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Objective: Obtaining a systematic medical history (MH) from a patient is a core competency in medical education and plays a vital role in the diagnosis of diseases. At the Faculty of Medicine at LMU Munich, students have their first course in MH taking during their second year. Due to the COVID-19 pandemic, the traditional bedside MH taking course had to be transformed into an online course (OC). Our objectives were to implement an online MH taking course, to evaluate its feasibility and to compare the evaluation results to a historic cohort that had undertaken the traditional bedside teaching course (BTC).Methods: 874 second-year students participated in the OC (BTC=827). After teaching the theoretical background via asynchronous online lectures, students participated in a practical exercise with fellow students using the video communication platform Zoom where they were able to practice taking a MH on the basis of fictitious, text-based patient cases. Students were then asked to evaluate the course through a standardized online survey with 31 questions on teaching quality and self-perceived learning success, which had also been used in previous years. The survey results were compared to the results of the historic cohort using the Mann-Whitney U test.Results: A total of n=162 students (18.5%) evaluated the OC. In the historic cohort, n=252 (30.5%) completed the survey. 85.3% of the OC respondents thought that the atmosphere during the practical exercise was productive and 83.0% greatly appreciated the flexibility in terms of time management. Moreover, they appreciated the online resources as well as having the opportunity to undertake a MH taking course during the COVID-19 pandemic. 27.7% of the respondents thought that traditional BTCs should be supplemented through more online activities in the future. With respect to the ability of independently taking a MH upon completion of the course, the OC was rated significantly lower relative to the BTC (mean OC=2.4, SD=±1.1 vs. mean BTC=1.9, SD=±1.1 (1=strongly agree; 5=strongly disagree); p

Background: Renal denervation has been shown to lower blood pressure in the presence of antihypertensive medications; however, long-term safety and efficacy data from randomised trials of renal denervation are lacking. In this pre-specified analysis of the SPYRAL HTN-ON MED study, we compared changes in blood pressure, antihypertensive drug use, and safety up to 36 months in renal denervation versus a sham control group. Methods: This randomised, single-blind, sham-controlled trial enrolled patients from 25 clinical centres in the USA, Germany, Japan, the UK, Australia, Austria, and Greece, with uncontrolled hypertension and office systolic blood pressure between 150 mm Hg and 180 mm Hg and diastolic blood pressure of 90 mm Hg or higher. Eligible patients had to have 24-h ambulatory systolic blood pressure between 140 mm Hg and less than 170 mm Hg, while taking one to three antihypertensive drugs with stable doses for at least 6 weeks. Patients underwent renal angiography and were randomly assigned (1:1) to radiofrequency renal denervation or a sham control procedure. Patients and physicians were unmasked after 12-month follow-up and sham control patients could cross over after 12-month follow-up completion. The primary endpoint was the treatment difference in mean 24-h systolic blood pressure at 6 months between the renal denervation group and the sham control group. Statistical analyses were done on the intention-to-treat population. Long-term efficacy was assessed using ambulatory and office blood pressure measurements up to 36 months. Drug surveillance was used to assess medication use. Safety events were assessed up to 36 months. This trial is registered with ClinicalTrials.gov, NCT02439775; prospectively, an additional 260 patients are currently being randomly assigned as part of the SPYRAL HTN-ON MED Expansion trial. Findings: Between July 22, 2015, and June 14, 2017, among 467 enrolled patients, 80 patients fulfilled the qualifying criteria and were randomly assigned to undergo renal denervation (n=38) or a sham control procedure (n=42). Mean ambulatory systolic and diastolic blood pressure were significantly reduced from baseline in the renal denervation group, and were significantly lower than the sham control group at 24 and 36 months, despite a similar treatment intensity of antihypertensive drugs. The medication burden at 36 months was 2·13 medications (SD 1·15) in the renal denervation group and 2·55 medications (2·19) in the sham control group (p=0·26). 24 (77%) of 31 patients in the renal denervation group and 25 (93%) of 27 patients in the sham control group adhered to medication at 36 months. At 36 months, the ambulatory systolic blood pressure reduction was −18·7 mm Hg (SD 12·4) for the renal denervation group (n=30) and −8·6 mm Hg (14·6) for the sham control group (n=32; adjusted treatment difference −10·0 mm Hg, 95% CI −16·6 to −3·3; p=0·0039). Treatment differences between the renal denervation group and sham control group at 36 months were −5·9 mm Hg (95% CI −10·1 to −1·8; p=0·0055) for mean ambulatory diastolic blood pressure, −11·0 mm Hg (−19·8 to −2·1; p=0·016) for morning systolic blood pressure, and −11·8 mm Hg (−19·0 to −4·7; p=0·0017) for night-time systolic blood pressure. There were no short-term or long-term safety issues associated with renal denervation. Interpretation: Radiofrequency renal denervation compared with sham control produced a clinically meaningful and lasting blood pressure reduction up to 36 months of follow-up, independent of concomitant antihypertensive medications and without major safety events. Renal denervation could provide an adjunctive treatment modality in the management of patients with hypertension. Funding: Medtronic. © 2022 Elsevier Ltd

