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Background Unfractionated heparin (UFH) bolus is occasionally administered during endovascular treatment (EVT) to reduce thrombotic complications in acute ischemic stroke patients. However, the MR CLEAN-MED trial showed an increase in symptomatic intracranial hemorrhages (sICH) and a non-significant shift towards worse functional outcome with UFH administration. We aimed to analyze the impact of periprocedural UFH bolus in a real-world setting in anterior (ACS) and posterior circulation stroke (PCS) patients. Methods We analyzed data from the German Stroke Registry-Endovascular Treatment using propensity score matching. Primary outcome was the modified Rankin Scale at 3 months, and secondary outcome measures included mortality, angiographic outcomes, post-EVT National Institute of Health Stroke Scale scores and ICH at 24 hours. Results Among 13,082 patients, 7948 with ACS (UFH bolus use in 15%) and 841 with PCS (UFH bolus use in 16.3%) were included in the propensity score matching analysis. Applying MR CLEAN-MED study criteria, UFH bolus was associated with worse functional outcomes (odds ratio [OR] 1.44; 95% CI 1.06--1.96). Analyzing all ACS and PCS patients, UFH bolus did not provide any net benefit. In ACS patients treated with intravenous thrombolysis (IVT), UFH bolus use was associated with worse functional outcomes (OR 2.40; 95% CI 1.34 to 5.06). Conclusion Our findings show transferability of the MR CLEAN-MED results into a real-world setting, confirming a negative effect of periprocedural UFH on functional outcome in this subgroup of patients. Considering all ACS and PCS patients, periprocedural UFH did not provide a net benefit and appears to be harmful, particularly in IVT-treated patients. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac output (CO) measurement is vital in veno-venous extracorporeal membrane oxygenation patient population to evaluate oxygen delivery and to early identify right heart failure. Standard clinical methods like pulmonary artery thermodilution and transpulmonary thermodilution are known to be inaccurate in the veno-venous extracorporeal membrane oxygenation setting, especially at high levels of recirculation. Objective: The aim of the study was to develop a simple noninvasive method to measure CO in patients during veno-venous extracorporeal membrane oxygenation. Methods: A mathematical model was developed where CO was analyzed as a combination of two flows: oxygenated blood from extracorporeal membrane oxygenation and less oxygenated mixed venous blood. The system of two mass balance equations for oxygen saturations was introduced to calculate CO. The procedure included measurement of recirculation (ELSA Monitor Transonic Systems Inc. Ithaca, USA) and arterial saturation at two extracorporeal membrane oxygenation flows after temporary pump flow decrease. Mathematic modeling that utilized a crude Monte Carlo method was used to analyze theoretical errors in CO calculations from unknown behavior of venous saturation. The developed concept was retrospectively applied to clinical data archive of 17 adult patients on veno-venous extracorporeal membrane oxygenation that included 52 measurement sessions. Results: Mathematical modeling suggests that proportion of results with error ⩽10% was between 86% and 100% if pre-oxygenated saturation was available and it was between 78% and 86% if pre-oxygenated saturation was not available. Application of two mass balance equation concept to clinical data suggests that as the decrease of the arterial saturation reaches 6% due to flow decrease, then CO calculations becomes highly reliable as 96% (2 standard deviations) of the results has a reproducibility within 6.4%. Conclusion: The mathematical model and clinical retrospective analysis demonstrates that the new methodology has the potential to accurately measure CO in veno-venous extracorporeal membrane oxygenation patients. The next step is validation in animal and clinical settings. [ABSTRACT FROM AUTHOR]

Background: Transcranial Doppler (TCD) ultrasound enables fast, safe, and continuous evaluations of brain function, proving to be helpful for the clinical diagnosis of various cerebrovascular diseases. Moreover, nowadays ultrasonography education for medical students has become a significant component of their education.The main aim was to assess a medical student's understanding of the anatomical position of the middle cerebral artery in relation to the transtemporal window, as well as the knowledge of blood flow velocities and the pulsatile index. Material and methods: This presentation consisted of a case series with 9 healthy subjects. They underwent TCD measurements using a 2 MHz impulse probe. The probe was set up above the zygomatic arch, along a horizontal line that intersects with the external ear canal. The focus of the investigation was the middle cerebral artery, which enables analysis of cerebral blood flow. The measurements were made for the peak-systolic (PSV), end-diastolic (EDV), mean blood velocities (MDV), and pulsatile index (PI) of the mean cerebral artery. The measurements were performed by an Anesthesia and Intensive Care specialist and an undergraduate medical student. All data was assessed for normality and the Pearson correlation coefficient was calculated. Results: The outcomes of the medical doctor's TCD were as follows: for the right middle cerebral artery: PSV= 107.74±18.20 cm/s, EVD= 43.88±8.15 cm/s, MDV= 42.94±7.83 cm/s, PI= 0.99±0.20; for the left middle cerebral artery: PSV= 91.35±10.50 cm/s, EDV= 42.94±8.80 cm/s, MDV= 39.84±9.33 cm/s, PI= 0.88±0.20. The outcomes of the medical student's TCD were as follows: for the right middle cerebral artery: PSV= 103.32±17.95 cm/s, EDV= 47.28±11.97 cm/s, MDV= 42.94±9.94, PI=0.90±0.18; for the left middle cerebral artery: PSV= 93.81±27.49 cm/s, EDV= 53.42±20.73 cm/s, MDV= 42.66±13.05 cm/s, PI= 0.91±0.21. Positive Pearson correlation coefficient was obtained, with r=0.68 for left PSV, r=0.55 for right PI and r=0.90 for right PI. Conclusions: Medical student can acquire real-time information on cerebral hemodynamics through TCD training. [ABSTRACT FROM AUTHOR]

