Statins did not reduce the frequency of exacerbations in individuals with COPD and cardiovascular comorbidities in the COSYCONET cohort.

BACKGROUND: The evidence regarding effects of statins on exacerbation risk in COPD remains controversial. Previous studies often excluded patients with cardiovascular comorbidities despite their high prevalence in COPD and role for exacerbations. Based on the cardioprotective properties of statins, we hypothesised that statins may reduce the risk of exacerbations especially in patients with cardiovascular comorbidities. METHODS: One thousand eight hundred eighty seven patients of the German COPD cohort COSYCONET (COPD and Systemic Consequences Comorbidities Network) of GOLD grades 1-4 (37.8% female, mean age 64.78 ± 8.3) were examined at baseline and over a period of 4.5 years for the occurrence of at least one exacerbation or severe exacerbation per year in cross-sectional and longitudinal analyses adjusted for age, gender, BMI, GOLD grade and pack-years. Due to their collinearity, various cardiovascular diseases were tested in separate analyses, whereby the potential effect of statins in the presence of a specific comorbidity was tested as interaction between statins and comorbidity. We also identified patients who never took statins, always took statins, or initiated statin intake during the follow-up. RESULTS: One thousand three hundred six patients never took statins, 31.6% were statin user, and 12.9% initiated statins during the follow-up. Most cardiovascular diseases were significantly (p < 0.05)may associated with an increased risk of COPD exacerbations, but in none of them the intake of statins was a significant attenuating factor, neither overall nor in modulating the increased risk linked to the specific comorbidities. The results of the cross-sectional and longitudinal analyses were consistent with each other, also those regarding at least 1 exacerbation or at least 1 severe exacerbation per year. CONCLUSION: These findings complement the existing literature and may suggest that even in patients with COPD, cardiovascular comorbidities and a statin therapy that targets these comorbidities, the effects of statins on exacerbation risk are either negligible or more subtle than a reduction in exacerbation frequency. TRIAL REGISTRATION: Trial registration ClinicalTrials.gov, Identifier: NCT01245933. Other Study ID (BMBF grant): 01GI0881, registered 18 November 2010, study start 2010-11, primary completion 2013-12, study completion 2023-09. https://clinicaltrials.gov/study/NCT01245933?cond=COPD&term=COSYCONET&rank=3.

Midregional proatrial naturetic peptide (MRproANP) and copeptin (COPAVP) as predictors of all-cause mortality in recently diagnosed mild to moderate COPD-results from COSYCONET.

BACKGROUND: MRproANP and COPAVP are prognostic markers for mortality in chronic obstructive pulmonary disease (COPD). Furthermore, these biomarkers predict mortality due to cardiovascular diseases, which are important prognostically determining comorbidities in patients with COPD. However, less is known about these biomarkers in recently diagnosed mild to moderate COPD. Therefore, we analyzed these biomarkers as potential predictors of mortality in recently diagnosed mild to moderate COPD. METHODS: The blood biomarkers considered were copeptin (COPAVP), midregional adrenomedullin (MRproADM), midregional proatrial naturetic peptide (MRproANP), and fibrinogen. Analyses were performed in patients with stable "recently diagnosed mild to moderate COPD" defined by GOLD grades 0-2 and diagnosis of COPD ≤ 5 years prior to inclusion into the COSYCONET cohort (COPD and Systemic Consequences-Comorbidities Network), using Cox regression analysis with stepwise adjustment for multiple COPD characteristics, comorbidities, troponin and NT-proBNP. RESULTS: 655 patients with recently diagnosed mild to moderate COPD were included. In the initial regression model, 43 of 655 patients died during the 6-year follow-up, in the final model 27 of 487. Regression analyses with adjustment for confounders identified COPAVP and MRproANP as statistically robust biomarkers (p < 0.05 each) of all-cause mortality, while MRproADM and fibrinogen were not. The fourth quartile of MRproANP (97 pmol/L) was associated with a hazard ratio of 4.5 (95%CI: 1.6; 12.8), and the fourth quartile of COPAVP (9.2 pmol/L) with 3.0 (1.1; 8.0). The results for MRproANP were confirmed in the total cohort of grade 0-4 (n = 1470 finally). CONCLUSION: In patients with recently diagnosed mild to moderate COPD, elevated values of COPVP and in particular MRproANP were robust, independent biomarkers for all-cause mortality risk after adjustment for multiple other factors. This suggests that these markers might be considered in the risk assessment of early COPD.

