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Background The purpose of this study is to investigate the impact of oxygen therapy on cardiovascular outcomes in relation to sex in patients with confirmed myocardial infarction (MI). Methods The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction trial randomized 6,629 patients to oxygen at 6 L/min for 6-12 hours or ambient air. In the present subgroup analysis including 5,010 patients (1,388 women and 3,622 men) with confirmed MI, we report the effect of supplemental oxygen on the composite of all-cause death, rehospitalization with MI, or heart failure at long-term follow-up, stratified according to sex. Results Event rate for the composite endpoint was 18.1% in women allocated to oxygen, compared to 21.4% in women allocated to ambient air (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.65-1.05). In men, the incidence was 13.6% in patients allocated to oxygen compared to 13.3% in patients allocated to ambient air (HR 1.03, 95% CI 0.86-1.23). No significant interaction in relation to sex was found ( P = .16). Irrespective of allocated treatment, the composite endpoint occurred more often in women compared to men (19.7 vs 13.4%, HR 1.51; 95% CI, 1.30-1.75). After adjustment for age alone, there was no difference between the sexes (HR 1.06, 95% CI 0.91-1.24), which remained consistent after multivariate adjustment. Conclusion Oxygen therapy in normoxemic MI patients did not significantly affect all-cause mortality or rehospitalization for MI or heart failure in women or men. The observed worse outcome in women was explained by differences in baseline characteristics, especially age. (Am Heart J 2021;237:13 & ndash;24.) Funding Agencies|Swedish Research CouncilSwedish Research CouncilEuropean Commission [VR20130307]; Swedish HeartLung FoundationSwedish Heart-Lung Foundation [HLF 2018-0187]; Region Stockholm [K 2017-4577]

The global crises of the early 21st century that have tested the international financial architecture. In seeking to ensure stability, governments have regulated financial and capital markets. This in turn has implicated international investment law, which investors have invoked as a shield against debt restructuring, bail-ins or bail-outs. Serving as an introduction to a book project on International Investment Law and the Global Financial Architecture, and summarizing its contributions, the paper maps out the interactions between international investment law and international financial regulation and considers how to conceptualize and draw the line between legitimate financial regulation and re-regulation for the protection of macro-economic stability and undue interference with investor rights.

Apart from advanced age, little is known about predictors of the long-term outcome after carotid artery stenting (CAS).We sought to determine whether atherosclerotic risk factors predict the long-term outcome after CAS.We enrolled 532 patients assigned for CAS. The primary composite end-point, including stroke, myocardial infarction and all-cause mortality, was observed in 100 patients (19%) during the long-term follow-up (median 28 months, interquartile range 14-49 months).Cumulative event rates at 1, 3 and 5 years were 4.4%, 17.1% and 33.4%, respectively. High-density lipoprotein (HDL) cholesterol was an independent predictor of event-free survival. The adjusted hazard ratio for the primary end-point was 0.97 per increase of 1 mg dL(-1) HDL cholesterol [95% confidence interval (CI) 0.95-0.99, P = 0.002) and 2.7 (95% CI 1.6-4.4, P0.001) for low HDL cholesterol (40 mg dL(-1) in men and50 mg dL(-1) in women). Inflammatory activation (leukocyte count10,000 mL(-1) or fibrinogen450 mg dL(-1) or erythrocyte sedimentation rate20 mm h(-1)) was the only other independent atherosclerotic risk factor (P = 0.001). Patients with low HDL cholesterol and elevated inflammatory activation were at very high risk, with a 5-year event rate of 59.4% (95% CI 43.6-75.2%) as compared to 15.1% (95% CI 8.2-22.0%) in those without both risk factors (log rank, P0.001). Age, occlusion of the contralateral carotid artery and heart failure were further independent risk predictors (P0.01 for all).Low HDL cholesterol is an independent predictor of the long-term outcome after CAS. The combination of low HDL cholesterol and elevated inflammatory markers identified high-risk patients.

Wie jungste Bericht an kleinen Patientenzahlen gezeigt haben, ist eine nichtchirurgische Intervention am ungeschutzten Hauptstamm der linken Koronararterie ohne grosere Komplikationen durchfuhrbar.

