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Twenty-five of 37 Cryptococcus neoformans strains of known serotype produced the basidiomycetous Filobasidiella state either alone or when paired with a strain of compatible mating-type. Sixteen strains were 'α' mating-type, four strains were ' a' mating-type, and five strains were self-fertile. F. neoformans serotypes A and D were interfertile with compatible mating-types of F. bacillispora serotypes B and C. C. neoformans var. gattii was interfertile with compatible mating-types of F. neoformans and F. bacillispora. F. bacillispora strains, which utilized creatinine and l-malic acid, were interfertile with compatible mating-types of F. neoformans, which did not utilize creatinine and l-malic acid. The interfertility between serotypes and biotypes eliminates the need for recognizing the names of C. neoformans var. gattii, C. bacillisporus, and F. bacillispora. It is proposed that C. neoformans var. gattii and C. bacillisporus be regarded as later, facultative synonyms of C. neoformans and that F. bacillispora be regarded as a later, facultative synonym of F. neoformans. [ABSTRACT FROM AUTHOR]

The article focuses on group intelligence test scores of gifted children, degree of consistency and factors related to consistency. Surveys of current practice have indicated that the use of scores from group tests of mental ability constitute one of the most common bases for identification of gifted children and more particularly for the inclusion of such children in special instructional programs designed to challenge their academic superiority. Although there have been many studies dealing with the subject of giftedness, apparently there have been few studies concerned with the correlates of giftedness. It was the purpose of this study to determine the consistency of the group intelligence test scores of a selected sample of gifted children and examine the consistency of the group tests as means of identifying children with intelligence quotients of 120 or higher. The article also examines some of the variables that might conceivably bear a relationship to giftedness, with particular attention to the relationship between these variables and consistency of the intelligence quotients secured by the children on recurring tests.

Consider an input–output system where the output is the tracking error given some desired reference signal. It is natural to consider under what conditions the problem has an exact solution, that is, the tracking error is exactly the zero function. If the system has a well defined relative degree and the zero function is in the range of the input–output map, then it is well known that the system is locally left invertible, and thus, the problem has a unique exact solution. A system will fail to have relative degree when more than one exact solution exists. The general goal of this paper is to describe a decomposition of an input–output system having a Chen-Fliess series representation into a parallel product of subsystems in order to identify possible solutions to the problem of zeroing the output. For computational purposes, the focus is on systems whose generating series are polynomials. It is shown that the shuffle algebra on the set of generating polynomials is a unique factorization domain so that any polynomial can be uniquely factored modulo a permutation into its irreducible elements for the purpose of identifying the subsystems in a parallel product decomposition. This is achieved using the fact that this shuffle algebra is isomorphic to the symmetric algebra over the vector space spanned by Lyndon words. A specific algorithm for factoring generating polynomials into its irreducible factors is presented based on the Chen-Fox-Lyndon factorization of words. [ABSTRACT FROM AUTHOR]

Background: Esophagectomy carries a high risk of morbidity and mortality compared to other major surgeries. With the aim of creating an easy-to-use clinical preoperative risk assessment tool and to validate previously described risk factors for major complications following surgery, esophagectomies at two tertiary medical centers were analyzed. Methods: A total of 450 patients who underwent esophagectomy for esophageal carcinoma at the University Medical Centre, Hamburg, or at the Medical Center University Duisburg-Essen, Germany (January 2008 to January 2020) were retrospectively analyzed. Epidemiological and perioperative data were analyzed to identify the risk factors that impact major complication rates. The primary endpoint of this study was to determine the incidence of major complications. Results: The mean age of the patients was 63 years with a bimodal distribution. There was a male predominance across the cohort (81% vs. 19%, respectively). Alcohol abuse (p = 0.0341), chronic obstructive pulmonary disease (p = 0.0264), and cardiac comorbidity (p = 0.0367) were associated with a significantly higher risk of major complications in the multivariate analysis. Neoadjuvant chemotherapy significantly reduced the risk of major postoperative complications (p < 0.0001). Conclusions: Various patient-related risk factors increased the rate of major complications following esophagectomy. Patient-tailored prehabilitation programs before esophagectomy that focus on minimizing these risk factors may lead to better surgical outcomes and should be analyzed in further studies. [ABSTRACT FROM AUTHOR]

