Sections of fecal cylinders were analyzed using fluorescence in situ hybridization targeting 180 bacterial groups. Samples were collected from three groups of women (N = 20 each) treated for bacterial vaginosis with ciprofloxacin + metronidazole. Group A only received the combined antibiotic regimen, whereas the A/Sb group received concomitant Saccharomyces boulardii CNCM I-745 treatment, and the A.Sb group received S. boulardii prophylaxis following the 14-day antibiotic course. The number of stool cylinders analyzed was 188 out of 228 in group A, 170 out of 228 in group A/Sb, and 172 out of 216 in group Ash.The colonic biomass was organized into a separate mucus layer with no bacteria, a 10-30 mu m broad unstirred transitional layer enriched with bacteria, and a patchy fermentative area that mixed digestive leftovers with bacteria. The antibiotics suppressed bacteria mainly in the fermentative area, whereas abundant bacterial clades retreated to the transitional mucus and survived. As a result, the total concentration of bacteria decreased only by one order. These effects were lasting, since the overall recovery of the microbial mass, bacterial diversity and concentrations were still below pre-antibiotic values 4 months after the end of antibiotic treatment. Sb-prophylaxis markedly reduced antibiotic effects and improved the recovery rates. Since the colon is a sophisticated bioreactor, the study indicated that the spatial anatomy of its biomass was crucial for its function. (C) 2015 The Authors. Published by Elsevier GmbH. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Objectives: The University Hospital Zurich offers an e-mail-based online consultation service for medical laymen since 1999. Questions in all fields of medicine are asked anonymously to a teledoctor. This study focuses on the evaluation of arterial hypertension-related requests, the characterization of users, the answers provided and the quality of advice given. Method: This retrospective study includes 39'091 requests in the period from August 1999 to October 2013. Of these, 197 requests (0.5%) were identified on the basis of hypertension-related health issues, as coded by ICD-10. A qualitative approach, described by Mayring, was supported by a professional text analysis program MAXQDA (VERBI Software, Berlin, Germany). The content analysis of the requests with inductive category development was followed by a quantitative analysis. Results: Requests about medication, treatment or side effects were asked in 17% and about recommendations on how to proceed in 26%. Most enquirers (72%) took one or more drugs, whereof 58% were cardiovascular medication. The teledoctors gave in 49% information about medication or treatment. Information on specific blood pressure values (13%) and lifestyle modification (9%) were asked. The enquirer received in 50% individual information on specific blood pressure values and in 46% recommendations for lifestyle changes with a focus on cardiovascular risk factors. In 79% arterial hypertension was previously diagnosed. In 18% questions were asked about gestational hypertension. The quality of advice in terms of clarity, support and fulfilled expectations were rated from good to very good in more than 82% of all enquiries. Conclusion: Teleconsultation in arterial hypertension requires a broad expertise from teledoctors, in particular on issues of multiple medications, cardiovascular risk factors as well as on specific issues such as pregnancy-induced hypertension. An email-based teleconsultation is a non-verbal form of communication with high demands in often complex medical contexts.

Carbon nanotube (CNT) field effect transistors (FETs) are expected to have several advantages over silicon-based FETs. While most of the literature deals with digital applications, this paper gives an overview on the present status of CNTFET technology for radio-frequency analog applications, including the respective requirements. Results for transistors and circuits achieved so far as well as possible fabrication approaches for performance improvement are discussed.

Background: Tropomyosin (Tm) is a thin-filament associated protein involved in the calcium dependent activation of cross-bridge cycling. It has been demonstrated previously that phosphorylation status of Tm impacts on the cardiac disease state in a humanized mouse model of hypertrophic cardiomyopathy (HCM). A reduction in Tm phosphorylation at Ser283 was shown to rescue the HCM phenotype, by restoring altered Ca2+ sensitivity of the myofilaments and reducing the production of reactive oxygen species (ROS). How phosphorylation of Tm reflects disease progression in hypertrophic, failing and mechanical unloaded hearts remains elusive.

