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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  127. Kongress der Deutschen Gesellschaft für Chirurgie; 20100420-20100423; Berlin; DOC10dgch029 /20100517/
    Publication Date: 2010-05-17
    Keywords: ddc: 610
    Type: conferenceObject
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  • 2
    Abstract: OBJECTIVE: To longitudinally evaluate effects of smoking cessation on quantitative CT in a lung cancer screening cohort of heavy smokers over 4 years. METHODS: After 4 years, low-dose chest CT was available for 314 long-term ex-smokers (ES), 404 continuous smokers (CS) and 39 recent quitters (RQ) who quitted smoking within 2 years after baseline CT. CT acquired at baseline and after 3 and 4 years was subjected to well-evaluated densitometry software, computing mean lung density (MLD) and 15th percentile of the lung density histogram (15TH). RESULTS: At baseline, active smokers showed significantly higher MLD and 15TH (-822+/-35 and -936+/-25 HU, respectively) compared to ES (-831+/-31 and -947+/-22 HU, p〈0.01-0.001). After 3 years, CS again had significantly higher MLD and 15TH (-801+/-29 and -896+/-23 HU) than ES (-808+/-27 and -906+/-20 HU, p〈0.01-0.001) but also RQ (-813+/-20 and -909+/-15 HU, p〈0.05-0.001). Quantitative CT parameters did not change significantly after 4 years. Importantly, smoking status independently predicted MLD at baseline and year 3 (p〈0.001) in multivariate analysis. CONCLUSION: On quantitative CT, lung density is higher in active smokers than ex-smokers, and sustainably decreases after smoking cessation, reflecting smoking-induced inflammation. Interpretations of quantitative CT data within clinical trials should consider smoking status. KEY POINTS: * Lung density is higher in active smokers than ex-smokers. * Lung density sustainably decreases after smoking cessation. * Impact of smoking cessation on lung density is independent of potentially confounding factors. * Smoke-induced pulmonary inflammation and particle deposition influence lung density on CT.
    Type of Publication: Journal article published
    PubMed ID: 28884215
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  • 3
    Keywords: cohort study ; RISK-FACTORS ; ASSOCIATION ; EXPERIENCE ; WOMEN ; etiology ; diabetes ; EPIC-GERMANY ; physical activity ; insulin ; MELLITUS ; CARDIOVASCULAR-DISEASE ; PREGNANCY ; parity ; prospective ; GLUCOSE-TOLERANCE ; Abortion ; Miscarriage ; Pregnancy loss ; SPONTANEOUS PRETERM BIRTH
    Abstract: Evidence that childbearing is associated with future development of diabetes remains conflicting and the role of pregnancy loss in this association has not been investigated. We aimed to examine whether pregnancy and/or pregnancy loss (miscarriage, abortion, or stillbirth) are associated with maternal higher risk of diabetes later in life, using a population-based prospective cohort study (mean follow-up = 10.7 years), including 13,612 women (aged 35-65 at baseline). We found pregnancy per se did not change the risk of diabetes after considering the effect of education, smoking, alcohol consumption, physical activity, BMI, waist/hip ratio, hypertension, and hyperlipidemia (fully-adjusted OR: 1.04, 95 % CI: 0.82-1.31). Having more than four live births was associated with around two times higher risk of diabetes later in life (fully-adjusted OR: 1.77, 95 % CI: 1.12-2.80). Having more than two miscarriages was associated with about two-fold higher risk of diabetes (fully-adjusted Odd ratio (OR): 1.85, 95 % CI: 1.17-2.93). After further adjustment for parity, the higher risk of diabetes in those who had history of more than two miscarriages did not change substantially (OR: 1.82; 95 % CI: 1.15-2.88), but the association between more than four live births and diabetes disappeared when the role of pregnancy loss was considered (fully-adjusted HR: 1.06; 95 % CI: 0.54-2.08). No significant association was found between abortion, stillbirth and risk of maternal diabetes. Pregnancy per se did not increase risk of diabetes. Women who experience more than two miscarriages are at around two times higher risk of diabetes later in life. The association between high parity and diabetes is mediated by history of miscarriages and known risk factors of diabetes. The underlying reason for association between miscarriage and diabetes needs further investigation.
