antimony medians in maternal and cord blood were weakly correlated (Spearman coefficient = 0.15; p < 0.03; 9.00 and 8.62 μg/L, respectively). Higher concentrations of toxic elements in maternal blood were associated with maternal smoking, low educational level, and partner involved in mining. KW - environmental exposure KW - metallic trace elements KW - maternal exposure KW - prenatal exposure KW - risk factors Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-150385 VL - 26 IS - 2 ER - TY - JOUR A1 - Gyberg, Viveca A1 - De Bacquer, Dirk A1 - De Backer, Guy A1 - Jennings, Catriona A1 - Kotseva, Kornelia A1 - Mellbin, Linda A1 - Schnell, Oliver A1 - Tuomilehto, Jaakko A1 - Wood, David A1 - Ryden, Lars A1 - Amouyel, Philippe A1 - Bruthans, Jan A1 - Conde, Almudena Castro A1 - Cifkova, Renata A1 - Deckers, Jaap W. A1 - De Sutter, Johan A1 - Dilic, Mirza A1 - Dolzhenko, Maryna A1 - Erglis, Andrejs A1 - Fras, Zlatko A1 - Gaita, Dan A1 - Gotcheva, Nina A1 - Goudevenos, John A1 - Heuschmann, Peter A1 - Laucevicius, Aleksandras A1 - Lehto, Seppo A1 - Lovic, Dragan A1 - Milicic, Davor A1 - Moore, David A1 - Nicolaides, Evagoras A1 - Oganov, Raphae A1 - Pajak, Andrzej A1 - Pogosova, Nana A1 - Reiner, Zeljko A1 - Stagmo, Martin A1 - Störk, Stefan A1 - Tokgözoglu, Lale A1 - Vulic, Dusko T1 - Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology JF - Cardiovascular Diabetology N2 - Background: In order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines. Methods: A total of 6187 patients (18-80 years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012-2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys. Results: A total of 2846 (46 %) patients had no diabetes, 1158 (19 %) newly diagnosed diabetes and 2183 (35 %) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60 %, respectively. A blood pressure target of <140/90 mmHg was achieved in 68, 61, 54 % and a LDL-cholesterol target of <1.8 mmol/L in 16, 18 and 28 %. Patients with newly diagnosed and previously known diabetes reached an HbA1c <7.0 % (53 mmol/mol) in 95 and 53 % and 11 % of those with previously known diabetes had an HbA1c >9.0 % (>75 mmol/mol). Of the patients with diabetes 69 % reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (approximate to 40 %) and only 27 % of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets. Conclusions: Despite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease. KW - heart KW - glycaemic control KW - cardiovascular diseases KW - myocardial infarction KW - glucose control KW - blood-glucose KW - risk factors KW - follow-up KW - mellitus KW - mortality KW - guidelines KW - coronary artery disease KW - type 2 diabetes KW - secondary prevention KW - management KW - guideline adherence KW - blood pressure KW - blood lipids Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-141358 VL - 14 IS - 133 ER -