Objectives The optimal hypothermic level during circulatory arrest in aortic arch surgery remains controversial, particularly in frozen elephant trunk (FET) procedures. We describe herein our experience for total arch replacement with FET technique under moderate systemic hypothermic circulatory arrest (≥ 28°C) during selective antegrade cerebral perfusion. Methods Between January 2009 and January 2016, 38 consecutive patients underwent elective total arch replacement for various aortic arch pathologies with FET technique using the E-vita Open hybrid prosthesis (Jotec GmbH, Hechingen, Germany). Selective unilateral or bilateral cerebral perfusion under moderate systemic hypothermic circulatory arrest (28.7°C ± 0.5°C) was used in all patients. Minimally invasive total arch replacement with FET via partial upper sternotomy was performed in 15 patients (39%) and in the remaining 23 patients (61%) via full sternotomy. Mean late follow-up was 3 ± 2 years and was 98% complete. Clinical data were prospectively entered into our institutional database. Results Cardiopulmonary bypass time accounted for 198 ± 58 minutes and the myocardial ischemic time 109 ± 29 minutes. Selective antegrade cerebral perfusion time was 55 ± 6 minutes. Lower body circulatory arrest time was 39 ± 11 minutes. Unilateral cerebral perfusion was performed in 31 patients (82%), and bilateral in 7 patients (18%). Intensive care unit stay was 4 ± 3 days. Thirty-day mortality was 5% (n = 2). Late survival at 3 years was 87 ± 3%. Two patients (5%) required reexploration for bleeding. Patients were discharged after a hospital length of stay of 7 ± 2 days. Postoperative permanent neurologic complication occurred in two patients (5%). Three patients (8%) experienced a transient neurologic disorder. New transient renal replacement therapy was necessary in three patients (8%). No spinal cord injury was noted. Conclusions Our data suggest that moderate systemic hypothermic circulatory arrest (≥ 28°C) in combination with antegrade cerebral perfusion can safely be applied for total aortic arch replacement with FET and offers sufficient neurologic and visceral organ protection. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to investigate the relationship between impaired peripheral arterial circulation as measured by ankle-brachial index (ABI) and restless legs syndrome (RLS) in the general population.Methods: Data are derived from three independent, German population-based, prospective studies: the control sample of BiDirect (N = 966), the second follow-up of SHIP (N = 2333), and a subsample of SHIP-Trend (N = 1269). RLS was assessed with questions based on the RLS minimal criteria. ABI was measured with an automated method in BiDirect and with Doppler ultrasound in both SHIP studies. An ABI score below 0.9 was indicative of peripheral arterial disease (PAD). Co-morbidities, medications and behavioural factors were self-reported. Additional measurements included body mass index and haemoglobin from blood serum. For BiDirect, a follow-up with identical methodology was performed after a median of 2.5 years.Results: In cross-sectional analyses, decreased ABI was not significantly associated with RLS as outcome in multivariable logistic regression models adjusted for several potential confounders (BiDirect: odds ratio (OR) = 1.07 for a -0.1 change in ABI, 95% confidence interval (CI): 0.81-1.42, p = 0.62; SHIP-2: OR = 0.99, CI: 0.85-1.16, p = 0.94; SHIP-Trend: OR = 0.99, CI: 0.87-1.13, p = 0.88). Similar non-significant results were achieved using PAD (instead of ABI) as an independent variable. In BiDirect, baseline ABI was not a significant predictor of incident RLS in longitudinal analysis (OR = 0.77, CI: 0.53-1.12, p = 0.17).Conclusion: Results from three independent studies suggest that reduced ABI is not a risk factor for RLS in the general population. [ABSTRACT FROM AUTHOR]