    Type of Publication: Journal article published
    PubMed ID: 22539240
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  • 4
    Keywords: ALCOHOL-CONSUMPTION ; CARDIOVASCULAR-DISEASE ; CORONARY-HEART-DISEASE ; RELATIVE VALIDITY ; dietary patterns ; TIME PHYSICAL-ACTIVITY ; GERMAN HEALTH INTERVIEW ; CASE-FATALITY RATES ; 52 COUNTRIES ; ANGINA-PECTORIS
    Abstract: The aim of this study was to assess the preventive potential of major lifestyle risk factors for acute myocardial infarction (AMI) in middle-aged men. Among 10,981 men in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition, aged 40.2-65.8 years when recruited, 378 developed first-ever AMI during a median follow-up period of 11.4 years. Current smoking, excess body weight, being physically inactive, but not high alcohol consumption, were identified as the major lifestyle risk factors for AMI using Cox regression analysis. A competing AMI risk model built from cause-specific Cox regression models and considering the risk of death predicted 353 AMI cases, 182 (51.6 %) of which were estimated as preventable through adherence to a healthy lifestyle profile (never smoking, normal body weight, physically active, and moderate alcohol consumption). The calculated age-specific 5-year incidence rates for AMI in the actual cohort and in a hypothetical, comparable cohort with all men following the healthy lifestyle profile were 128 and 39, respectively, per 100,000 person-years for the age group 40-44, increasing to 468 and 307 per 100,000 person-years for the age group 65-69. The estimated AMI incidence rates for men with the healthy lifestyle profile are still somewhat higher than the average rates reported for documented low-incidence regions, such as parts of Japan. Our analysis confirms the strong primary preventive potential for AMI based on avoidance of smoking and excess body weight, and on regular physical activity.
    Type of Publication: Journal article published
    PubMed ID: 24399287
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  • 5
    Keywords: Germany ; DISEASE ; POPULATION ; WOMEN ; MEN ; RATES ; TRENDS ; ISCHEMIC-STROKE ; PHYSICAL-ACTIVITY ; 30-DAY CASE-FATALITY
    Abstract: BACKGROUND AND PURPOSE: Because primary prevention of stroke is a priority, our aim was to assess the primary preventive potential of major lifestyle risk factors for stroke in middle-aged women and men. METHODS: Among 23 927 persons, 551 (195 women and 356 men) had a first diagnosis of stroke during an average follow-up of 12.7 years. Using Cox proportional hazards models, we estimated the associations of adiposity, smoking, physical activity, alcohol consumption, and diet with risk of developing stroke. A competing risk model built from cause-specific proportional hazards models accounting for concurrent risk of death was used to calculate relative and absolute reductions in stroke occurrences that could have been achieved by maintaining a healthy lifestyle pattern. RESULTS: Obesity, smoking, alcohol consumption, diet, and physical inactivity were each identified as modifiable lifestyle risk factors for stroke. About 38% of stroke cases were estimated as preventable through adherence to a healthy lifestyle profile (never smoking, maintaining optimal body mass index and waist circumference, performing physical exercise, consuming a moderate quantity of alcohol, and following a healthy dietary pattern). Age-specific estimates of 5-year incidence rates for stroke in the actual cohort and in a hypothetical, comparable cohort of individuals following a healthy lifestyle would be reduced from 153 to 94 per 100 000 women and from 261 to 161 per 100 000 men for the age group 60 to 65 years. CONCLUSIONS: Our analysis confirms the strong primary prevention potential for stroke based on avoidance of excess body weight, smoking, heavy alcohol consumption, unhealthy diet, and physical inactivity.
    Type of Publication: Journal article published
    PubMed ID: 24876086
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  • 6
    Abstract: We want to report and discuss the indication for open surgery for an asymptomatic penetrating aortic ulcer (PAU) in the era of thoracic endovascular aortic repair (TEVAR). A 31-year-old female presented with the diagnosis of an aneurysm in the distal aortic arch. With respect to the patients young age, the controversial status of connective tissue disorders and in the absence of concomitant disease, open repair was indicated. There was no proof of a mycotic plaque or connective tissue disease in the microbiological-, pathological analysis and at electron-microscopy. The patient was discharged on the thirteenth postoperative day. In spite of good preliminary results of TEVAR in PAU, in selective cases there is still an indication for open surgery.