Background: Intraoperative blood loss has an unfavorable impact on the outcome of patients undergoing liver surgery. Today, the use of devices capable of minimizing this risk with high technical performance becomes mandatory. Into this scenario fits the CUSA® Clarity Ultrasonic Surgical Aspirator System. This prospective survey involving five liver surgery centers had the objective of investigating whether this innovative ultrasonic surgical aspirator is safe and effective in the transection of the liver parenchyma. Materials and Methods: This clinical study was a prospective, multicenter, single-arm Post-Market Clinical Follow-up study investigating 100 subjects who underwent liver surgery using the CUSA Clarity Ultrasonic Surgical Aspirator System at five centers during a period of 1 year and 8 months. After collecting all the patient's clinical information and instrument usage details, surgeons completed a brief survey giving their opinions on the performance of CUSA. Therefore, safety and efficacy outcomes were evaluated. Results: Surgeons had a 95% success rate in complete removal of the mass with an average overall operative time of 4 hours and 34 minutes. Overall, there were no complications or device deficiencies. Conclusion: The CUSA Clarity Ultrasonic Surgical Aspirator System performs well during liver surgery with a low complication rate. ClinicalTrials.gov Identifier: NCT04298268. [ABSTRACT FROM AUTHOR]

One of the fundamental problems in shape analysis is to align curves or surfaces before computing geodesic distances between their shapes. Finding the optimal reparametrization realizing this alignment is a computationally demanding task, typically done by solving an optimization problem on the diffeomorphism group. In this paper, we propose an algorithm for constructing approximations of orientation-preserving diffeomorphisms by composition of elementary diffeomorphisms. The algorithm is implemented using PyTorch, and is applicable for both unparametrized curves and surfaces. Moreover, we show universal approximation properties for the constructed architectures, and obtain bounds for the Lipschitz constants of the resulting diffeomorphisms. [ABSTRACT FROM AUTHOR]

Shape analysis methods have in the past few years become very popular, both for theoretical exploration as well as from an application point of view. Originally developed for planar curves, these methods have been expanded to higher dimensional curves, surfaces, activities, character motions and many other objects. In this paper, we develop a framework for shape analysis of curves in Lie groups for problems of computer animations. In particular, we will use these methods to find cyclic approximations of non-cyclic character animations and interpolate between existing animations to generate new ones. [ABSTRACT FROM AUTHOR]

Background Pyogenic liver abscesses are currently treated by either percutaneous computer tomography (CT)-guided drainage or by laparoscopic and a conventional liver resection when conservative treatment fails but may be associated with substantial morbidity and mortality. Methods A minimally invasive technique involving debridement of right liver abscesses was employed using a minimally invasive video-assisted hepatic abscess debridement ( VAHD) after unsuccessful percutaneous CT-guided drainage. Clinical data, complication rates and outcomes of patients were recorded retrospectively. Results Between 2011 and 2014, VAHD was performed on 10 patients at two centres with no observed recurrence of a liver abscess. The median age of the patients was 57 years (range 42-78) with a median pre-operative size of a liver abscess of 78 mm (range 40-115). The median operation time was 47 min (range 23-75), and the median postoperative hospital stay was 9 days (range 7-69). One patient developed a subcutaneous abscess that required further surgery. No patient died, and there were no major complications related to the VAHD. Conclusions Video-assisted hepatic abscess debridement is a feasible technique that shows promising results for the treatment of a recurrent right liver abscess. [ABSTRACT FROM AUTHOR]