Introduction: Acute tobacco cigarette (TC) smoking increases blood pressure and sympathetic nerve activity, whereas there are scarce data on the impact of electronic cigarette (EC) smok-ing. We assessed the acute effects of TC, EC and sham smoking on blood pressure, heart rate and sympathetic nervous system. Methods: We studied 12 normotensive male habitual smokers (mean age 33 years) free of cardiovascular disease. The study design was randomized and sham controlled with three experimental sessions (sham smoking, TC smoking and EC smoking). After baseline measurements at rest, the subjects were then asked to smoke (puffing habits left uncontrolled) two TC cigarettes containing 1.1 mg nicotine, EC smoking or simulated smoking with a drinking straw with a filter (sham smoking), in line with previous methodology. Results: EC smoking at 5 and 30 min compared to baseline was accompanied by the augmentation of mean arterial pressure (MAP) and heart rate (p < 0.001 for all). The muscle sympathetic nerve activity (MSNA) decrease was significant during both TC and EC sessions (p < 0.001 for both comparisons) and was similar between them (−25.1% ± 9.8% vs. −34.4% ± 8.3%, respectively, p = 0.018). Both MSNA decreases were significantly higher (p < 0.001 for both comparisons) than that elicited by sham smoking (−4.4% ± 4.8%). Skin sympathetic nerve activity increase was significant in both TC and EC groups (p < 0.001 for both comparisons) and similar between them (73.4% ± 17.9% and 71.9% ± 7%, respectively, p = 0.829). Conclusion: The unfavorable responses of sympathetic and arterial pressure to EC smoking are similar to those elicited by TC in healthy habitual smokers. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

Aims: Currently there are scarce epidemiological data regarding prevalence, clinical phenotype, and therapy of hypertensive urgencies (HU) and emergencies (HE). The aim of this article was to record the prevalence, clinical characteristics, and management of patients with HU and HE assessed in an emergency department (ED) of a tertiary hospital. Methods and results: The population consisted of patients presenting with HE and HU in the ED (acute increase in systolic blood pressure (BP) ≥ 180 mmHg and/or diastolic BP ≥120 mmHg with and without acute target organ damage, respectively). Of the 38 589 patients assessed in the ED during a 12-month period, 353 (0.91%) had HU and HE. There were 256 (72.5%) cases presented as HU and 97 (27.5%) as HE. Primary causes for both HU and HE were stress/anxiety (44.9%), increased salt intake (33.9%), and non-adherence to medication (16.2%). Patients with HU reported mainly dizziness/headache (46.8%) and chest pain (27.4%), whereas those with HE presented dyspnoea (67%), chest pain (30.2%), dizziness/headache (10.3%), and neurological disorders (8.2%). In HE, the underlying associated conditions were pulmonary oedema (58%), acute coronary syndrome (22.6%), and neurological disorders/stroke (7.2%). All HE cases were hospitalized and received intensive healthcare, including dialysis. Conclusion: This 1-year single-centre registry demonstrates a reasonable prevalence of HU and HE contributing to the high volume of visits to the ED. Stress, increased salt intake and non-adherence were main triggers of HE and HU. Dizziness and headache were the prevalent symptoms of HU patients while heart failure was the most common underlying disease in patients with HE. © 2021 Published on behalf of the European Society of Cardiology. All rights reserved.