    Type of Publication: Journal article published
    PubMed ID: 20464674
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  • 7
    Keywords: CT ; TRIAL ; SPIRAL COMPUTED-TOMOGRAPHY ; RECRUITMENT
    Abstract: PURPOSE: Low-dose multislice-CT (MSCT) detects many early-stage lung cancers with good prognosis, but whether it decreases lung cancer mortality and at which costs is yet insufficiently explored. Scope of the present study is to examine within a common European effort whether MSCT screening is capable to reduce the lung cancer mortality by at least 20 % and at which amount of undesired side effects this could be achieved. METHODS: Overall 4,052 heavy smoking men and women were recruited by a population-based approach and randomized into a screening arm with five annual MSCT screens and an initial quit-smoking counseling, and a control arm with initial quit-smoking counseling and five annual questionnaire inquiries. RESULTS: In the first screening round, 2,029 participants received a MSCT providing 1,488 negative and 540 suspicious screens with early recalls (early recall rate 26.6 %) leading to 31 biopsies (biopsy rate 1.5 %) and 22 confirmed lung cancers (detection rate 1.1 %). Among the lung cancers, 15 were adenocarcinomas, 3 squamous cell carcinomas, one small-cell lung cancer, and 3 others, whereby 18 were in clinical stage I, one in stage II, and 3 in stage III. One interval cancer occurred. CONCLUSIONS: The indicated performance indicators fit into the range observed in comparable trials. The study continues finalizing the second screening round and for the first participants even the last screening round. The unresolved issue of the precise amount of side effects and the high early recall rate precludes currently the recommendation of MSCT as screening tool for lung cancer.
    Type of Publication: Journal article published
    PubMed ID: 22526165
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  • 8
    Keywords: CELLS ; MICE ; kidney ; NEPHROPATHY ; INJURY ; INCREASED EXPRESSION ; HUMAN FIBROBLASTS ; REPLICATIVE SENESCENCE ; RENAL-TRANSPLANTATION ; CYCLE INHIBITOR P16(INK4A)
    Abstract: Long-term graft survival after kidney transplantation remains unsatisfactory and unpredictable. Interstitial fibrosis and tubular atrophy are major contributors to late graft loss; features of tubular cell senescence, such as increased p16(INK4a) expression, associate with these tubulointerstitial changes, but it is unknown whether the relationship is causal. Here, loss of the INK4a locus in mice, which allows escape from p16(INK4a)-dependent senescence, significantly reduced interstitial fibrosis and tubular atrophy and associated with improved renal function, conservation of nephron mass, and transplant survival. Compared with wild-type controls, kidneys from INK4a(-/-) mice developed significantly less interstitial fibrosis and tubular atrophy after ischemia-reperfusion injury. Consistently, mice that received kidney transplants from INK4a/ARF(-/-) donors had significantly better survival 21 days after life-supporting kidney transplantation and developed less tubulointerstitial changes. This correlated with higher proliferative rates of tubular cells and significantly fewer senescent cells. Taken together, these data suggest a pathogenic role of renal cellular senescence in the development of interstitial fibrosis and tubular atrophy and kidney graft deterioration by preventing the recovery from injury. Inhibiting premature senescence could have therapeutic benefit in kidney transplantation but has to be balanced against the risks of suspending antitumor defenses.
    Type of Publication: Journal article published
    PubMed ID: 22797186
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  • 9
    Abstract: INTRODUCTION: In the German lung cancer screening trial LUSI, smoking cessation counseling (SCC) was offered to all participants at time of randomization, and smoking habits were asked for within annual questionnaire inquiries. We analyzed the smoking habits of the participants within the first 2 years of follow-up and especially the potential effect of the SCC on these habits. MATERIALS AND METHODS: We used the smoking data of the initial inquiry on which the decision on invitation to the study was based, the socio-economic data of the questionnaire filled-in at time of randomization, the psycho-social data obtained during the SCC, and the annual questionnaire data of the first two annual follow-up screening rounds. RESULTS: Smoking prevalence decreased in the entire cohort significantly by 4 %, whereby the decrease was with 4.5 % statistically not significantly higher in the control arm than in the screening arm with 3.4 %. The decline was much stronger in the subgroup of attendees to stop-smoking counseling and mounted up therein to 10 %. In some participants, an increase of readiness to quit smoking was observed during the counseling hour, but did not show effects on smoking status 2 years later. DISCUSSION: We did not see a tendency to increased smoking among participants of the intervention arm or the entire study. The decline of smoking prevalence among the attendees of the counseling might be due to self-selection. Since the issue of effectiveness of smoking cessation counseling is important, further research with randomization into offering counseling or no intervention should be taken into consideration.
    Type of Publication: Journal article published
    PubMed ID: 26814889
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