Sampling strategy, characteristics and representativeness of the InGef research database.

OBJECTIVES: The aim of this study was to describe the sampling strategy as well as characteristics and the external validity of a representative sample database drawn from the German InGef research database. STUDY DESIGN: This is a retrospective cohort study using anonymized claims data for the year 2019. METHODS: The InGef research database is an anonymized healthcare database with longitudinal claims data from approximately 8.8 Mio insurees. A sample of four million insurees was drawn intended to be representative for the German population with respect to age, sex and region. In addition to demographic information, data on hospitalization rates, mortality rates and drug prescription rates were analysed from the InGef sample database for the year 2019 to demonstrate validity and representativeness. Corresponding national reference data were obtained from official sources. RESULTS: The distributions of sex and age were similar in the InGef sample database and Germany (proportion of women: 50.8% vs 50.7%; mean age: 44.1 vs 43.9 years). The proportion of insurees living in the eastern part of Germany was lower in the InGef sample database (16.5% vs 19.5%). There was good accordance with German reference data with respect to hospitalization rates and overall mortality rates. Prescription rates for the 20 most often reimbursed drug classes were slightly higher in the InGef sample database. CONCLUSIONS: The InGef sample database shows good overall agreement with the German population on measures of morbidity, mortality and drug usage.

The contribution of comorbidities to mortality in hospitalized patients with heart failure.

BACKGROUND: Heart failure (HF) with reduced ejection fraction (HFrEF) has a worse prognosis than HF with preserved EF (HFpEF). The study aimed to evaluate whether different comorbidity profiles of HFrEF- and HFpEF-patients or HF-specific mechanisms contribute to a greater extent to this difference. METHODS: We linked data from two health insurances to data from a cardiology clinic hospital information system. Patients with a hospitalization with HF in 2005-2011, categorized as HFrEF (EF < 45%) or HFpEF (EF ≥ 45%), were propensity score (PS) matched to controls without HF on comorbidites and medication to assure similar comorbidity profiles of patients and their respective controls. The balance of the covariates in patients and controls was compared via the standardized difference (SDiff). Age-standardized 1-year mortality rates (MR) with 95% confidence intervals (CI) were calculated. RESULTS: 777 HFrEF-patients (1135 HFpEF-patients) were PS-matched to 3446 (4832) controls. Balance between patients and controls was largely achieved with a SDiff < 0.1 on most variables considered. The age-standardized 1-year MRs per 1000 persons in HFrEF-patients and controls were 267.8 (95% CI 175.9-359.8) and 86.1 (95% CI 70.0-102.3). MRs in HFpEF-patients and controls were 166.2 (95% CI 101.5-230.9) and 61.5 (95% CI 52.9-70.1). Thus, differences in MRs between patients and their controls were higher for HFrEF (181.7) than for HFpEF (104.7). CONCLUSIONS: Given the similar comorbidity profiles between HF-patients and controls, the higher difference in mortality rates between HFrEF-patients and controls points more to HF-specific mechanisms for these patients, whereas for HFpEF-patients a higher contribution of comorbidity is suggested by our results.

Development of an enantioselective amine-silver co-catalyzed Conia-ene reaction.

The development of a novel cooperative catalytic system for an amine-silver co-catalyzed Conia-ene reaction of alkyne-tethered C-H-acidic compounds is reported. By using a cost-effective silver salt and a small diamine for the 5-exo-dig-cyclization the cyclopentane products are obtained in very good yields. The enantioselectivity of the reaction could be controlled by exchanging the diamine co-catalyst with a cinchona-derived primary amine.

[Return to Work After Shoulder Arthroscopy as an Index of Cost Effectiveness]. / Nutzenbewertung der minimal-invasiven Schulterchirurgie aus Sicht der Kostenträger.