Fragestellung/Zielsetzung: Um dem steigenden Bedarf an Mentoring für Medizinstudieren gerecht zu werden, wurde 2010 das Mentoring Programm MeCuM-Mentor an der medizinischen Fakultät der LMU, München ins Leben gerufen [ref:1]. Neben dem 1:1 Mentoring gehören verschieden, [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung/Zielsetzung: Im Rahmen der COVID-19 Pandemie wurde der Anamnesekurs für Medizinstudierende an der LMU München in Präsenzform ausgesetzt und durch ein virtuelles Format ersetzt. Im Folgenden soll das virtuelle Format evaluiert werden, sowie die Frage beantwortet werden, [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Objectives: The COVID-19 pandemic has led to major adjustments in health care systems and significantly affected medical education. Accordingly, our mentoring program MeCuM-Mentor had to expand its virtual elements, in order to continue to meet the needs for mentoring at the medical faculty of the Ludwig-Maximilians-University Munich .Methods: Here we report on our recently implemented online formats to facilitate training for currently coached peer mentors, as well as the introduction of an online consultation hour and a new social mentoring event called PubQuiz .Results: First results demonstrated feasibility of the above-mentioned virtual formats, which were positively rated by the participants in small voluntary evaluation questionnaires. Utilization rates indicate existing need for mentoring during the pandemic. In addition, the new event PubQuiz promotes social interaction among peers during isolation due to COVID-19.Conclusion: With the transition to online formats, mentoring at the Medical Faculty could be continued during COVID-19. The newly introduced mentoring event PubQuiz will be repeated. However, it remains unclear to what extent online formats can replace in-person one-to-one mentoring conversations or peer mentoring meetings. Zielsetzungen: Die COVID-19-Pandemie hat zu großen Anpassungen in den Gesundheitssystemen geführt und die medizinische Ausbildung erheblich beeinträchtigt. Dementsprechend musste unser Mentoring-Programm MeCuM-Mentor seine virtuellen Elemente erweitern, um dem Mentoring-Bedarf an der Medizinischen Fakultät der Ludwig-Maximilians-Universität München weiterhin gerecht zu werden.Methoden: Hier berichten wir über unsere neu implementierten Online-Formate zur Erleichterung der Ausbildung studentischer Peer-Mentor*innen sowie über die Einführung einer Online-Sprechstunde und einer neuen sozialen Mentoring-Veranstaltung namens PubQuiz .Ergebnisse: Erste Ergebnisse zeigen die Realisierbarkeit der virtuellen Formate, die von den Teilnehmern positiv bewertet wurden. Die Auslastung der Formate deutet auf einen bestehenden Bedarf an Mentoring während der Pandemie hin. Darüber hinaus fördert die neue Veranstaltung PubQuiz die soziale Interaktion unter den Studierenden während der Kontaktbeschränkungen aufgrund von COVID-19.Schlussfolgerung: Mit dem Übergang zu Online-Formaten konnte das Mentoring an der Medizinischen Fakultät während COVID-19 fortgesetzt werden. Das neu eingeführte PubQuiz wird wiederholt. Es bleibt jedoch unklar, inwieweit Online-Formate persönliche Mentoring-Gespräche oder Peer-Mentoring-Treffen ersetzen können.

Background: In light of the COVID-19 pandemic and resulting demand for innovative hospital management we organized an interactive online discussion for medical students and healthcare professionals about hospital management during the crisis.Objective: The event offered an opportunity to learn from a hospital crisis management. We looked at how this new online format compares to a traditional discussion event. Methods: We used an online platform with four guests, a moderator and about 100 attendees. During the event we gathered demographic facts through an interactive questionnaire tool and an extensive evaluation afterwards.Results: The event was rated with an overall grade of 1.4 (Likert from 1 to 6, 1 best grade; SD 0.5) and participants agreed that this format should be organized again (1.2; SD 0.5). 70% of audience members preferred the online format of the event. Due to the high volume, only about 30% (total n~35) of the questions posed by the audience were addressed.Conclusion: Firstly, most participants preferred the event to be online, contrary to our expectation. Secondly, the handling of the amount of individual questions posed significant challenges.Finally, the number of attendees and questions suggested a continuing demand among students and physicians for further education regarding hospital management, especially regarding COVID-19. These findings also require a critical look at future formats and topics of podium discussions in medical education. The online format might be a good alternative to face-to-face lectures. Hintergrund: Die COVID-19-Pandemie und die daraus resultierende Nachfrage nach innovativem Krankenhausmanagement hat uns dazu bewogen, eine interaktive Online-Diskussion für Medizinstudierende und Angehörige der Gesundheitsberufe zum Thema Krankenhausmanagement während der Krise zu organisieren.Zielsetzung: Das Ziel der Veranstaltung war aus dem Krankenhauskrisenmanagement zu lernen. Dazu haben wir unser neues Online-Format mit einer traditionellen Veranstaltung verglichen.Methoden: Wir haben eine Online-Plattform mit vier Gästen, einem Moderator und etwa 100 Teilnehmern aufgesetzt. Während der Veranstaltung haben wir mit Hilfe eines interaktiven Fragebogen-Tools und einer anschließenden umfangreichen Teilnehmerbefragung demographische Daten gesammelt.Ergebnisse: Die Veranstaltung wurde mit einer Gesamtnote von 1,4 bewertet (Likert von 1 bis 6, 1 beste Note; SD 0,5) und die Teilnehmer haben sich dafür ausgesprochen, dass dieses Format erneut organisiert werden sollte (1,2; SD 0,5). 70% der Zuhörer bevorzugten das Online-Format der Veranstaltung. Aufgrund der hohen Zahl an gestellten Fragen konnten nur etwa 30% (insgesamt n~35) der vom Publikum gestellten Fragen angesprochen werden.Fazit: Erstens bevorzugten die meisten Teilnehmer, entgegen unserer Erwartung, die Online-Veranstaltung. Zweitens stellte die Bewältigung der hohen Anzahl an Fragen eine große Herausforderung dar. Drittens deuten die hohe Anzahl an Teilnehmern und Fragen auf eine anhaltend hohe Nachfrage von Studierenden und Ärzten nach Weiterbildung im Bereich des Krankenhausmanagements, insbesondere in Bezug auf COVID-19, hin. Diese Ergebnisse erfordern auch einen kritischen Blick auf zukünftige Formate und Themen von Podiumsdiskussionen in der medizinischen Ausbildung. Das Online-Format könnte eine gute Alternative zu Präsenz-Vorträgen sein.