Routine control angiography is a valuable tool with high-sensitivity in detecting restenosis after coronary stenting. However, the prognostic role of restenosis is still controversial. We investigated the impact of restenosis on 4-year mortality in patients undergoing routine control angiography after coronary stenting.All the patients undergoing successful implantation of coronary stents for de novo lesions from 1998 to 2009 and routine control angiography after 6-8 months at two centres in Munich, Germany were studied. Restenosis was defined as diameter stenosis a parts per thousand yen50% in the in-segment area at follow-up angiography. The primary outcome was 4-year mortality. The study included 10 004 patients with 15 004 treated lesions. Restenosis was detected in 2643 (26.4%) patients. Overall, there were 702 deaths during the follow-up. Of these, 218 deaths occurred among patients with restenosis and 484 deaths occurred among patients without restenosis [unadjusted hazard ratio: HR: 1.19; (95% confidence interval CI: 1.02-1.40); P = 0.03]. The Cox proportional hazards model adjusting for other variables identified restenosis as an independent correlate of 4-year mortality [HR: 1.23; (95% CI: 1.03-1.46); P = 0.02]. Other independent correlates of 4-year mortality were age [for each 10-year increase, HR: 2.34; (95% CI: 2.12-2.60); P < 0.001], diabetes mellitus [HR: 1.68; (95% CI: 1.41-1.99); P < 0.001], current smoking habit [HR: 1.39; (95% CI: 1.09-1.76); P = 0.01], and left ventricular ejection fraction [for each 5% decrease, HR: 1.39; (95% CI: 1.31-1.48); P < 0.001].In this large cohort of patients, the presence of restenosis at follow-up angiography after coronary stenting was predictive of 4-year mortality. Whether routine control angiography after coronary stenting is beneficial and influences outcomes should be evaluated by properly designed randomized trials.

SummaryThere is limited clinical data comparing different P2Y12-receptor inhibitors in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock. The aim of the ISAR-SHOCK registry was to compare the clinical outcome of patients treated with clopidogrel vs prasugrel in this setting. Patients (n=145) with AMI complicated by cardiogenic shock and undergoing primary PCI in two centres (Deutsches Herzzentrum München and Klinikum rechts der Isar, Technical University Munich) between January 2009 and May 2012 were included in this registry. The use of prasugrel for patients within this registry reflected co-morbidities and platelet function testing results during the acute AMI phase. Early outcome at 30-days was reported with regard to all-cause mortality, myocardial infarction (MI), stent thrombosis (ST) and bleeding events. With regard to antiplatelet treatment in the 145 cardiogenic shock patients, 50 patients were initially treated or immediately switched to prasugrel while 95 patients were treated with clopidogrel. All-cause mortality was lower in prasugrelvs clopidogrel-treated patients (30 % vs 50.5%, HR: 0.51, 95% CI [0.29–0.92], p=0.025). No significant differences in prasugrel- vs clopidogrel-treated patients were observed for the occurrence of MI (p=0.233), ST (p=0.306) or TIMI major bleedings (p=0.571). Results of the ISAR-SHOCK registry suggest that the use of prasugrel in AMI patients complicated by cardiogenic shock might be associated with a lower mortality risk as compared to clopidogrel therapy without increasing the risk of bleeding. These findings, however, need confirmation from specifically designed randomised studies in this high-risk cohort of patients.

25.6±18.3months) started at hospital admission and was interrupted in the case of cardiac and non cardiac death.Results: Group A patients were older (67.4±12.1 vs 63.1±12.7years,P<0.0001), with higher BNP (2.2±0.6 vs 2.0±0.5 ng/L, P<0.0001) and TnI (48.2±77.3vs 35.9±56.3ng/mL) levels and lower ejection fraction (43.6±10.2vs 45.6±8.9%,P<0.001).Cumulative survival was significantly reduced in group A patients (log-Rank test, P<0.001).At multivariate regression analysis fT3 levels <2.06 ng/L resulted the strongest predictor of all cause death (HR 2.74, P<0.01).Conclusions: fT3 dosage is a simple blood test that is often performed at hospital admission.As a predictor of mortality, it allows the identification of high risk STEMI patients, that might benefit from a strict surveillance and more aggressive medical therapy.