We compare the value of TACE to liver resection for patients with BCLC stage A and B HCC. For patients with HCC in cirrhosis LT is the treatment of choice. TACE represents the current standard for unresectable BCLC stage B patients not eligible for LT. Recently liver resection for HCC and significant cirrhosis has become increasingly popular. A systematic search of the literature and meta-analysis was conducted to identify studies, reporting short- and long-term results of hepatic resection versus TACE for HCC treatment. The data were analyzed regarding the odds for 30-day mortality and hazard ratio for overall-survival. 12 studies comparing short- and long-term outcome of HR versus TACE for HCC were identified. Peri-interventional mortality and overall survival were investigated. Peri-interventional mortality was higher for surgical resection (n.s.), and overall-survival was significantly better for surgically treated patients at one year (P=0.002) and 3 years (P≤0.00001). The hazard ratio of overall-survival for all twelve studies was 0.70 (P=0.0001) and significantly in favor of surgical treatment. Although large RCTs are missing and the available data are limited and not homogeneous a reappraisal of the current treatment guidelines should be considered based on the superior long-term outcome for surgically treated patients. [ABSTRACT FROM AUTHOR]

Background While much discussion has been placed on the problem of poor compliance in the treatment of schizophrenia, there has been little discussion on the concordance between patients and psychiatrists, an important contributing factor to patient-centred care. Objective To estimate the concordance between patients' and psychiatrists' (ordinal and cardinal) valuations of multiple goals for schizophrenia treatment and to illustrate the utility of the self-explicated method in valuing a large number of treatment goals. Design Twenty treatment goals were identified during focus groups and literature review and were presented to patients and psychiatrists during structured interviews. Respondents were asked to rank the multiple treatment goals and rate them on a 5-point Likert scale. Three scores were calculated based on the ranking (1-20), rating (Likert scale) (1-5) and a self-explicated method estimated as the product of rating and ranking score (1-100). Concordance was tested using Spearman's rho for overall ordinal rankings and via anova and F-test for the cardinal values assigned to a specific treatment goal. Participants A total of 105 outpatients diagnosed with schizophrenia and 160 psychiatrists in Germany. Results Patient and psychiatrist values were concordant when the ordinal properties of their valuations were assessed by rating (ρ = 0.63; P = 0.002), ranking (ρ = 0.51; P = 0.02) and self-explicated methods (ρ = 0.54; P = 0.01). Significant discordances were found when comparing the cardinal value placed on any given treatment goal using all three approaches, but the self-explicated method produced a more discerning statistic. Relative to patients, psychiatrists significantly ( P < 0.05) overvalued reduced lack of emotion, improved sexual pleasure and improved communication while undervaluing reuptake of activities of daily living, improved satisfaction and recovered capacity for work. Conclusions While there is an overall concordance between patients' and psychiatrists' valuation, significantly different valuations on specific goals can be identified. Here, psychiatrists tend to focus on 'textbook' outcomes, while patients are more concerned with functioning and living a normal life. This study also demonstrates the importance of comparing the concordance in treatment goals and the importance of preference-based methods, such as the self-explicated method, in the study of concordance. [ABSTRACT FROM AUTHOR]