Purpose: The ultimate aim of this study is to investigate how health information needs’ satisfaction actually makes a difference to the patients' management of a chronic clinical condition. The literature falls short of providing evidence on the interaction between patients' health information seeking behaviour and the successful management of a clinical condition. On the other hand, patient education and good information seeking practices are deemed necessary for hypertension management daily decisions. Design/methodology/approach: A specially designed questionnaire study was developed: The survey design was informed by the information seeking behaviour model of Wilson for studying hypertension patients' information needs, information resources and obstacles patients face while seeking hypertension-related information. Moreover, clinical information was collected in order to make associations and inference on the impact of information seeking on patients' clinical outcomes. Findings: The study included 111 patients submitted to the outpatient hypertension clinic of a university hospital in Athens for a 24-h ambulatory blood pressure measurement (ABPM). The analysis showed that those reporting higher satisfaction level of their information needs achieved lower values in ABPM (ABPM

The aim of this study was to evaluate several sociodemographic, lifestyle, and clinical characteristics of the IKARIA study participants and to find healthy aging trajectories of multimor-bidity of Ikarian islanders. During 2009, 1410 people (aged 30+) from Ikaria Island, Greece, were voluntarily enrolled in the IKARIA study. Multimorbidity was defined as the combination of at least two of the following chronic diseases: hypertension; hypercholesterolemia; diabetes; obesity; cancer; CVD; osteoporosis; thyroid, renal, and chronic obstructive pulmonary disease. A healthy aging index (HAI) ranging from 0 to 100 was constructed using 4 attributes, i.e., depression symptomatology, cognitive function, mobility, and socializing. The prevalence of multimorbidity was 51% among men and 65.5% among women, while the average number of comorbidities was 1.7 ± 1.4 for men and 2.2 ± 1.4 for women. The most prevalent chronic diseases among men with multimorbidity were hypertension, hypercholesterolemia, and obesity while among women they were hypertension, hypercholesterolemia, and thyroid disease. Multimorbidity was correlated with HAI (Spearman’s rho = −0.127, p < 0.001) and for every 10-unit increase in HAI, participants had 20% lower odds of being multimorbid. Multimorbidity in relation to HAI revealed a different trend across aging among men and women, coinciding only in the seventh decade of life. Aging is usually accompanied by chronic diseases, but multimorbidity seems to also be common among younger adults. However, healthy aging is a lifelong process that may lead to limited co-morbidities across the lifespan. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Background and Purpose: Tandem lesions in the anterior circulation account for up to 30% of all large vessel occlusion strokes. The optimal periprocedural approach in these lesions is still a matter of debate. Methods: Data from the German Stroke Registry - Endovascular Treatment between June 2015 and December 2019 were analyzed. The German Stroke Registry - Endovascular Treatment is an academic, independent, prospective, multicenter, observational registry study with 25 participating stroke centers from all over Germany enrolling consecutive mechanical thrombectomy patients. Tandem lesions were defined as a combination of a relevant extracranial internal carotid artery (ICA) pathology (ipsilateral stenosis >70% or occlusion) and concomitant intracranial large vessel occlusion. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction score of 2b-3. The modified Rankin Scale score of 0 to 2 at 3 months indicated good outcome. The aim of this study was to investigate the safety and efficacy of different technical strategies in tandem lesions. Results: Out of 6635 patients, 874 (13.2%) presented with tandem lesions. Of these, 607 (69.5%) underwent acute treatment of the extracranial ICA. Acute treatment of the extracranial ICA lesion led to a higher probability of successful reperfusion (odds ratio, 40.63 [95% CI, 30.03-70.06]) compared with patients who did not undergo acute treatment of the extracranial ICA lesion and was associated with good clinical outcome (39.5% versus 29.3%, P