Background: Low adherence to treatment in Multiple Sclerosis (MS) has been shown to lead to poor health outcomes. Various strategies to improve adherence have been suggested including educative programs, injection devices and dedicated nurse assistance. Objective: To assess the impact of elements of the patient support program on adherence; to explore disease factors affecting adherence; and to determine whether these factors influence the choices of supportive elements. Methods: A prospective, observational cohort study was conducted. MS patients were eligible if they had switched to Interferon beta-1b (IFNB-1b) between 1 and 3 months prior to inclusion. Data were collected at months 6, 12, 18 and 24 after inclusion. Adherence was defined as completion of both study protocol and medication at 24 months. Patients underwent evaluations of disability, quality of life, depression, and coping styles. Results: A total of 1077 patients from 15 countries were included, of which 61.8% were adherent to IFNB-1b after 24-months. Depression, quality of life and autoinjector devices were baseline predictors of adherence at 24-months. Coping styles did not show to have substantial impact on adherence. Lower quality of life increased the probability of choosing supportive elements. Conclusion: The study showed that the usage of autoinjector devices chosen during the study was the strongest predictor of drug adherence of all the supportive elements tested in this study. (C) 2011 Elsevier B.V. All rights reserved.

Background Beta-blockers, used as an adjunctive to diuretics, digoxin and angiotensin converting enzyme inhibitors, improve survival in chronic heart failure. We report a prospectively planned economic analysis of the cost of adjunctive beta-blocker therapy in the second Cardiac Insufficiency BIsoprolol Study (CIBIS II). Methods Resource utilization data (drug therapy, number of hospital admissions, length of hospital stay, ward type) were collected prospectively in all patients in CIBIS . These data were used to determine the additional direct costs incurred, and savings made, with bisoprolol therapy. As well as the cost of the drug, additional costs related to bisoprolol therapy were added to cover the supervision of treatment initiation and titration (four outpatient clinic/office visits). Per them (hospital bed day) costings were carried out for France, Germany and the U.K. Diagnosis related group costings were performed for France and the U.K. Our analyses took the perspective of a third party payer in France and Germany and the National Health Service in the U.K. Results Overall, fewer patients were hospitalized in the bisoprolol group, there were fewer hospital admissions perpatient hospitalized, fewer hospital admissions overall, fewer days spent in hospital and fewer days spent in the most expensive type of ward. As a consequence the cost of care in the bisoprolol group was 5-10% less in all three countries, in the per them analysis, even taking into account the cost of bisoprolol and the extra initiation/up-titration visits. The cost per patient treated in the placebo and bisoprolol groups was FF35 009 vs FF31 762 in France, DM11 563 vs DM10 784 in Germany and pound 4987 vs pound 4722 in the U.K. The diagnosis related group analysis gave similar results. Interpretation Not only did bisoprolol increase survival and reduce hospital admissions in CIBIS II, it also cut the cost of care in so doing. This `win-win' situation of positive health benefits associated with cost savings is Favourable from the point of view of both the patient and health care systems. These findings add further support for the use of beta-blockers in chronic heart failure.

This is a report on an epithelial inclusion cyst covering the septal leaflet of the tricuspid valve. The tumor was an accidental finding in a 5 1/2 years-old boy with congenital heart disease including double-chambered right ventricle, ventricular and atrial septal defects and subvalvular aortic stenosis. Histological examination showed a two-layered ciliated epithelium, typically present in the respiratory system. Embryologic tissue heterotopia arising from sequestered entodermal elements from the primitive foregut during cardiac organogenesis is a possible explanation for the locality and histology of the tumor. To our knowledge, a similar case has never been presented before.

All patients examined [52] with malignant disease of the female genital tract showed lymphocyte reactions to encephalitogenic factor (EF) of more than 10% as measured by the macrophage electrophoretic mobility (MEM) test and its modification (MOD-MEM). Whilst 13 patients with non-malignant disease of the genital tract and 30 normals showed lymphocyte reaction to EF of less than 6%, 4 patients with nonmalignant gynaecological disease gave values above the 10% limit. The lymphocyte reactions of this latter group of patients were discussed with respect to their previous clinical histories. Some of the malignant cases were carcinoma of the cervix in situ so that the MEM test would appear to be of value in the early diagnosis of cancer. The need for caution in the interpretation of results is discussed as well as further possible applications of the technique.

Es wird die Isolierung des Proteins der „pregnancy zone“ mit Hilfe von Immunadsorbentien beschrieben.

