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- Poelzl, Gerhard, et al.
(författare)
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Repetitive use of levosimendan in advanced heart failure : need for stronger evidence in a field in dire need of a useful therapy
- 2017
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 243, s. 389-395
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Tidskriftsartikel (refereegranskat)abstract
- Patients in the latest stages of heart failure are severely compromised, with poor quality of life and frequent hospitalizations. Heart transplantation and left ventricular assist device implantation are viable options only for a minority, and intermittent or continuous infusions of positive inotropes may be needed as a bridge therapy or as a symptomatic approach. In these settings, levosimendan has potential advantages over conventional inotropes (catecholamines and phosphodiesterase inhibitors), such as sustained effects after initial infusion, synergy with beta-blockers, and no increase in oxygen consumption. Levosimendan has been suggested as a treatment that reduces re-hospitalization and improves quality of life. However, previous clinical studies of intermittent infusions of levosimendan were not powered to show statistical significance on key outcome parameters. A panel of 45 expert clinicians from 12 European countries met in Rome on November 24-25, 2016 to review the literature and envision an appropriately designed clinical trial addressing these needs. In the earlier FIGHT trial (daily subcutaneous injection of liraglutide in heart failure patients with reduced ejection fraction) a composite Global Rank Score was used as primary end-point where death, re-hospitalization, and change in N-terminalprohormone-brain natriuretic peptide level were considered in a hierarchical order. In the present study, we tested the same end-point post hoc in the PERSIST and LEVOREP trials on oral and repeated i.v. levosimendan, respectively, and demonstrated superiority of levosimendan treatment vs placebo. The use of the same composite end-point in a properly powered study on repetitive levosimendan in advanced heart failure is strongly advocated.
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| 2. |
- Reinhardt, Nils, et al.
(författare)
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Geochemistry and Mineralogy of Rare Earth Elements (REE) in Bauxitic Ores of the Catalan Coastal Range, NE Spain
- 2018
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Ingår i: Minerals. - : MDPI. - 2075-163X. ; 8:12
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Tidskriftsartikel (refereegranskat)abstract
- Karst bauxite deposits are currently investigated as a new resource for rare earth elements (REE) in order to avoid present and future supply shortfalls of these critical metals. The present work focuses on the geochemistry and mineralogy of the REE in karst bauxite deposits of the Catalan Coastal Range (CCR), NE-Spain. It is revealed that the studied bauxitic ores have a dominant breccia and local ooido-pisoidic and pelitomorphic texture. The bauxitic ores are mostly composed of kaolinite and hematite, as well as of lesser amounts of boehmite, diaspore, rutile and calcite. The mineralogy and major element composition indicate incomplete bauxitization of an argillaceous precursor material possibly derived from the erosion of the Mesozoic Ebro massif paleo-high. The studied bauxites are characterized by ∑REE (including Sc, Y) between 286 and 820 ppm (av. 483 ppm) and light REE to heavy REE (LREE/HREE) ratios up to 10.6. REE are mainly concentrated in phosphate minerals, identified as monazite-(Ce) and xenotime-(Y) of detrital origin and unidentified REE-phosphates of a possible authigenic origin. REE remobilization presumably took place under acidic conditions, whereas REE entrapment in the form of precipitation of authigenic rare earth minerals from percolating solutions was related to neutral to slightly alkaline conditions. During the bauxitization process no significant REE fractionation took place and the REE distribution pattern of the bauxitic ores was governed by the REE budget of the precursor material. Finally, adsorption as a main REE scavenging mechanism in the studied CCR bauxite deposits should not be considered, since the presented data did not reveal significant REE contents in Fe-and Mn-oxyhydroxides and clay minerals.
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