Objectives: Due to the COVID-19 pandemic, medical curricula face major challenges. This also applies to mentoring programs, where face-to-face meetings are considered essential. Methods: The LMU Munich medical faculty mentoring program (MeCuM-Mentor) adapted to counteract the unforeseen pause of conventional course formats and associated uncertainty of many students. We here present an approach to transform the established large scale or group mentoring events of our program into online formats. Three projects are presented as examples: 1. HowTo Klink (HK), mainly informative in nature and with peer-mentoring character, 2. FacharztDuell (FAD) and 3. "Auf ein Gespräch mit... (AEGM)", both with a focus on career counseling.Results: Initial evaluations show a similarly high participation rate and a high level of satisfaction among the participating students. Students' evaluation of whether the projects presented should take place in presence or in online format has so far shown no clear trend.Conclusion: Prospective studies are necessary to investigate the effectiveness of these online formats and analyse differences in participant behaviour. The extent to which online mentoring can replace classic mentoring functions has to be discussed anew. Ziele: Aufgrund der COVID-19-Pandemie stehen medizinische Curricula aktuell vor großen Herausforderungen. Dies gilt auch für Mentoring-Programme, bei denen persönlicher Austausch als wesentlich angesehen wird.Methoden: Das Mentoring-Programm der Medizinischen Fakultät der LMU München (MeCuM-Mentor) wurde angepasst, um der unvorhergesehenen Pause der bisherigen Kursformate und der damit verbundenen Unsicherheit vieler Studierender entgegenzuwirken. Wir stellen hier einen Ansatz vor, um die etablierten Groß- oder Gruppen-Mentoring-Veranstaltungen unseres Programms in Online-Formate zu transformieren. Beispielhaft werden drei Projekte vorgestellt: 1. HowTo Klink (HK), wesentlich mit informativem sowie mit Peer-Mentoring-Charakter, 2. FacharztDuell (FAD) und 3. Auf ein Gespräch mit ... (AEGM), beide mit Schwerpunkt Berufsberatung.Ergebnisse: Initiale Bewertungen zeigen eine ähnlich hohe Teilnahmequote und Zufriedenheit der Studierenden. Die Einschätzung der Studierenden, ob die genannten Projekte in Präsenz- oder Online-Format stattfinden sollen, hat bisher keinen klaren Trend gezeigt.Fazit: Prospektive Studien sind erforderlich, um die Wirksamkeit dieser Online-Formate zu untersuchen und Unterschiede im Verhalten der Teilnehmer zu analysieren. Inwieweit Online-Mentoring klassische Mentoring-Funktionen ersetzen kann, muss neu diskutiert werden.

Zielsetzung: Der Fokus des Medizinstudiums liegt hauptsächlich auf der Vermittlung von Wissen und praktischen Fähigkeiten, während der Persönlichkeitsbildung und der Entwicklung des kritischen Denkens wenig Raum gegeben wird [[link:http://www.nklm.de*http://www.nklm.de]].[zum vollständigen Text gelangen Sie über die oben angegebene URL], Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

Objectives: The COVID-19 pandemic has led to major adjustments in health care systems and significantly affected medical education. Accordingly, our mentoring program MeCuM-Mentor had to expand its virtual elements, in order to continue to meet the needs for mentoring at the medical faculty of the Ludwig-Maximilians-University Munich. Methods: Here we report on our recently implemented online formats to facilitate training for currently coached peer mentors, as well as the introduction of an online consultation hour and a new social mentoring event called PubQuiz. Results: First results demonstrated feasibility of the above-mentioned virtual formats, which were positively rated by the participants in small voluntary evaluation questionnaires. Utilization rates indicate existing need for mentoring during the pandemic. In addition, the new event PubQuiz promotes social interaction among peers during isolation due to COVID-19. Conclusion: With the transition to online formats, mentoring at the Medical Faculty could be continued during COVID-19. The newly introduced mentoring event PubQuiz will be repeated. However, it remains unclear to what extent online formats can replace in-person one-to-one mentoring conversations or peer mentoring meetings., Zielsetzungen: Die COVID-19-Pandemie hat zu großen Anpassungen in den Gesundheitssystemen geführt und die medizinische Ausbildung erheblich beeinträchtigt. Dementsprechend musste unser Mentoring-Programm MeCuM-Mentor seine virtuellen Elemente erweitern, um dem Mentoring-Bedarf an der Medizinischen Fakultät der Ludwig-Maximilians-Universität München weiterhin gerecht zu werden. Methoden: Hier berichten wir über unsere neu implementierten Online-Formate zur Erleichterung der Ausbildung studentischer Peer-Mentor*innen sowie über die Einführung einer Online-Sprechstunde und einer neuen sozialen Mentoring-Veranstaltung namens PubQuiz. Ergebnisse: Erste Ergebnisse zeigen die Realisierbarkeit der virtuellen Formate, die von den Teilnehmern positiv bewertet wurden. Die Auslastung der Formate deutet auf einen bestehenden Bedarf an Mentoring während der Pandemie hin. Darüber hinaus fördert die neue Veranstaltung PubQuiz die soziale Interaktion unter den Studierenden während der Kontaktbeschränkungen aufgrund von COVID-19. Schlussfolgerung: Mit dem Übergang zu Online-Formaten konnte das Mentoring an der Medizinischen Fakultät während COVID-19 fortgesetzt werden. Das neu eingeführte PubQuiz wird wiederholt. Es bleibt jedoch unklar, inwieweit Online-Formate persönliche Mentoring-Gespräche oder Peer-Mentoring-Treffen ersetzen können., GMS Journal for Medical Education; 38(1):Doc8

