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"Middeke, Martin"
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Cardiovascular mortality risk in young adults with isolated systolic hypertension: findings from population-based MONICA/KORA cohort study
The clinical significance of isolated systolic hypertension in young adults (ISHY) remains a topic of debate due to evidence ISHY could be a spurious condition resulting from exageratted pulse pressure amplification in “young tall men with elastic arteries”. Hence, we aimed to investigate whether ISHY is associated with an increased risk of cardivascular (CVD) mortality in a sample of 5597 young adults (49.8% men, 50.2% women) between 25 and 45 years old from the prospective population-based MONICA/KORA cohort. ISHY was prevalent in 5.2% of the population, affecting mostly men (73.1%), and associated with increased smoking, obesity, and hypercholesterolemia in comparison to participants with normal blood pressure (BP). Within a follow-up period of 25.3 years (SD ± 5.2; 141,768 person–years), 133(2.4%) CVD mortality cases were observed. Participants with ISHY had a hazard ratio (HR) of 1.89(1.01–3.53, p < 0.05) times higher risk of CVD mortality than participants with normal BP, even following adjustment for CVD risk factors. However, adjustment for antihypertensive medication (HR 0.46; 0.26–0.81, p < 0.001) and increasing height (HR 0.96; 0.93–0.99, p < 0.05) revealed independently protective effects against CVD mortality, suggesting that although ISHY is associated with an increased risk of CVD mortality, the protective effects of increasing height or antihypertensive medication should be considered in treatment rationale.
Journal Article
Of precariousness : vulnerabilities, responsibilities, communities in 21st-century British drama and theatre
Invites monographs (and collections) on issues in contemporary Anglophone dramatic literature and theatre performance. The book series is dedicated to the analysis and renegotiation of contemporary writers and plays and their historical, political, formal, theoretical and methodological contexts.
Book
Artificial intelligence-based assessment of central aortic haemodynamics using non-invasive pulse wave analysis in constrictive pericarditis
BackgroundConstrictive pericarditis (CP) is a rare but significant pericardial disease resulting in impaired ventricular filling and heart failure symptoms, often following cardiac surgery. Its clinical presentation complicates diagnosis, mimicking other causes of heart failure. Recent technological advances, including artificial intelligence (AI)-based non-invasive pulse wave analysis (AI-PWA), have the potential for improved haemodynamic assessment and clinical decision-making.ObjectivesThis study evaluates the clinical utility of AI-PWA in assessing central aortic blood pressure (CABP), arterial stiffness and cardiac function in CP.MethodsThis prospective case-control study enrolled 12 adult CP patients and 12 age- and sex-matched healthy controls. CABP and peripheral blood pressure (PBP) were measured using the VascAssist2. Haemodynamic parameters, including pulse wave velocity (PWV), augmentation index@75 (AIx@75), cardiac index, stroke volume and dP/dtmax, were assessed and compared between groups.ResultsCP patients showed significantly lower mean CABP than systolic PBP (101.8±23.4 mm Hg vs 112.3±22.9 mm Hg). PWV showed elevated values (>9 m/s) in nnn (42%) of cases, indicating increased arterial stiffness (8.88±1.94 m/s). AIx@75 was higher in CP patients (22.55±8.36%) compared with controls (16.38±6.53%), reflecting increased wave reflection, increased systemic vascular resistance or enhanced aortic compliance. Cardiac performance was notably impaired in the CP group, with reduced stroke volume (64.8±18.8 mL vs 94.9±25.0 mL, p=0.003) and dP/dtmax (724.9±228.2 mm Hg/s vs 1055.3±203.2 mmHg/s, p=0.0011), indicating impaired ventricular function. The heart failure index was significantly higher in CP patients (31.8±18.3% vs . 6.4±6.5%, p<0.001), indicating substantial functional compromise.ConclusionAI-PWA provides clinically relevant insights into central haemodynamics and arterial stiffness in CP patients. This non-invasive approach may enhance diagnosis and management of CP and should be considered for integration into routine cardiologic evaluation protocols.
Journal Article
The Methuen Drama guide to contemporary British playwrights
This is an authoritative single-volume guide to the work of 25 British playwrights from the 1980s to the present written by an international team of 25 eminent scholars. It is the perfect companion for students of Theatre Studies and English Literature.
Book
Diagnostic and therapeutic delays in lung cancer during the COVID-19 pandemic: a single center experience at a German Cancer center
Background
The COVID-19 pandemic has had negative drawbacks on the healthcare system worldwide and on individuals other than those directly affected by the virus. Delays in cancer therapy and diagnosis have been reported in the literature. We hypothesized similar effects on patients with lung cancer at our center.
Methods
We retrospectively analyzed data of patients referred to our center with newly diagnosed lung cancer from 2018 to 2022. We considered distribution of UICC Stages and time from case presentation in our multidisciplinary tumor board or from therapeutic indication from treating physician to therapy initiation (surgery, systemic therapies and radiation) to define delays in diagnosis and treatment.
Results
1020 patients with newly diagnosed lung cancer were referred to our center from 2018 to 2022, with a median of 206 cases yearly (range: 200–208). Cases with Stage IV in 2020–2022 were significantly higher than in 2018–2019 (57% vs. 46%,
p
= 0,001). 228 operative resections took place between 2018 and 2022, 100 from January 2018 to February 2020 and 128 from March 2020 to December 2022. Median time from presentation in our tumor board to resection was also significantly longer after the beginning of the pandemic than before (22 days vs. 15,5 days,
p
= 0,013). No significant delays were observed for administration of systemic treatment and initiation of radiation.
Conclusions
During the pandemic higher disease stages were reported for patients with lung cancer, yet there were no clinically relevant delays in treatment. In the context of the post-covid era new diagnostic strategies are necessary to facilitate early diagnosis of lung cancer. Despite the pandemic, for patients with suspicious symptoms prompt access to healthcare facilities is essential for early diagnosis.
Journal Article
Of Precariousness
The book series CDE Studies invites monographs (and collections) on issues in contemporary Anglophone dramatic literature and theatre performance. The book series is dedicated to the analysis and renegotiation of contemporary writers and plays and their historical, political, formal, theoretical and methodological contexts.
eBook
The Methuen Drama Guide to Contemporary Irish Playwrights
The Methuen Drama Guide to Contemporary Irish Playwrights is an authoritative guide to the work of twenty-five playwrights from the last 50 years whose work has helped to shape and define Irish theatre. Written by a team of international scholars, it provides an illuminating survey and analysis of each writer's plays and will be invaluable to anyone interested in, studying or teaching contemporary Irish drama. The playwrights examined range from John B. Keane, Brian Friel and Tom Murphy, to the crop of writers who emerged in the 1990s and who include Martin McDonagh, Marina Carr, Emma Donoghue and Mark O'Rowe. Each essay features: • a biographical sketch and introduction to the playwright • a discussion of their most important plays • an analysis of their stylistic and thematic traits, the critical reception and their place in the discourses of Irish theatre • a bibliography of texts and critical material With a total of 190 plays discussed in detail, over half of which were written during the 1990s and 2000s, The Methuen Drama Guide to Contemporary Irish Playwrights is unrivalled in its study of recent plays and playwrights.
eBook