The worldwide shortage of adequate donor organs implies that living donor liver transplantation represents a valuable alternative to cadaveric transplantation. In addition to the complex surgical procedure the correct identification of eligible donors and recipients plays a decisive role in living donor liver transplantation. Donor safety must be of ultimate priority and overrules all other aspects involved. In contrast to the slightly receding numbers in Europe and North America, in recent years Asian programs have enjoyed constantly increasing living donor activity. The experience of the past 15 years has clearly demonstrated that technical challenges of both bile duct anastomosis and venous outflow of the graft significantly influence postoperative outcome. While short-term in-hospital morbidity remains increased compared to cadaveric transplantation, long-term survival of both graft and patient are comparable or even better than in deceased donor transplantation. Especially for patients expecting long waiting times under the MELD allocation system, living donor liver transplantation offers an excellent therapeutic alternative. Expanding the so-called „Milan criteria“ for HCC patients with the option for living donor liver transplantation is currently being controversially debated. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic procedures in oncological surgery are either done in curative or palliative intent. We present two experiments comparing laparoscopic to conventional surgery in the curative and palliative setting regarding short-term (stress and immune alteration) and long-term aspects (survival time and recurrence rate). Methods: We established two syngenic tumor-bearing small animal models for curative liver resection (Morris hepatoma 3924A, ACI rats) and palliative colon resection (BSp73 ASML, BOX rats). Male rats were operated on, performing laparoscopic and conventional liver resection as well as laparoscopic and conventional colon resection; control groups (anesthesia) were included. The following parameters of the stress and immune system were measured: corticosterone, neopterine, Il-1-b, Il-6, and body weight as a parameter of postoperative recovery. Analyzed long-term parameters were survival time, tumor weight, and recurrence rate (histology). Results: After colon resection, analysis of variance showed significant differences in all short-term parameters, including body weight after laparoscopic versus conventional colon resection (p <0.05). In the case of laparoscopic versus conventional liver resection, only Il-6 showed globally statistically significant differences for the short-term parameters (p = 0.05). Long-term parameters were not significantly different between the laparoscopic and conventional groups, regardless of the type of resection (colon or liver) or the operative setting (curative or palliative). However, there were differences after curative liver resection compared to the control group (anesthesia alone). Conclusion: These results suggest that the type of intraabdominal operation (colon or liver) may influence the degree of trauma of an operation more than the type of technique (laparoscopic or open). The perioperative alteration of stress and immune function has no implications on the long-term results, such as survival time or recurrence, neither in the curative nor in the palliative setting. The thesis that laparoscopic surgery results in less pain, which in turn means less stress and less alteration of the immune system and therefore results in a lower rate of postoperative metastasis is only valid for laparoscopic colonic resection in our model. The part of the thesis that states that fewer metastases should occur after laparoscopic oncological surgery cannot be confirmed in our study. [ABSTRACT FROM AUTHOR]

Background & Aims Cholangiocarcinoma (CCA) represents a primary hepatic malignancy with incidence and mortality rising globally. Surgical treatment has remained the only potentially curative treatment option, but it is still unclear which patients benefit most from extended liver surgery, highlighting the need for new pre-operative stratification strategies. Osteopontin is a secreted extracellular glyco-phosphoprotein that has been associated with inflammation, metabolic disorders and cancer. Here, we examined the potential of circulating osteopontin serum levels as a diagnostic or prognostic biomarker in patients with CCA undergoing extended liver surgery. Methods Osteopontin expression levels were analysed in human and murine CCA tumour samples, using semi-quantitative reverse transcriptase PCR and immunohistochemistry. Osteopontin serum concentrations were measured by enzyme-linked immunosorbent assay in 107 patients with CCA undergoing elective tumour resection as well as 55 healthy controls. Results were correlated with clinical data. Results Correlating with an upregulation in CCA tumour cells and the tumour stroma, serum levels of osteopontin were elevated in patients with cholangiocarcinoma compared to healthy controls and patients with primary sclerosing cholangitis. Importantly, pre- and postoperative elevations of osteopontin showed a striking association with poor postoperative survival. Conclusions Serum osteopontin concentrations represent a promising prognostic biomarker in patients resectable CCA which could help to guide preoperative treatment decisions and to identify patients that will particularly benefit from extended liver surgery. Lay summary: Extended liver surgery is the only potentially curative treatment for patients with cholangiocarcinoma (CCA/biliary cancer), but it is currently unclear which patients benefit most from surgery. Detecting serum levels of osteopontin – a specific secreted glycoprotein involved in multiple human diseases – in CCA patients might help to identify those patients that particularly benefit from tumour resection. [ABSTRACT FROM AUTHOR]