Currently, renal denervation (RDN) has proven its overall procedural and renal safety in registries and trials. Available data, suggest that vascular complications are rather scarce in modern studies using established neuromodulation catheters of different technologies and kidney parameters are mainly maintained stable overtime in RDN patients. Identification of the impact of energy delivery at vascular level by means of advanced methodologies such as optical coherence tomography (OCT) is a meaningful research tool. This accumulation of evidence on the acute and late effects of the procedure in the renal artery tissue especially when a new catheter is tested, as in the present work can further enhance our knowledge on the pathophysiology and clinical outcome of RDN. © 2020 Hellenic Society of Cardiology

Despite the availability of a numerous antihypertensive agents, hypertension treatment and control rates remain low in many countries. The role of the sympathetic nervous system has long been recognized, but recent sham control renal denervation studies demonstrated conflicting results. In this reviewe paper, the authors performed a systematic review and meta-analysis to examine outcomes of sham-controlled studies utilizing new technologies and procedures. Six published randomized, sham-controlled studies were included in this meta-analysis. Of those, three trials used the first-generation radiofrequency renal denervation device and technique and the other three used second-generation devices and techniques. In total, 981 patients with hypertension were randomized in all 6 trials to undergo renal denervation (n = 585) or sham procedure (n = 396). Overall, renal denervation resulted in a decrease of 24-hours systolic ambulatory blood pressure (ABP) by 3.62 mm Hg (95% CI: −5.28-−1.96; I2 = 0%), compared to sham procedure (GRADE: low). Renal denervation also reduced daytime systolic ABP by 5.51 mm Hg (95% CI: −7.79-−3.23; I2 = 0%), compared to sham procedure but not nighttime systolic ABP. Office systolic blood pressure was reduced by 5.47 mm Hg (95% CI −8.10-−2.84; I2 = 0%), compared to sham control. Further analysis demonstrated that second-generation devices were effective in reducing blood pressure, whereas the first-generation devices were not. These results indicate that effective renal denervation can result in significant and clinically meaningful blood pressure reduction. The second-generation devices provide better renal nerve ablation. © 2020 Wiley Periodicals, Inc.

Background: Type 2 diabetes mellitus (T2DM) is a chronic, non communicable, multi-system disease that has reached epidemic proportions. Chronic exposure to hyperglycaemia affects the microvasculature, eventually leading to diabetic nephropathy, retinopathy and neuropathy with high impact on the quality of life and overall life expectancy. Sexual dysfunction is an often-overlooked microvascular complication of T2DM, with a complex pathogenesis originating from endothelial dysfunction. Objective: The purpose of this review is to present current definitions, epidemiological data and risk factors for diabetic retinopathy, nephropathy, neuropathy and sexual dysfunction. We also describe the clinical and laboratory evaluation that is mandatory for the diagnosis of these conditions. Methods: A comprehensive review of the literature was performed to identify data from clinical studies for the prevalence, risk factors and diagnostic methods of microvascular complications of T2DM. Results: Diabetic nephropathy and retinopathy affect approximately 25% of patients with T2DM; diabetic neuropathy is encountered in almost 50% of the diabetic population, while the prevalence of erectile dysfunction ranges from 35-90% in diabetic men. The duration of T2DM along with glycemic, blood pressure and lipid control are common risk factors for the development of these complications. Criteria for the diagnosis of these conditions are well established, but exclusion of other causes is mandatory. Conclusion: Early detection of microvascular complications associated with T2DM is important, as early intervention leads to better outcomes. However, this requires awareness of their definition, prevalence and diagnostic modalities. © 2020 Bentham Science Publishers.