The patient with dementia, the caregiver and the doctor: cognition, depression and quality of life from three perspectives.

BACKGROUND: For comprehensive information about the situation of patients with dementia or mild cognitive impairment (MCI), clinicians have to rely on information from different sources, e.g. caregivers or the patients themselves, which may differ from each other. In addition to the assessment of cognitive impairment, the importance of evaluating not only depressive symptoms but also health related quality of life (HRQOL) in clinical research and practice in dementia has increased. OBJECTIVE: To examine about how the ratings of patients, caregivers and clinicians regarding the patients' cognitive impairment, depression and HRQOL relate to each other by comparing these three perspectives by using self- and proxy-rating measures. METHOD: One hundred outpatients with mild to moderate dementia or MCI and their family caregivers participated in this study. Depression and cognitive impairment were examined with self- and proxy-ratings as well as the Mini-Mental Status Examination (MMSE); HRQOL was assessed with the SF-12 Health Survey and the EUROHIS quality of life index. RESULTS: We found high correspondence between caregivers' assessment of cognitive function and MMSE scores, while patients' self-rating did not correlate with MMSE. HRQOL was underestimated by caregivers compared to self-rating. Concerning depression, the patients' assessment was in good accordance with the clinician's evaluation. CONCLUSION: The study suggests that patients with mild to moderate dementia and MCI are important informants of their HRQOL and depressive symptoms, but they underestimate their cognitive deficits. Assessing different perspectives of the patients' HRQOL is relevant in order to obtain a comprehensive understanding of the patients' well-being.

MIS instruments. An experimental comparison of various ergonomic handles and their design.

BACKGROUND: Various handles are available for use in minimally invasive surgery. Nonergonomic positioning of the hand and fingers can lead to pressure areas, nerve irritation, and rapid fatigue. This study was designed to compare the ergonomic efficiency of several different handles, along with the concepts underlying them, in an attempt to find the best one for laparoscopic surgery. We also consider whether the position of the surgeon in relation to the patient and the posture of the surgeon have any influence on the use of the handles. METHOD: A ring handle positioned in-line (the Microsurge/Vygon 01-1007), an axial handle (the Aesculap PM-953), a shank handle (the Wilo 25.00), and a functional model of a new ergonomic multifunctional handle (the MFEHG Schafreuter) were tested and evaluated by 15 volunteers during an objective test using a transparent pelvitrainer with the left and right hand in a frontal and left and right lateral positions. Our analysis was based on their subjective answers to a questionnaire developed from ergonomic checklists and the semiquantitative observations of the test leader about their posture during testing. RESULTS: There were no significant differences in the results of the objective tests. Subjectively, the shank handle was preferred by most test persons, followed by the functional model for the right hand and the axial handle for the left hand; the ring handle positioned in-line scored poorly for both right and left hands. Arm movements were greater in the latter than in the frontal position. CONCLUSIONS: A clear recommendation for any one of the three currently available handles cannot be given. The results obtained with a simple model of a multifunctional handle were highly promising, and it may be possible to extend it to a real multifunctional instrument.

Application systems for intracorporeal laser-induced shockwave lithotripsy using the Nd:YAG Q-switched laser.

For laser-induced shockwave lithotripsy, the electromagnetic energy of a laser light pulse is converted intracorporeally into the acoustic energy of a shockwave. The lithotriptor is based on a specially developed, Q-switched Nd:YAG laser whose high power light pulses (70 mJ, 25 nsec) are coupled into a flexible quartz fiber with a core diameter of 600 mum. Using focusing elements, energy densities higher than 6 x 10 5 J m -2 can be achieved, resulting in an optical breakdown in water followed by a shockwave. As a result of different absorption mechanisms, the breakdown threshold can be decreased by placing a metallic target into the laser beam. The different shockwave formations of such optomechanical transducers have been measured. First clinical applications have been performed.