Objectives Skeletal muscle wasting, also known as sarcopenia, has recently been identified as a serious comorbidity in patients with heart failure (HF). We aimed to assess the impact of sarcopenia on endothelial dysfunction in patients with HF with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF). Design Cross-sectional study. Setting Ambulatory patients with HF were recruited at Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany. Participants We assessed peripheral blood flow (arm and leg) in 228 patients with HF and 32 controls who participated in the Studies Investigating Comorbidities Aggravating HF (SICA-HF). Measurements The appendicular skeletal muscle mass of the arms and the legs combined was assessed by dual energy x-ray absorptiometry (DEXA). Sarcopenia was defined as the appendicular muscle mass two standard deviations below the mean of a healthy reference group of adults aged 18 to 40 years, as suggested for the diagnosis of muscle wasting in healthy aging. All patients underwent a 6-minute walk test and spiroergometry testing. Forearm and leg blood flow were measured by venous occlusion plethysmography. Peak blood flow was assessed after a period of ischemia in the limbs to test endothelial function. Results Sarcopenia was identified in 37 patients (19.5%). Patients with sarcopenia presented with lower baseline forearm blood flow (2.30 ± 1.21 vs. 3.06 ± 1.49 vs. 4.00 ± 1.66 mL min −1 100 mL −1 ; P = .02) than those without sarcopenia or controls. The group of patients with sarcopenia showed similar baseline leg blood flow (2.06 ± 1.62 vs. 2.39 ± 1.39 mL min −1 100 mL −1 ; P = .11) to those without but lower values when compared to controls (2.06 ± 1.62 vs. 2.99 ± 1.28 mL min −1 100 mL −1 ; P = .03). In addition, patients with and without sarcopenia presented with lower peak flow in the forearm when compared to controls (18.37 ± 7.07 vs. 22.19 ± 8.64 vs. 33.63 ± 8.57 mL min −1 100 mL −1 ; P < .001). A similar result was observed in the leg (10.89 ± 5.61 vs. 14.66 ± 7.19 vs. 21.37 ± 13.16 mL min −1 100 mL −1 ; P < .001). Peak flow in the forearm showed a significant correlation with exercise capacity (relative peak VO 2 : R = 0.47; P < .001; absolute peak VO 2 : R = 0.35; P < .001; and 6-min walk distance: R = 0.20; P < .01). Similar correlations were observed between peak flow in the leg and exercise capacity (absolute peak VO 2 : R = 0.42, P < .001; relative peak VO 2 : R = 0.41, P < .001; and 6-min walk test: R = 0.33; P < .001). Logistic regression showed peak flow in the leg to be independently associated with the 6-min walk distance adjusted for age, hemoglobin level, albumin, creatinine, presence of sarcopenia, and coronary artery disease (hazard ratio, 0.903; 95% confidence interval, 0.835-0.976; P = .01). Conclusion Patients with HF associated with sarcopenia have impaired endothelial function. Lower vasodilatation had a negative impact on exercise capacity, particularly prevalent in patients with sarcopenia. [ABSTRACT FROM AUTHOR]

Background: Fractures of the extremities are often complicated by a variable degree of swelling secondary to hemorrhage and soft tissue injury. Patients typically require up to 7 days of inpatient bed rest and elevation to reduce swelling to an acceptable level for operative treatment with internal fixation. Alternatively, an intermittent pneumatic compression device, such as the Vascular Impulse Technology (VIT) system, can be used at the injured extremity to reduce the posttraumatic swelling. The VIT system consists of a pneumatic compressor that intermittently rapidly inflates a bladder positioned under the arch of the hand or the foot, which results in compression of the venous hand or foot plexus. That intermittent compression induces an increased venous velocity and aims to reduce the soft tissue swelling of the affected extremity.Methods/design: The VIT study is a prospective, monocenter, randomized controlled trial to compare the VIT system with elevation in the treatment of posttraumatic swelling in the case of a fracture of the upper and lower extremity. This study will include 280 patients with fractures of the upper and the lower extremity with nine different injury types. For each of the nine injury types a separate randomization to the two intervention groups (VIT group or control group) will be performed. The primary outcome parameter is the time taken for the swelling to resolve sufficiently to permit surgery. A separate analysis for each of the nine injury types will be performed.Discussion: In the proposed study, the effectiveness of the VIT system in the treatment of posttraumatic swelling of upper and lower extremity fractures will be evaluated.Trial Registration: German Clinical Trial Register, No. DRKS00010510 . Registered on 17 July 2016. [ABSTRACT FROM AUTHOR]