Background: Renal functional reserve (RFR), defined as the difference between stress and resting glomerular filtration rate (GFR), may constitute a diagnostic tool to identify patients at higher risk of developing acute kidney injury or chronic kidney disease. Blunted RFR has been demonstrated in early stages of hypertension and has been attributed to impaired vascular reactivity due to an overactive sympathetic nervous system (SNS). Objective: The purpose of this study was to investigate whether RFR correlates with other phenotypes expressing overactivity of the SNS in patients with essential hypertension and preserved renal function. Methods: Thirty-six patients with untreated essential hypertension and a GFR >60 mL/min/1.73 m2 were enrolled. The following parameters were measured: RFR, 24-h ambulatory blood pressure (BP) profile, a treadmill stress test, and an echocardiographic examination. Urine and venous samples were obtained at specific time points for the determination of clinical parameters, and both resting and stress GFR were calculated by using endogenous creatinine clearance for the measurement of RFR after an acute oral protein load (1 g/kg). Results: Twenty-one patients had a RFR

Background: Primary aldosteronism is one of the most common causes of secondary hypertension. Patients with this endocrine syndrome are at increased cardiovascular risk, higher than hypertensive individuals with equal blood pressure levels. Objectives: The study aimed to thoroughly present and critically discuss the novel insights into the field of primary aldosteronism, focusing on the clinically meaningful aspects. Method: We meticulously evaluated existing data in the field of primary aldosteronism in order to summarize future perspectives in this narrative review. Results: Novel data suggests that a subclinical form of primary aldosteronism might exist. Interesting findings might simplify the diagnostic procedure of the disease, especially for the localization of primary aldosteronism. The most promising progress has been noted in the field of the molecular basis of the disease, suggesting new potential therapeutic targets. Conclusion: Several significant aspects are at early stages of evaluation. Future research is essential to investigate these well-promising perspectives. © 2020 Bentham Science Publishers.

Medizinstudierende sehen sich während und nach Beendigung ihres Studiums mit einer Vielzahl möglicher Karrierewege konfrontiert. Im Rahmen des bestehenden Mentoring Programms für Medizinstudierende an der LMU, München [ref:1] haben wir daher eine Gesprächsreihe veranstaltet,[zum vollständigen Text gelangen Sie über die oben angegebene URL], Gemeinsame Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA), des Arbeitskreises zur Weiterentwicklung der Lehre in der Zahnmedizin (AKWLZ) und der Chirurgischen Arbeitsgemeinschaft Lehre (CAL)

Background: Arterial stiffness is linked to the progression of atherosclerosis, while activation of vitamin D receptor exerts favorable cardiovascular effects in patients with renal insufficiency. In this study, we investigated the effects of oral treatment with paricalcitol, a potent vitamin D receptor activator, on arterial stiffness and osteopontin, a marker of atherosclerosis, in hypertensive patients with chronic kidney disease (CKD) and secondary hyperparathyroidism. Methods: We followed up 29 treated hypertensive patients (mean age: 74.1 years, 19 men, office blood pressure = 132/85 mmHg) with CKD stages 3–5 (mean glomerular filtration rate [GFR] = 19.4 ml/min/1.73 m2) who were on therapy with oral paricalcitol for 1 year. The control group consisted of 10 age-, sex-, and GFR-matched hypertensive patients with secondary hyperparathyroidism. Results: After 1 year of treatment with paricalcitol compared to baseline, there was no statistical difference in levels of GFR, office blood pressure, and osteopontin (p = NS for all), while carotid-femoral PWV was reduced from 11.8 ± 2.6 m/s to 11.2 ± 2.4 m/s (p < 0.05). The control group exhibited no significant changes in carotid-femoral PWV (p = NS). Conclusions: Treatment with oral paricalcitol in hypertensive subjects suffering from CKD stages 3–5 and secondary hyperparathyroidism is accompanied by amelioration of arterial stiffness as reflected by the reduction of carotid-femoral PWV. © 2018 Hellenic Society of Cardiology

Purpose: To investigate the effect of bonding agent on the bonding strength between Co-Cr dental alloy, prepared by selective laser melting (SLM), and feldspathic porcelain. Materials and Methods: The experiments were conducted according to ISO 9693 and the conventional protocols for the production of metal-ceramic dental restorations. After Al2O3 air-particle abrasion, metal substrates of Co-Cr dental alloy specimens were bonded, using bonding agent (25 specimens), with dental porcelain positioned in layers (opaque, dentin, enamel). Control specimens (25) were also produced without bonding agent. Bonding strength was measured using 3-point bending tests, and the results were statistically analyzed using the t-test and Weibull statistics. Elemental (by SEM/EDS) and crystallographic analyses (by XRD) were conducted on the bonding agent, along cross sections of alloy-porcelain interfaces, and on fracture surfaces. Results: Cohesive fracture occurred (on the porcelain side). The application of the bonding agent decreased the average bonding strength (from 42.27 ± 5.85 to 36.25 ± 3.26 MPa, P = 0.00006), attributed to the nonexisting reaction between the TiO2-rich bonding agent and the Co-Cr alloy, but it increased the Weibull modulus (from 7.84 to 12.16), which reflects the reliability of the bond in the tested metal-ceramic specimens. Conclusions: Although the application of bonding agent slightly decreased the bonding strength, all the measured values of the metal-ceramic specimens produced by the SLM technique, with or without the bonding agent, are markedly higher than the minimum value required by ISO 9693 (25 MPa). Moreover, the use of bonding agent favors the increase of the Weibull modulus. © 2019 by the American College of Prosthodontists