Cost-effectiveness of shoulder arthroscopy was analyzed and assessed by the days off work as part of the indirect costs. We retrospectively evaluated a group of 266 inpatients on sick leave after arthroscopic shoulder surgery. Mean duration till return to full duty was 9.5 days, the mean sick leave benefit was € 485. There was a statistically significant difference in the mean time to return to work between the older (age >50) and the younger group (age under 50). Secondary data analysis of sick leave and sickness benefits as indirect costs of medical treatment seems to be well suited to provide essentiell information to health care policy makers and those charged with distributing disability funds.

Comparison of basal insulin therapies with regard to the risk of acute myocardial infarction in patients with type 2 diabetes: an observational cohort study.

AIMS: To assess the risk of acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus treated with long-acting insulin analogues in comparison with other basal insulin therapy. METHODS: We used German insurance claims data from the years 2004-2009 to conduct a study in a retrospective cohort of patients with type 2 diabetes. Naïve insulin users were defined as patients who had an insulin-free history before the first prescription of long-acting analogue insulin, human NPH insulin or premixed insulin and who were pretreated with oral antidiabetic drugs. Adjusted hazard ratios (HRs) of AMI and corresponding 95% confidence intervals (CIs) were calculated using sex-stratified Cox models. Propensity-score-matched analyses were conducted as sensitivity analyses. RESULTS: We identified 21,501 new insulin users. Patients treated with premixed insulin were older than patients treated with analogue or NPH insulin (mean age 70.7 vs. 64.1 and 61.6 years, respectively) and had more comorbidities. Regarding the risk of AMI, adjusted HRs showed no statistically significant difference between NPH and analogue insulin (HR 0.94, 95% CI 0.74-1.19), but a higher risk for premixed than for analogue insulin (HR 1.27, 95% CI 1.02-1.58). Contrary to the primary analysis, the propensity-score-matched analysis did not show an increased risk for premixed insulin. CONCLUSIONS: In contrast to a former database study, no difference was observed for the risk of AMI between long-acting analogue and NPH insulin in this study. Neither long-acting analogue insulin nor premixed insulin appears to be associated with AMI in patients with type 2 diabetes.

Evaluating methods for intersectoral comparison of quality of care. A routine data analysis of elective percutaneous coronary interventions.

OBJECTIVES: To compare the quality of care regarding the use of elective percutaneous coronary interventions (PCIs) in the inpatient and outpatient setting and to evaluate different methods of confounder control in this context. METHODS: Based on data of three statutory health insurances including more than nine million insurance members, a retrospective cohort study between 2005 and 2009 was conducted. The occurrence of myocardial infarction, stroke, further coronary intervention and death was ascertained following the first PCI in the study period, which was preceded by a one-year period without a PCI. A Cox proportional hazard model was used to assess the influence of the setting of the elective PCI on the risk for complications after the PCI for each outcome separately. Age, sex, the number of diseases of the Elixhauser comorbidity measure, past acute coronary syndrome, coronary artery disease, dyslipidemia, past stroke, past coronary artery bypass surgery and the year of the PCI were included as covariables. The analyses were repeated in a propensity score matched cohort as well as in inverse probability of treatment weighted analyses. RESULTS: The cohort comprised 4,269 patients with an outpatient PCI and 26,044 patients with an inpatient PCI. The majority of the analyses revealed no statistically significant effect of the setting of the PCI on the risk of myocardial infarction, stroke and further coronary interventions, whereas a reduced mortality risk was observed for outpatient PCIs. Similar results were obtained in the propensity score analyses. CONCLUSIONS: The analysis revealed that the adjusted risk for complications following an elective PCI is similar between the inpatient and the outpatient setting. For mortality the risk differed but this might be explained by residual or unmeasured confounding. The different methods applied in this study revealed mostly similar results. Since our study only covered one aspect of quality of care in the field of PCI and did not consider drug treatment in hospital or in the outpatient setting, further studies are needed which include these aspects.

Biomimetic organocatalytic C-C-bond formations.