3D integration technologies show increasing importance for high volume applications while realizing the smallest system dimensions at least. Therefore vertical interconnect and wafer bonding technologies were optimized and adapted to reach a high yield using quite narrow contact areas and bond frames. These technologies must enable mechanical stable bonding with high degree of strength, hermeticity, and an electrical connection from all layers of the stack to the next level.

Background: The REVIVAL-2 study showed that stem cell mobilization by G-CSF does not influence infarct size, left ventricular function and coronary restenosis in patients with AMI that underwent successful percutaneous coronary intervention (PCI). The objective of the present analysis was to assess the impact of G-CSF treatment on 5-year clinical outcomes from the REVIVAL-2 trial.

Purpose: In clopidogrel treated patients undergoing percutaneous coronary intervention (PCI), high platelet reactivity (HPR) is associated with a higher risk for thrombotic events including stent thrombosis. Prasugrel may be advantageous over clopidogrel especially in HPR patients but data is limited in support for this hypothesis. Here, we report the results of the ISAR-HPR registry based on routine platelet function testing for guidance of tailored antiplatelet treatment in our centre. Methods: Outcomes were compared between two cohorts. We identified 428 HPR patients (AU x min ≥468 on the Multiplate analyzer) between 2007-2008 without any modification of antiplatelet treatment. This group served as a control cohort. Between 2009-2011, we identified 571 patients with HPR and used this information for guidance of tailored P2Y12 receptor directed antiplatelet therapy (reloading with clopidogrel, switch to prasugrel) (adapted cohort). The primary outcome was the composite of the incidence of death from any cause or of stent thrombosis (definite and probable) after 30 days. Major bleedings according to TIMI classification were also monitored. Results: The incidence of the primary outcome was significantly lower in the adapted cohort vs. the control cohort (see figure, OR 3.1, 95% CI 1.3-7.2; p=0.009; 7 (1.2%) vs. 16 (3.7%) events). The incidence of in hospital major bleeding was numerically but not significantly higher in the adapted vs. the control cohort (1.9 vs. 0.7%, P=0.10). Figure 1 Figure 1 Conclusions: These findings suggest a usefulness of routine platelet function testing for guidance of antiplatelet treatment with intensification of P2Y12 receptor inhibition.

Little is known about the antiplatelet action of the 3 rd generation thienopyridine prasugrel in patients showing high platelet reactivity (PR) levels on clopidogrel. Thus, we aimed to determine the antiplatelet efficacy of prasugrel loading (LD) and maintenance dose (MD) treatment in a registry of patients with high PR levels on clopidogrel and a consecutive switch over to prasugrel in a setting of routine platelet function testing. In our registry of patients treated by percutaneous coronary intervention (n=73) with high levels of PR on clopidogrel, the ADP-induced platelet aggregation (PA, in AU x min) was assessed on a Multiplate analyser 1) after clopidogrel LD, 2) after prasugrel LD and 3) on prasugrel MD (5 vs. 10 mg/day). In patients with high PR levels on clopidogrel, prasugrel LD resulted in significantly lower PA values (574 [462-698] vs. 156 [89-234] AU x min; p<0.0001). Only 2.7% of patients showed high PR (HPR, ≥468 AU x min) following prasugrel LD. On prasugrel MD, PA was significantly higher as compared to prasugrel LD (248 [145-406] vs. 156 [89-234] AU x min; p<0.0001) with more patients showing HPR on MD vs. LD (16.4% vs. 2.7%; p=0.009). For prasugrel MD, HPR rates were higher in 5 vs. 10 mg/day treated patients (46.2% vs. 10.0%; p=0.006). In conclusion, for patients with high PR levels on clopidogrel, prasugrel LD abolished this status in the majority of patients. However, prasugrel response variability was detected, being more pronounced on prasugrel MD vs. LD treatment. The clinical impact of these findings warrants further investigation.