Mit Hilfe der einfachen radialen Immunodiffusion nach Mancini u. Mitarb. wurde die Konzentration des Proteins der „pregnancy zone“ in 383 Seren gesunder Schwangerer von der 6. bis 44. Schwangerschaftswoche bestimmt. Als Bezugssubstanz (Standard) diente ein Schwangerenserum mit uberdurchschnittlich hoher PZ-Konzentration. Die Serumkonzentration des Proteins wies erhebliche individuelle Unterschiede auf. Bis zur 24. Schwangerschaftswoche war ein nahezu linearer Anstieg der Durchschnittswerte der PZ-Serumkonzentration erkennbar. Danach bildeten die Serumkonzentrationen bis zur 32. Schwangerschaftswoche ein Plateau und fielen zum Geburtstermin hin wieder etwas ab. Bei Schwangeren jenseits der 42. Schwangerschaftswoche wurden besonders hohe Durchschnittswerte gefunden. Die Konzentrationsunterschiede waren nur bis zur 14. Schwangerschaftswoche signifikant.

Mit Hilfe des Makrophagen-Elektrophorese-Mobilitatstestes konnte die vermutete immunsuppressive Aktivitat des schwangerschaftsassoziiertenα2-Glykoproteins (Protein der „pregnancy zone“) signifikant nachgewiesen werden. Seren von Schwangeren sowie Nichtschwangeren unter hormonaler Kontrazeption die dieses Schwangerschaftsprotein enthielten, wiesen ebenfalls eine immunsuppressive Aktivitat auf. Dagegen waren mannliches AB-Spenderserum und menschliches Serumalbumin nicht immunsuppressiv wirksam. Aus den Versuchen last sich ableiten das das schwangerschaftsassoziierte α2-Glykoprotein eher auf den afferenten Schenkel der Immunantwort einwirkt und nicht mit der Wirkung des Mediators (migration inhibiting factor) interferiert.

Es wird eine einfache Methode zur Herstellung monospezifischer Antiseren gegen das Protein der Schwangerschaftszone beschrieben.

Zur Isolierung schwangerschaftstypischer Proteine wurden gepooltes Sehwangeren-, Retroplacentar- und Nabelschnurserum unter Anwendung der Salzfallung mit Rivanol und Ammoniumsulfat, der einfachen und recyclischen Gelfiltration mit Sephadex G-200, der Ionenaustauschchromatographie an DEAE-Sephadex A-25 und A-50 sowie der Elektrofokussion mit Ampholine pH 3–10 und pH 4–6 fraktioniert. Die in den Fraktionen enthaltenen schwangerschaftstypischen Proteine wurden mit einer Mischung absorbierter Kaninchenantisera gegen Schwangerenserum und Placentaextrakt in der Immunodiffusion nach Ouchterlony und der Immunelektrophorese nach Scheidegger nachgewiesen. Als effektives Verfahren erwies sich die Salzfraktionierung mit Ammoniumsulfat in Verbindung mit der recyclischen Gelchromatographie. Es konnten Proteinfraktionen gewonnen werden, die neben einem schwangerschaftstypischen Protein immunelektrophoretisch nur zwei Normalserumproteine enthalten. Aus dem Verhalten bei der Fraktionierung konnten Ruckschlusse auf das Molekulargewicht der schwangerschaftstypischen Proteine gezogen werden.

The concentration in serum of the pregnancy zone protein (PZ), a high molecular pregnancy-associated alpha2-glycoprotein, increases during pregnancy, when oral contraceptives are taken and under certain pathological conditions. PZ is probably part of a multifactorial immunological defence system which prevents the premature rejection of the fetus and placenta which together may be regarded as an allograft. Normally, the PZ serum concentration begins to rise during the 6th – 12th week of pregnancy and reaches its peak at about the 24th week. The mean values then remain stable and afterwards diminish slightly toward the end of the pregnancy. In contrast, the mean values in mothers with insulin-dependent diabetes mellitus continue to rise. Excessively high serum PZ concentrations are significantly more frequent among pregnant diabetic patients, especially where there is also rhesus D antigen incompatibility. No correlation was found between excessively high values and the risk features used for the Priscilla White classification. A few patients with progressive proliferative retinopathy even had unusually low values.