Mother Nature utilizes simple precursors to build up complex organic molecules efficiently. One important example is the C3 building block dihydroxyacetone phosphate, which is used in various enzyme-catalyzed reactions. Following this biosynthetic strategy the DHAP equivalent 'dioxanone' can be used in organocatalytic reactions to synthesize sugars, aminosugars, carbasugars, polyoxamic acids and sphingosines. In this respect, organocatalytic domino reactions can also be seen as biomimetic as they are reminiscent of tandem reactions that may occur during biosyntheses of complex natural products. In nature, the coenzyme thiamin (vitamin B1), a natural thiazolium salt, is used in biochemical nucleophilic acylations ('Umpolung'). The catalytic active species is a nucleophilic carbene. Mimicking this approach, organocatalytic carbene catalysis has emerged to an exceptionally fruitful research area, which is used in asymmetric C-C bond formations.

Solid-phase synthesis of monocyclic beta-lactam derivatives.

Liquid-phase studies concerning the solid-phase synthesis of monocyclic beta-lactams via the ester-enolate imine condensation route have been conducted utilizing triazene esters 1 and 2 as model compounds. Esters were attached to benzylamine resin 6 by a triazene linker employing the respective diazonium salts. Immobilized ester-enolates 8 and 10 were reacted with various imines and imine precursors to give polymer-bound beta-lactams 14 and 17 in different substitution patterns. Traceless cleavage from the triazene linker yields the desired beta-lactams 16 and 19.

Asymmetric synthesis of beta-phosphono malonates via Fe2O3-mediated phospha-Michael addition to Knoevenagel acceptors.

[reaction: see text]. The first asymmetric P-C bond formation under heterogeneous conditions was achieved via a Fe2O3-mediated conjugate addition of a chiral phosphite to alkylidene malonates. The easy cleavage of the chiral auxiliary from the addition products leads to optically active beta-substituted beta-phosphono malonates in good yields and high enantiomeric excesses.

Solid-phase synthesis of beta-amino ketones and six-ring carbamates via immobilized alpha-alkoxycarbonylamino sulfones.

[reaction: see text] beta-Amino ketones and substituted 1,3-oxazinan-2-ones have been synthesized utilizing polymer-bound and carbamate-linked alpha-alkoxycarbonylamino sulfones. Key steps in the synthesis are the immobilization of the N-acylimine precursor, the Mannich-type addition of various nucleophiles, and the diastereoselective reduction of the resin-bound ketone.

Efficient asymmetric synthesis of alpha-trifluoromethyl-substituted primary amines via nucleophilic 1,2-addition to trifluoroacetaldehyde SAMP- or RAMP-hydrazone.

[reaction: see text] An efficient asymmetric synthesis of alpha-trifluoromethyl-substituted primary amines via nucleophilic 1,2-addition of alkyllithium reagents to trifluoroacetaldehyde SAMP- or RAMP-hydrazone followed by benzoylation and SmI(2)-promoted nitrogen-nitrogen single bond cleavage is described.

Asymmetric synthesis of alpha-branched primary amines on solid support via novel hydrazine resins.

[reaction: see text]. Two novel chiral hydrazine resins for asymmetric solid-phase synthesis have been developed. The enantiopure beta-methoxyamino auxiliaries, derived from trans-4-hydroxy-(S)-proline and (R)-leucine, were attached to Merrifield resin and transformed into their corresponding hydrazines. Immobilization of various aldehydes, followed by 1,2-addition of organolithium reagents to the resulting enantiopure hydrazones and reductive cleavage from the solid support, furnished alpha-branched amines, which were isolated as their corresponding amides in good overall yields and enantiomeric excesses of up to 86%.

A Novel Hydrazine Linker Resin and Its Application for the Solid-Phase Synthesis of alpha-Branched Primary Amines.