Background: Postresectional liver failure is the most frequent cause of fatal outcome following liver surgery. Diminished preoperative liver function in the elderly might contribute to this. Therefore, the aim of the present study was to evaluate preoperative liver function in patients <60 or >70 years of age scheduled for liver resection. Methods: All consecutive patients aged <60 or >70 years who are about to undergo elective liver surgery between 2011 and 2013 and underwent the methacetin breath liver function test (LiMAx) preoperatively were included. Histologic assessment of the resected liver gave insight into background liver disease. Correlation between age and liver function was calculated with Pearson's test. Results: Fifty-nine patients were included, 31 were aged <60 and 28 were aged >70 years. General patient characteristics and liver function LiMAx values (340 (137-594) vs. 349 (191-530) μg/kg/h, p = 0.699) were not significantly different between patients aged <60 and >70 years. Moreover, no correlation between age and preoperative liver function LiMAx values was found (R = 0.04, p = 0.810). Conclusion: Liver function did not seem to differ between younger and older patients. [ABSTRACT FROM AUTHOR]

publisher‐imprint‐name Springer volume‐issue‐count 1 issue‐article‐count 46 issue‐toc‐levels 0 issue‐pricelist‐year 2016 issue‐copyright‐holder The Author(s) issue‐copyright‐year 2016 article‐contains‐esm Yes article‐numbering‐style Unnumbered article‐registration‐date‐year 2016 article‐registration‐date‐month 9 article‐registration‐date‐day 10 article‐toc‐levels 0 toc‐levels 0 volume‐type Regular journal‐product ArchiveJournal numbering‐style Unnumbered article‐grants‐type OpenChoice metadata‐grant OpenAccess abstract‐grant OpenAccess bodypdf‐grant OpenAccess bodyhtml‐grant OpenAccess bibliography‐grant OpenAccess esm‐grant OpenAccess online‐first false pdf‐file‐reference BodyRef/PDF/40169_2016_Article_120.pdf pdf‐type Typeset target‐type OnlinePDF issue‐type Regular article‐type OriginalPaper journal‐subject‐primary Medicine & Public Health journal‐subject‐secondary Medicine/Public Health, general journal‐subject‐collection Medicine open‐access true --> Background: Elevated expression levels of S100A6, a calcium‐binding low‐molecular‐weight protein, were demonstrated in various malignancies. Moreover, increased serum levels of S100A6 were suggested as a novel biomarker for various inflammatory and malignant diseases including lung and gastric cancer. However, up to now, serum concentrations of S100A6 have not been analyzed in patients with cholangiocarcinoma (CCA). Methods: S100A6 mRNA expression levels were analyzed in human and murine CCA tumor samples, using semi‐quantitative reverse transcriptase PCR. S100A6 serum concentrations were measured using an enzyme‐linked immunosorbent assay in 112 patients with CCA referred to surgery for curative resection and were compared to those of 42 healthy controls. Results were correlated with clinical data. Results: S100A6 mRNA expression levels were significantly up‐regulated in tumor samples of CCA patients and in tumor tissue of a CCA mouse model. In contrast, serum levels of S100A6 were not significantly altered in patients with CCA compared to healthy controls. Whereas no differences became apparent within the different clinical subgroups of CCA, patients with primary sclerosing cholangitis (PSC)‐based CCA displayed higher levels of S100A6 compared to the other patients. Nevertheless, patients with higher S100A6 serum concentrations showed a trend towards an impaired prognosis compared to patients with lower levels. Finally, within our cohort of patients both the diagnostic and prognostic potentials of S100A6 were similar to those of the clinically established biomarkers CEA and CA19‐9. Conclusion: Although S100A6 was expressed at significantly higher levels in human and murine CCA tumor samples, S100A6 serum levels were not regulated in patients with CCA and are thus not suitable for diagnosis of CCA. However, CCA‐patients with elevated S100A6 displayed a trend toward an impaired prognosis compared to patients with lower S100A6 levels, supporting its further evaluation as a prognostic biomarker in CCA. [ABSTRACT FROM AUTHOR]