Background The pharmaceutical therapy for acute ischemic stroke has shortcomings in reopening large vessels and dissolving long thrombi, and endovascular treatment has been found to provide added value. The Aperio thrombectomy device showed promising results in an experimental study. The purpose of this study was to evaluate the device clinically. Methods 119 patients with acute stroke were treated in nine centers using the Aperio thrombectomy device. Target vessel, diameter, thrombus length, procedure time, recanalization, number of deployments, additional use of anticoagulants, complications, and the use of additional devices were assessed. Results The median thrombus length was 15 mm (range 1.5-20 mm) and the average time from device insertion to recanalization was 30 min (range 5-120 min). Blood flow restoration (Thrombolysis In Cerebral Infarction (TICI) 2-3) was achieved in 85%. In the majority of cases complete clot removal was achieved (TICI 0, 12%; TICI 1, 2%; TICI 2a, 14%; TICI 2b, 18%; TICI 3, 53%). The median number of deployments was 2 (range 1-6). Twelve procedural complications (10%) occurred. Conclusions The Aperio thrombectomy device seems to be an effective and adequately safe tool for reopening occluded cerebral arteries in the setting of acute stroke. [ABSTRACT FROM AUTHOR]

There is an abundace of studies on the influence of rest and exercise as well as external compression on cutaneous, subcutaneous and muscle tissue blood flow using different measurement techniques. As a novel approach, we simultaneously examined the influence of a custom-made elastic thigh bandage on cutaneous and subcutaneous venous blood oxygenation (SO2), post-capillary venous filling pressures (rHb) and blood flow (flow) using the non-invasive laser-Doppler spectrophotometry system "Oxygen-to-see(O2C)". Parameters were obtained in 20 healthy volunteers in 2 mm and 8 mm tissue depth during rest, 5 and 10 minutes of moderate bicycle exercise following a 10-minute recovery period. Without the bandage, results matched the known physiological changes indicating higher blood backflow from superficial and deep veins. Underneath the elastic bandage, we observed lower post-capillary filling pressures during exercise. However, after the bandage was removed in the post-exercise period, all obtained parameters of microcirculation remained increased, indicating a higher amount of local venous blood volume in this area. Our observations might be the result of external compression, thermoregulatory and exercise-dependent vascular mechanisms. With the O2C device, a promising new non-invasive technique of measuring local microcirculation in soft tissue exists. This study gives new insights in the field of non-invasive diagnostics with special regard to the influence of elastic bandages on local microcirculation. [ABSTRACT FROM AUTHOR]

Influenza A(H1N1)pdm09 viruses cause sporadically very severe disease including fatal clinical outcomes associated with pneumonia, viremia and myocarditis. A mutation characterized by the substitution of aspartic acid (wild-type) to glycine at position 222 within the haemagglutinin gene (HA-D222G) was recorded during the 2009 H1N1 pandemic in Germany and other countries with significant frequency in fatal and severe cases. Additionally, A(H1N1)pdm09 viruses exhibiting the polymorphism HA-222D/G/N were detected both in the respiratory tract and in blood. Specimens from mild, fatal and severe cases were collected to study the heterogeneity of HA-222 in A(H1N1)pdm09 viruses circulating in Germany between 2009 and 2011. In order to enable rapid and large scale analysis we designed a pyrosequencing (PSQ) assay. In 2009/2010, the 222D wild-type of A(H1N1)pdm09 viruses predominated in fatal and severe outcomes. Moreover, co-circulating virus mutants exhibiting a D222G or D222E substitution (8/6%) as well as HA-222 quasispecies were identified (10%). Both the 222D/G and the 222D/G/N/V/Y polymorphisms were confirmed by TA cloning. PSQ analyses of viruses associated with mild outcomes revealed mainly the wild-type 222D and no D222G change in both seasons. However, an increase of variants with 222D/G polymorphism (60%) was characteristic for A(H1N1)pdm09 viruses causing fatal and severe cases in the season 2010/2011. Pure 222G viruses were not observed. Our results support the hypothesis that the D222G change may result from adaptation of viral receptor specificity to the lower respiratory tract. This could explain why transmission of the 222G variant is less frequent among humans. Thus, amino acid changes at HA position 222 may be the result of viral intra-host evolution leading to the generation of variants with an altered viral tropism. [ABSTRACT FROM AUTHOR]

Plasma clearance of indocyanine green has recently been established as a tool to monitor hepatic function and perfusion non-invasively. Reduced indocyanine green clearance has been associated with adverse outcome in cardiac surgery patients, and cardiopulmonary bypass has been hypothesized to be one important triggering factor. We performed a prospective observational study comparing the influence of off-pump and on-pump coronary surgery on perioperative indocyanine green clearance. Twenty-five consecutive adult patients without known pre-existing hepatic diseases scheduled for off-pump coronary artery bypass grafting were evaluated for hepatic dysfunction pre- and postoperatively with serial measurements of indocyanine green plasma clearance, specific laboratory values and liver function scores. Twenty-five matched patients who underwent coronary artery bypass grafting surgery with cardiopulmonary bypass in the same period served as controls. Parameters of postoperative hepatic function, including measurements of indocyanine green plasma clearance and specific laboratory values and scores, did not differ significantly between patients undergoing off-pump coronary artery bypass grafting and patients undergoing coronary artery bypass grafting with extracorporeal circulation. In patients without pre-existing hepatic diseases, a significant influence of cardiopulmonary bypass on perioperative indocyanine green plasma clearance as well as on liver specific laboratory parameters and scores cannot be proven. [ABSTRACT FROM AUTHOR]