AIMS Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) concerning opinion on the evidence relating to dual antiplatelet therapy (DAPT) duration after coronary stenting. METHODS AND RESULTS Results from three randomised clinical trials were scheduled to be presented at the American Heart Association Scientific Sessions 2014 (AHA 2014). A web-based survey was distributed to all individuals registered in the EuroIntervention mailing list (n=15,200) both before and after AHA 2014. A total of 1,134 physicians responded to the first (i.e., before AHA 2014) and 542 to the second (i.e., after AHA 2014) survey. The majority of respondents interpreted trial results consistent with a substantial equipoise regarding the benefits and risks of an extended versus a standard DAPT strategy. Two respondents out of ten believed extended DAPT should be implemented in selected patients. After AHA 2014, 46.1% of participants expressed uncertainty about the available evidence on DAPT duration, and 40.0% the need for clinical guidance. CONCLUSIONS This EAPCI survey highlights considerable uncertainty within the medical community with regard to the optimal duration of DAPT after coronary stenting in the light of recent reported trial results. Updated recommendations for practising physicians to guide treatment decisions in routine clinical practice should be provided by international societies.

Background: Hypertension (HT) is an important risk factor for cardiovascular disease and might precipitate pathology of the aortic valve. Objective: To investigate the association of HT with aortic dysfunction (including both aortic regurgitation and stenosis) and the impact of antihypertensive treatment on the natural course of underlying aortic disease. Methods: We performed a systematic review of the literature for all relevant articles assessing the correlation between HT and phenotype of aortic disease. Results: Co-existence of HT with aortic stenosis and aortic regurgitation is highly prevalent in hypertensive patients and predicts a worse prognosis. Certain antihypertensive agents may improve haemodynamic parameters (aortic jet velocity, aortic regurgitation volume) and remodeling of the left ventricle, but there is no strong evidence of benefit regarding clinical outcomes. Renin-angiotensin system inhibitors, among other vasodilators, are well-tolerated in aortic stenosis. Conclusion: Several lines of evidence support a detrimental association between HT and aortic valve disease. Therefore, HT should be promptly treated in aortic valvulopathy. Despite conventional wisdom, specific vasodilators can be used with caution in aortic stenosis. © 2019 Bentham Science Publishers.

Introduction: Although the first results from studies suggested important benefits regarding blood pressure (BP) control in resistant hypertension by the use of diverse systems of renal denervation (RDN) in the setting of resistant hypertension, the Symplicity HTN-3, randomized sham-controlled trial reduced the enthusiasm and led to a more critical approach towards this neuromodulation innovative therapy. Nowadays there is an ongoing research attempt to justify the pathophysiological background of RDN since overdrive of the sympathetic nervous system is one of the key mechanisms leading to the development and progression of the hypertensive and cardiovascular diseases. Conclusion: Future RDN trials based on the clinical findings and gaps from previous works will try to identify those parameters to help identify better BP response, target the most suitable population and conclude whether this interventional approach can contribute to the clinical problem of uncontrolled hypertension. © 2018 Bentham Science Publishers.

Purpose of Review: To summarize the evidence regarding the distribution of renal nerves and their patterns of anatomic variations in animal and human settings. Moreover, the methodology and results of studies regarding renal nerve stimulation (RNS) in both preclinical and clinical models are presented. Recent Findings: There are differences regarding the number and the size of renal fibers, as well as their distance from the lumen in the diverse parts of the main renal arteries and the branches. In both animals and humans, RNS is safe and results in an increase of blood pressure (BP) while the effect on heart rate varies. In this context, the ConfidenHT™ system constitutes an integrated solution for effective RNS in humans. Summary: Due to the diversity of renal nerve anatomy in humans, arterial areas for more effective renal denervation cannot be homogenously defined. The concept of mapping of renal nerves can improve completeness of renal denervation therapies by means of integrated RNS solutions such as the ConfidenHT™ system. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.