Background The nuclear factor-erythroid 2-related factor 2 (Nrf2) -antioxidant response element (ARE) pathway is important for the regulation of antioxidative stress response and detoxification. To activate the expression of its target genes, such as heme oxygenase-1 (HO-1) and NAD(P)H dehydrogenase (quinone) 1 (NQO1), Nrf2 binds to the ARE within the promoter region of these genes. Partial hepatectomy and consecutive liver regeneration lead to oxidative stress with activation of the Nrf2-ARE pathway. The aim of this study was to investigate ARE activity in vivo during liver regeneration after partial hepatectomy. Materials and methods Transgenic ARE-luc mice were used. In these mice, the luciferase reporter gene is under the control of an ARE promoter element. Following 2/3 partial hepatectomy (PHx), mice underwent in vivo bioluminescence imaging up until the ninth postoperative day. In addition, liver tissue was analyzed by immunohistochemistry (Nrf2 and HO-1), quantitative reverse transcription-PCR (HO-1 and NQO1) and in vitro luminescence assays. Results Bioluminescence imaging revealed a significant increase in Nrf2-ARE activity after PHx. The signal maximum was recorded on the third day after PHx. Seven days postoperatively, the signal almost reached baseline levels. In immunohistochemistry, significantly more hepatocytes were positive for Nrf2 and HO-1 on the third postoperative day compared with baseline levels. The mRNA expression of HO-1 and NQO1 were significantly increased on day 3 as measured by qRT-PCR. Conclusions This study demonstrated the time-dependent activation of the Nrf2-ARE system during liver regeneration in vivo . The transgenic ARE-luc mouse provided a convenient model for studying Nrf2-mediated gene expression noninvasively and may facilitate further experiments with therapeutic modulation of the antioxidative stress response. [ABSTRACT FROM AUTHOR]

Introduction. The venovenous/portal venous (VVP) bypass technique has generally become obsolete in liver transplantation (LT) today. We evaluated our experience with 163 consecutive LTs that used a VVP bypass. Patients and Methods. The liver transplant program was started in our center in 2010. LTs were performed using an extracorporal bypass device. Results. Mean operative time was 269 minutes and warm ischemic time 43 minutes. The median number of transfusion of packed cells and plasma was 7 and 14. There was no intraoperative death, and the 30-day mortality was 3%. Severe bypass-induced complications did not occur. Discussion. The introduction of a new LT program requires maximum safety measures for all of the parties involved. Both surgical and anaesthesiological management (reperfusion) can be controlled very reliably using a VVP bypass device. Particularly when using marginal grafts, this approach helps to minimise both surgical and anaesthesiological complications in terms of less volume overload, less use of vasopressive drugs, less myocardial injury, and better peripheral blood circulation. Conclusion. Based on our experiences while establishing a new liver transplantation program, we advocate the reappraisal of the extracorporeal VVP bypass. [ABSTRACT FROM AUTHOR]

Study Objective: To identify risk factors for coagulopathy in patients undergoing liver resection. Design: A retrospective cohort study. Setting: Patients who underwent liver resection at a university hospital between April 2010 and May 2011 were evaluated within seven days after surgery. Patients: One hundred forty-seven patients were assessed for eligibility. Thirty needed to be excluded because of incomplete data (23) or a preexisting coagulopathy (7). Measurements: Coagulopathy was defined as 1 or more of the following events: international normalized ratio =1.4, platelet count b80,000/µL, and partial thromboplastin time N38 seconds. Related to the time course and coagulation profile thresholds, 3 different groups could be distinguished: no coagulopathy, temporary coagulopathy, and persistent coagulopathy. Main Results: Seventy-seven patients (65.8%) had no coagulopathy, whereas 33 (28.2%) developed temporary coagulopathy and 7 (6%) developed persistent coagulopathy until day 7. Preoperative international normalized ratio (P = .001), postoperative peak lactate levels (P = .012), and resected liver weight (P = .005) were identified as independent predictors. Preoperative liver transaminases and transfusion volumes of red blood cells and fresh frozen plasma were significantly higher in patients with persistent coagulopathy. Conclusions: Epidural anesthesia is feasible in patients scheduled for liver resection. Caution should be observed for patients with extended resection (> 3 segments) and increased postoperative lactate. In patients with preexisting liver disease, epidural catheters should be avoided. [ABSTRACT FROM AUTHOR]