Objectives. To assess the prevalence and risk factors of ulnar artery occlusion (UAO) in an unselected SSc patient cohort and to determine whether UAO is associated with digital ulcers (DUs).Methods. A total of 79 SSc patients and 40 ‘healthy’ controls underwent colour duplex sonography of the radial and ulnar artery to compare blood flow velocity, resistive indices (RIs) and presence of occlusion and were followed for a mean of 53 months.Results. In both, radial and ulnar arteries, peak systolic velocity (PSV) and end-diastolic velocity (EDV) were significantly lower and RI higher in SSc patients compared with controls (PSVrad: 40.1 vs 48.6 cm/s; PSVuln 38.2 vs 56.6 cm/s; EDVrad 3.8 vs 10.4 cm/s; EDVuln 3.0 vs 13.0 cm/s; RIrad 0.91 vs 0.82; RIuln 0.92 vs 0.80; all P < 0.01). Seventeen (21.5%) SSc patients had UAO (11 patients bilateral) compared with none in the control subjects. Patients with UAO had a significantly longer disease duration (170 vs 66 months, P < 0.001). At baseline, the prevalence of DU was not different in upper extremities with UAO [8/28 (28.6%)] compared with upper extremities without UAO [36/129 (27.9%)]. However, during follow-up new or recurrent DU occurred more often in upper extremities with UAO than in those without UAO [14/28 (50%) vs 24/113 (21.2%); relative risk (RR) = 2.4; 95% CI 1.4, 3.7; P = 0.002].Conclusion. Blood flow is significantly decreased in radial and ulnar arteries in SSc. UAO is frequent and an important risk factor for the development of DUs in patients with SSc. [ABSTRACT FROM PUBLISHER]

There is still a lack of quantitative information concerning optimal blood flow in the aorta and in the carotid arteries during extracorporeal circulation (ECC). Problems are not only based on the location of the aortic cannula, they are furthermore associated with the cannula design itself and the effects on blood cells and aortic wall shear stresses. We simulated a two-phase fluid flow induced by different cannulas in the ascending aorta during ECC. Three commercially available cannulas were examined according to their influence on red blood cells (RBC). Additionally, mass flow in the carotid vessels and wall shear stresses acting on the aortic wall were evaluated. A constant volume flow of blood (3.4 L/min) was applied. Numerical results demonstrate a strong relation between the mass flow rate in the carotid vessels and the geometry of the aortic outflow cannula. RBC distributions both in the aorta and the carotid vessels changed depending on cannula geometry. Maximum blood velocities, shear stresses on the aortic wall, and the fluid mechanical load acting on RBCs varied depending on each cannula design. This numerical approach demonstrates the significant influence of the cannula design on the distribution of RBCs in the carotid vessels during ECC. [ABSTRACT FROM AUTHOR]

Apart from misdiagnosis, the Lazarus phenomenon, a spontaneous return of circulation after cardiac arrest, is a potential cause for false positive death certification. Because of medicolegal consequences and thus a negative publication bias, the incidence of false positive death certification is unknown. As a false positive death certification results in criminal prosecution and thus media interest, numerous media archives in Germany, Austria and Switzerland were searched for such reports. A total of nine cases of false positive death certification in these three countries were identified since the early 1990s of which eight occurred in an emergency medical service system setting. Apart from a lack of diligence of emergency physicians, a Lazarus phenomenon could be the reason for such incidents. As definite signs of death will not have developed only a few minutes after stopping CPR it might be difficult for an emergency physician to definitely certify a patient’s death in an out-of-hospital setting with 100% safety. Thus, prehospital death certification poses a risk of error and subsequent legal prosecution of the emergency physician, as a Lazarus phenomenon may still occur in this phase. Delegation of death certification from emergency physicians to qualified physicians in a follow-up examination might increase both legal safety for emergency physicians in the field and patient safety. [ABSTRACT FROM AUTHOR]