A novel hydrazine linker resin for solid-phase organic synthesis has been developed. Starting from Merrifield resin, the new N-butyl-N-methylpolystyrene-hydrazine linker is prepared in three steps. Polymer-supported hydrazones, readily prepared from aldehydes and the hydrazine resin, react with alkyl- and arylorganolithium reagents under 1,2-addition to the C-N double bond to afford the corresponding hydrazines. Release from solid support was achieved by reductive N-N bond cleavage using the borane-tetrahydrofuran complex. The resulting alpha-branched primary amines were protected as their amides or carbamates, respectively, and, after purification, were obtained in good overall yields and in high purity (12 examples).

Diastereo- and enantioselective synthesis of alpha,beta-disubstituted gamma-nitro methyl sulfonates.

A novel asymmetric synthesis of highly enantioenriched homotaurine precursors has been developed via diastereo-selective Michael addition of lithiated enantiopure sulfonates to nitroalkenes by using 1,2:5,6-di-O-isopropylidene-alpha-D-allofuranose as chiral auxiliary.

Diastereo- and enantioselective total synthesis of stigmatellin A.

Stigmatellin A (1) isolated from the myxobacterium Stigmatella aurantiaca is a powerful inhibitor of electron transport in mitochondria and chloroplasts. The first highly diastereo- and enantioselective total synthesis of this important natural product is described. Key steps in the synthesis are the alkylation of the SAMP-hydrazone (S)-13, a titanium mediated syn-diastereoselective aldol reaction, the anti-diastereoselective triacetoxyborohydride reduction of the aldol adduct (R,R,S)-16, formation of the chromone system via Baker Venkataraman rearrangement and exclusive (E) C=C double bond formation via Horner-Wadsworth-Emmons reaction.

Efficient asymmetric synthesis of alpha-alkylated 1, 4-cyclohexanedione derivatives, important chiral building blocks in the synthesis of natural products.

Alkylation of 1,4-cyclohexanedione monoethylene acetal SAMP-hydrazone with various electrophiles (10 examples given) and subsequent cleavage of the hydrazones with saturated oxalic acid furnished highly enantiomerically enriched alpha-alkylated mono-protected 1,4-cyclohexanedione derivatives in high yields and enantiomeric excesses of ee = 28, 80->/=99%. Reduction of the ketones gave the corresponding alcohols in good yields with high enantiomeric excesses (ee = 80->/=98%) and cis/trans-ratios of usually 85:15.

Recovery of carbonyl compounds from N,N-dialkylhydrazones.

Deprotonation of enantiomerically pure hydrazones and subsequent trapping with suitable electrophiles generates new stereogenic centers with excellent stereoselectivity. To liberate the original carbonyl functionality in the final products, it is necessary to cleave the hydrazone moiety. In recent years, many reagents have been developed to regenerate carbonyl compounds from the corresponding dialkylhydrazones which are compatible with a wide range of functionalities. This has allowed the use of hydrazones in the total synthesis of complex natural products. This Account is meant to be an overview of methods which are classified as oxidative, hydrolytic, and reductive cleavage procedures.

Solid-phase synthesis of beta-lactams via the ester enolate-imine condensation route.

The ester enolate-imine condensation route to beta-lactams via an immobilized ester enolate has been achieved for the first time. The key reaction in the synthesis is the cyclization of the resin bound ester dianion and an imine. Traceless cleavage from the T1-triazene linker system yields the desired beta-lactams.

Asymmetric Synthesis of Novel Ferrocenyl Ligands with Planar and Central Chirality.

A stereogenic center at the position beta to the metallocene backbone is present in ferrocenyl ligands 2, which are interesting for asymmetric catalysis. These planar-chiral compounds are accessible for the first time by a highly diastereoselective and enantioselective synthesis (de=93-97 %; ee>/=96 %) from the ferrocenyl ketones 1. A variety of donor groups (E(1)=Ph(2)P small middle dotBH(3), SMe, SiPr; E(2)=SMe, STol, SePh, Ph(2)P small middle dotBH(3), iPr(2)P small middle dotBH(3)) can be introduced as electrophiles. Tol=tolyl=CH(3)C(6)H(4).