Background: The recurrence of hepatitis C virus (HCV) after liver transplantation (OLT) leads to recurrent cirrhosis in up to 40% of patients.Aims: To identify patients who profit the most from antiviral therapy and to delineate whether early treatment after OLT is effective to reach sustained virological response (SVR), we analyzed factors associated to SVR during pegylated interferon/ribavirin (PegIFN/RBV) therapy.Methods: A retrospective analysis of efficiency and viral decline kinetics in 83 HCV-infected liver transplant recipients who received therapy with PegIFN/RBV was carried out.Results: Forty-one of 83 (49.4%) patients became HCV RNA-negative. SVR was achieved in 26/83 (31.3%) patients. Viral decline of at least 2 log 10 (n = 47) at week 12 was significantly associated with an end-of-treatment (EOT) response. Eleven early viral response patients were not able to clear HCV RNA, whereas five patients without a 2 log decline achieved SVR. The highest predictive value for SVR was an undetectable viremia at week 24 (92%).Conclusions: The outcome of antiviral combination therapy for HCV reinfection after OLT can be best predicted by week-24 virologic response. The high SVR rates in patients with detectable HCV RNA at week 12 might suggest a prolonged treatment protocol in liver transplant recipients. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate annual direct medical costs of adult SLE patients with active autoantibody positive disease on medication in Germany., Methods: A multicentre, observational, retrospective European study with German sub-analysis was performed. Costs were assessed according to national tariffs., Results: 10 German centres included 77 patients. The mean (SD) annual direct medical costs of patients were € 3 452.21 (3 777.07), and were 3.4 times higher in severe than non-severe patients (€ 5 291.07 vs. 1 564.97; p<0.001). Cost of medication (€ 2 349.40) represented 68.1% of the total cost. Flares, especially severe flares, were identified as cost predictors. Each flare increased the annual total cost by € 2 164,01 (p<0,001)., Conclusion: The annual direct medical cost of SLE patients in Germany is linked to disease severity. Medical treatments and severe flares were identified as the cost predictors and drivers, respectively., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Schizophrenia is a severe mental illness associated with hallucinations, delusions, apathy, poor social functioning, and impaired cognition. Researchers and funders have been hesitant to focus efforts on treatment preferences of patients with schizophrenia because of the perceived cognitive burden that research methods, such as conjoint analysis, place on them., Objective: The objective of this study was to test if patients diagnosed with schizophrenia were able to complete a choice-based conjoint analysis (often referred to as discrete-choice experiments) and to test if meaningful trade-offs were being made., Methods: German outpatients diagnosed with schizophrenia were eligible to participate in this study if they were aged 18-65 years, had received treatment for at least 1 year and were not experiencing acute symptoms. Conjoint analysis tasks were based on six attributes, each with two levels, which were identified via a literature review and focus groups. A psychologist in a professional interview facility presented each respondent with the eight tasks with little explanation. All interviews were recorded, transcribed, and analyzed to verify that respondents understood the tasks. Preferences were assessed using logistic regression, with a correction for clustering., Results: We found evidence that the 21 patients diagnosed with schizophrenia participating in the study could complete conjoint analysis tasks in a meaningful way. Patients not only related to the scenarios presented in conjoint tasks, but explicitly stated that they used their own preferences to judge which scenarios were better. Statistical analysis confirmed all hypotheses about the attributes (i.e. all attributes had the expected sign). Having a supportive physician, not feeling slowed, and improvements in stressful situations (p < 0.01) were the most important attributes., Conclusions: We found that patients diagnosed with schizophrenia can complete conjoint analysis tasks, that they base their decisions on their own preferences, and that patients make trade-offs between attributes.

Solely on the basis of Raman spectra and quantum chemical calculations, the previously unknown cluster anion Si 9 (structure shown) was characterized and its structure determined. The anion is formed as a component of solid phases by the thermal decomposition of alkali metal monosilicides.4- (structure shown) was characterized and its structure determined. The anion is formed as a component of solid phases by the thermal decomposition of alkali metal monosilicides., (© 1998 WILEY-VCH Verlag GmbH, Weinheim, Fed. Rep. of Germany.)