Abstract: Background: Survival rate after out-of-hospital cardiac arrest (OHCA) has not significantly increased over the last decade. However, survival rate has been used as a quality benchmark for many emergency medical services. A uniform resuscitation registry may be advantageous for quality management of cardiopulmonary resuscitation (CPR). This study was conducted to evaluate the establishment of a national CPR registry in Germany. Materials and methods: A prospective cohort study was performed that included 469 patients who experienced OHCA requiring CPR in the metropolitan area of Dortmund, Germany. Cardiac arrest was defined as concomitant appearance of unconsciousness, apnoea or gasping and pulselessness. All data were collected via a secure and confidential paper-based method as the data set ‘Preclinical care’. Results: Quality of data was classified as ‘good’ in 33.4%, ‘moderate’ in 48.4%, and ‘bad’ in 18.2% of the patients, respectively. Sixty-two percent had OHCA in private residences, 24% of the patients had a first monitored rhythm of ventricular fibrillation (VF) or ventricular tachycardia (VT), 35.2% had return of spontaneous circulation (ROSC) on scene, and patients presenting VF/VT as the first monitored rhythm had higher ROSC rates (51.3%) compared to patients with asystole (22.6%). Conclusion: The data set ‘Preclinical care’ proved to be congruent with the Utstein style, provided further information for national and international comparisons, and enabled a detailed analysis. Optimisation of data collection and introduction of strict control mechanisms may further improve data quality. [Copyright &y& Elsevier]

The article looks at scientific enquiries into cases of German postpartum psychoses among women in childbed. The oldest of these enquiries were published books by Felix Plater, J. Schenck, among others. One reference is the work of Carl Fuerstner who viewed the etiology of postpartum psychoses as a disturbance of blood circulation. Another work is that of Heinrich Neumann who considered the transition of prepartum to postpartum psychoses as a metamorphosis of the illness.

The article presents abstracts of the research papers presented at the 23th Congress on Clinical Hemorheology and Microcirculation of the German Society, held in Dresden, Germany, on 4-6 November 2004. A research paper titled "Contribution of Rho-Kinase to Basal Vascular Tone," by E. Bussemaker, F. Pistrosch, P. Gross and J. Passauer, tested the role of Rho-kinase for the regulation of the peripheral vascular tone in healthy, normotensive volunteers. Another paper titled "The Nature of EDHF in the Renal Vasculature," by E. Bussemaker, P. Gross, and I. Fleming, studied the nature of EDHF (endothelium-derived hyperpolarizing factor) in the human interlobar renal artery.

The article presents abstracts from papers that were presented at the annual meeting of the German Society for Microcirculation and Vascular Biology on October 7-9, 2004 in Berlin, Germany. In session 1 of the meeting papers were presented on the mechanotransduction in the vascular wall. In session 2 of the meeting papers were presented on signaling by reactive oxygen/nitrogen species in the vascular wall. In session 3 of the meeting papers were presented on the platelet function in vascular disease.

[Display omitted] • The inhibition of Curcumae Rhizoma on thrombin was demonstrated for the first time. • Handheld NIR spectrometers can be used to evaluate pharmacodynamics of Curcumae Rhizoma. • The analytical performance of handheld-NIR is compared with that of benchtop NIR. • The key factor limiting the performance of handheld NIR is scanning range. • An accurate global PLSR model was developed for the analysis of two products of Curcumae Rhizoma. It's far from enough to describe the blood circulation promoting effect of Curcumae Rhizoma (CR), which is widely grown as a functional vegetable or spice in south and southeast Asian countries, and processed Curcumae Rhizoma (PCR), only by disclosing the content of a couple of relative compounds. In this study, the thrombin inhibitory effect as well as 2,2′-azino-bis (3-ethylbenz-thiazoline-6-sulfonic acid) (ABTS) and 2,2-diphenyl-picrylhydrazyl (DPPH) free radical scavenging ability of CR/PCR extracts was investigated, and TANGO Fourier transform near-infrared (FT-NIR, Bruker, Germany)—a benchtop instrument allowing the full range NIR wavelength scanning—and handheld-NIR spectrometer (Micro-NIR, NIR-S-G1, InnoSpectra corporation, China) that can be connected to smart phones were used to realize the rapid detection of pharmacodynamic indicators. model was evaluated based on the determination coefficient (R2), root mean square error (RMSE), standard error of test set (SEP) and ratio of performance to deviation (RPD). The results of pharmacodynamics experiment confirmed for the first time that CR has significant inhibitory effect on thrombin, and the modeling results revealed that Micro-NIR had a good prediction on the antioxidant capacity (ABTS and DPPH free radical clearance) with RPD greater than 3, but showed a general predictive performance on thrombin inhibition ability (RPD = 2.434). In contrast, FT-NIR provided a good prediction for all the three indicators, with R2 greater than 0.9 and RPD greater than 4.5. Further insights into the capability of the two devices were obtained by analyzing the wavebands selection work. In the full wavelength range, wavebands related to thrombin inhibition were mainly distributed in the combination area which is out of the reach of handheld Micro-NIR, thus resulting in a decrease in the prediction ability. Therefore, compared to the benchtop-NIR, the detection range of the handheld-NIR is the main factor limiting its capability Based on an overall assessment, handheld NIR spectrometer, by greatly expanding the application scenario of NIR technology, is considered as a useful device with a satisfying predictive ability through model construction. [ABSTRACT FROM AUTHOR]

High-risk percutaneous procedures are necessary in patients with contraindications to surgery in whom the inherent risk of the underlying disease is very high. Circulatory support may be provided with an intra-aortic balloon pump. If active cardiac support is required different devices have been successfully used. We report the case of a 75-year-old patient admitted in cardiogenic shock with a severe coronary three-vessel disease with distal left main stenosis. The ejection fraction was 23%. The high-risk PCI of the distal left main coronary artery and left circumflex artery PCI as the main supplying vessel was supported by Lifebridge (Lifebridge Medizintechnik GmbH, Ampfing, Germany), a new portable mechanical circulatory support system. During the procedure we evaluated the macro- and microcirculation. The complex procedure succeeded with a flow of 2–2.5l providing both adequate macro- and microcirculation. [Copyright &y& Elsevier]

Background: To assess age-related changes of blood flow and geometry of the caval veins and right atrium (RA) using 4D flow cardiovascular magnetic resonance (CMR) data obtained in a population-based study. Methods: An age-stratified sample (n = 126) of the population of the city of Freiburg, Germany, underwent transthoracic echocardiography and electrocardiogram-triggered and navigator-gated 4D flow CMR at 3 Tesla covering the caval veins and right heart. Study participants were divided into three age groups (1:20–39; 2:40–59; and 3:60–80 years of age). Analysis planes were placed in the superior and inferior caval vein. Subsequently, RA morphology and three-dimensional blood inflow pattern was assessed. Results: Blood flow of the RA showed a clockwise rotating helix without signs of turbulence in younger subjects. By contrast, such rotation was absent in 12 subjects of group 3 and turbulences were significantly more frequent (p < 0.001). We observed an age-related shift of the caval vein axis. While the outlets of the superior and inferior caval veins were facing each other in group 1, lateralization occurred in older subjects (p < 0.001). A convergence of axes was observed from lateral view with facing axes in older subjects (p = 0.004). Finally, mean and peak systolic blood flow in the caval veins decreased with age (group 3 < 2 < 1). Conclusions: We have provided reference values of 4D CMR blood flow for different age groups and demonstrated the significant impact of age on hemodynamics of the RA inflow tract. This effect of aging should be taken into account when assessing pathologic conditions of the heart in the future. [ABSTRACT FROM AUTHOR]

Objective: Chemerin has been found to be highly expressed in the kidneys of rodents and has been suggested to affect metabolic syndrome (MetS)-related phenotypes which are in turn related to kidney damage. Only few clinical studies have addressed the relation between circulating chemerin and renal function in humans, and no population-based analyses have yet been performed. The potential influence of MetS-related phenotypes on the assumed association has been largely neglected. We aimed to investigate the association of serum chemerin with renal function in a general population with special regard to possible interactions between chemerin and metabolic phenotypes., Design, Patients and Measurements: Linear and logistic regression models were applied to analyse data from 4082 subjects of the German Study of Health in Pomerania. Main outcomes included estimated glomerular filtration rate (eGFR), serum creatinine and cystatin C and chronic kidney disease., Results: Inverse associations of chemerin with eGFR were observed. The components of the MetS emerged as modulating factors in this relation and enhanced the association. Logistic regression models confirmed the relation between chemerin and eGFR and revealed that each increase in chemerin per 25 ng/mL was associated with an about threefold higher odds of chronic kidney disease [odds ratio 2.72 (95% confidence interval 2.26-3.29)]., Conclusions: Our results demonstrate a strong inverse association between serum chemerin levels and renal function. This association might be explained by MetS-related phenotypes, which lead to renal damage and are associated with increased chemerin levels and/or an impaired renal elimination of chemerin by diseased kidneys., (© 2017 John Wiley & Sons Ltd.)

This article presents information on a poster stamp which was issued to promote the German Health Exhibition in 1914. Poster stamps were an extremely popular advertising medium until approximately the middle of the 20th century. The stamp illustrated in the article depicts a stylised heart and systemic and pulmonary circulations. Due to their vivid designs and colours poster stamps were once very popular collectible items and nowadays, to a large extent, replaced by true stamps in the form of commemorative issues.

Background: In 2005 revised guidelines for cardiopulmonary resuscitation (CPR) were published by the European Resuscitation Council replacing the guidelines implemented in the year 2000. The aim of this study was to test the compliance with valid guidelines and to establish the quality of pre-hospital CPR provided by paramedics over a period of 38 months., Patients and Methods: A total of 299 CPRs performed by paramedics of the emergency medical services of Hamburg, Germany between 1(st) November 2004 and 31(st) December 2007 were analyzed. Digital recordings of automated external defibrillators and emergency protocol data were analyzed in detail. CPR was judged as incorrect if the defibrillation energy level did not correspond to the valid guidelines or if the interval between defibrillations exceeded a tolerance range of more than 30% compared to the valid guidelines., Results: All CPRs (299) were included in the analysis of which 197 (65.9%) were intended to follow the 2000 guidelines and 102 (34.1%) the 2005 guidelines. Return of spontaneous circulation (ROSC) was achieved in 164 cases (54.8%) and survival to hospital admission in 125 cases (41.8%). CPR was performed accurately according to guidelines in only 26 cases (8.7%). In 273 cases (91.3%) the guidelines were not followed completely. Concerning the translation of guidelines into practice most faults occurred due to wrong intervals (89.3%), wrong defibrillation energy (33.4%) and medical errors, such as defibrillating an asystolic patient (7.0%). Primary survival rates were not significantly different when CPR accurately followed the 2000 or 2005 guidelines (40.1% versus 45.1%). Comparing primary survival rates of cases in which the guidelines were followed completely, there was no significant difference between the 2000 guidelines (15 out of 21 cases 71.4%) and 2005 guidelines (4 out of 5 cases 80.0%). However, compliance with valid guidelines significantly increased primary survival rates compared to non-compliance with valid guidelines (19 out of 26 cases 73.1% versus 106 out of 273 cases 38.8%; p=0.007). This effect was independent of the duration of CPR. Comparing CPR with monophasic defibrillation (189 cases) or biphasic defibrillation (58 cases), there was a significantly higher rate of ROSC (56.1% versus 72.4%) and a significantly higher rate of primary survival (41.3% versus 56.9%) in favour of biphasic defibrillation., Conclusion: The results of our study show that compliance with valid guidelines is low and furthermore suggest that compliance with guidelines significantly reduces mortality. Future research may be warranted into the question of how to increase compliance with current CPR guidelines in pre-hospital emergency care.

There were close relationships between Renaissance medicine and antitrinitarianism in 16th and 17th century. Forming an important part of the radical reformation antitrinitarianism won many disciples in the Holy Roman Empire and proved its attraction for physicians. This paper centers on two public scandals in Heidelberg and Altdorf involving the reknown university professors and physicians Thomas Erastus and Ernst Soner. Michael Servetus' new concept of the blood flow through the lungs was discussed in Heidelberg. In Altdorf Caspar Hofmann, Soner's colleague, developed a special theory of the blood flow and corresponded with William Harvey. Erastus and Soner sharply critisized the hermectical and neoplatonical ideas of Paracelsus. Although sympathizing with antitrinitarianism they denounced the Paracelsians as heretics. The Polish antitrinitarians were called Socinians, from Faustus Socinus. Their doctrine tended to be Aristotelic and rationalistic. Soner combined a socinian theology with a heterodox Aristotelianism referring to Andrea Cesalpino. Again after Soner's death some of his pupils and other physicians advocated socinianism in Gdansk (Martin Ruar, Florian Krause, Daniel Zwicker, Valentin Baumgart).

Andrea Argoli (1570-1657), professor of mathematics at the University of Padua from 1632 to 1657, published at Padua in 1644 in the work Pandosion sphaericum an accurate and succinct exposition of the theory of the circulation of the blood. Argoli's exposition actually is a summary of Jan de Wale's (Walaeus, 1604-1649) first Epistola de motu sanguinis, republished at Padua, just a year prior to the Pandosion, as an appendix to the fourth edition of De motu cordis of William Harvey. Argoli cites a hitherto unknown very expert anatomist at Padua, John George Verden, who carried out experiments at Padua designed to measure the volume of arterial blood emitted from each contraction of the left ventricle in small and large dogs. It is now possible to identify Verden with Johann Georg Wirsung (1589-1643), from Augsburg, the discoverer of the main pancreatic duct by ligation of the chyliferous ducts.

In 1636, the Rostock professor of medicine and the art of poetry, Peter Lauremberg (1585-1639), was one of the earliest to mention circulation which had been discovered by William Harvey and documented in his anatomical manual. In 1628 William Harvey proved the existence of the blood circulation by calculating the "cardiac output in a half an hour (semihora)". The answer to the question why Harvey chose half an hour as the time range can be found in the way of measuring time usual at that period. The sandglasses were turned half-hourly in maritime navigation and the wheel-clocks on shore had only the hour-hand. Improved chronometry was one of the prerequisites for measuring cardiac output. The minute-hand became usual after 1700 and the second-hand later on. Taking into consideration the alterations of cardiac output made the latter one of the most important circulation parameters in diagnostics, prognostication and therapeutics.

A review of the earliest publications and letters of the scientists who have received credit for the first description of red cells illustrates the philosophical and practical difficulties of assigning priorities for discoveries. A knowledge of the scientific and cultural ambience of the day, of reports of scientific contemporaries or predecessors, both partisans and adversaries, and other background information illustrates how the consensus in crediting the discovery originated. However, the broader question remains: what are the proper criteria for assigning priority of discovery, yesterday, today and tomorrow?