the thoracic and cardiovascular surgeon
130130;140300
The Thoracic and Cardiovascular Surgeon
Category: 11 – 14 02 2023 52nd Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery (DGTHG) Congress Center Hamburg
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Issue S 01/2023
Martens, A.;
Isleem, E.;
Kaufeld, T.;
Arar, M.;
Natanov, R.;
Korte, W.;
Rudolph, L.;
Krüger, H.;
Gerber, I.;
Haverich, A.;
Shrestha, M. L.:
Insufficient Reimbursement for Complex Aortic Arch Procedures within the German DRG System
Knochenhauer, T.;
Demal, T. J.;
Detter, C.;
Nappi, F.;
Di Perna, D.;
Pol, M.;
Juvonen, T.;
Mariscalco, G.;
Gatti, G.;
Peterss, S.;
Perrotti, A.;
Fiore, A.;
Pettinari, M.;
Dell'aquila, A. M.;
Vendramin, I.;
Rinaldi, M.;
Quintana, E.;
Pinto, A. G.;
Field, M.;
Reichenspurner, H.;
Biancari, F.;
Conradi, L.:
Outcome in Night- versus Daytime Surgery for Acute Type A Aortic Dissection
Luehr, M.;
Yildiz, M.;
Ma, W. G.;
Heck, R.;
Polycarpou, A.;
Jassar, A.;
Kreibich, M.;
Dohle, D. S.;
Weiss, G.;
Hagl, C.;
Rega, F.;
Schachner, T.;
Martens, A.;
Corte, A. Della;
Osada, H.;
Tsagakis, K.;
Schoenhoff, F.:
Acute Type A Aortic Dissection in Under 30 Years: Demographics, Etiology, and Postoperative Outcomes of 139 Patients
De Silva, N.;
Salem, M.;
Friedrich, C.;
Diraz, S.;
Broll, A.;
Pommert, N. S.;
Puehler, T.;
Schoettler, J.;
Cremer, J.;
Haneya, A.:
Does Duration of Aortic Cross Clamp Affect Outcome in Patients Undergoing Surgical Repair of Acute Dissection of Aorta Type A? A Large Retrospective Cohort Study
Sandhaus, T.;
Abdyvasiev, K.;
Samson-Himmelstjerna, P.;
Safarov, R.;
Lang, S.;
Rachow, T.;
Sponholz, C.;
Steiner, M.;
Oczko, J.;
Kirov, H.;
Färber, G.;
Doenst, T.:
Nonintubated VATS Combined with Pleurodesis and PleurX Catheter in Patients with Recurrent Pleural Effusions
Kozin, I.;
Chechoeva, A.;
Münch, P.;
Jashnieh, P.;
Schmidt, V.;
Gräf, M.;
Soler, S.;
Bartok, E.;
Lichtenberg, A.;
Weber, E.;
Aubin, H.:
Early Immune Response of Decellularized Extracellular Matrix in Rat Aortic Conduit Implantation Model
Pölzl, L.;
Hirsch, J.;
Eder, J.;
Nägele, F.;
Graber, M.;
Lechner, S.;
Engler, C.;
Grimm, M.;
Holfeld, J.;
Gollmann-Tepeköylü, C.:
Innate Reverse Remodeling Reveals Novel Treatment Option for Heart Failure
Münch, P.;
Jashnieh, P.;
Kozin, I.;
Schmidt, V.;
Gehlweiler, K.;
Chekhoeva, A.;
Gräf, M.;
Soler, S.;
Bartok, E.;
Lichtenberg, A.;
Weber, E.;
Aubin, H.:
Influence of Decellularized Aortic Valve ECM on the Phenotype of Bone Marrow–Derived Macrophages
Silaschi, M.;
Alaj, E.;
Wilde, N.;
Vogelhuber, J.;
Sugiura, A.;
Tanaka, T.;
Sudo, M.;
Zimmer, S.;
Nickenig, G.;
Weber, M.;
Bakhtiary, F.:
Reoperative Mitral Valve Replacement versus Transcatheter Valve-in-Valve and Valve-in-Ring Procedures in High-Risk Patients
Pommert, N. S.;
Puehler, T.;
Zhang, X.;
Saad, M.;
Haneya, A.;
Schöttler, J.;
Huenges, K.;
Frank, D.;
Cremer, J.;
Lutter, G.:
Transcatheter Aortic Valve Replacement Does Not Change Concomitant Tricuspid Regurgitation
Pecha, S.;
Burger, H.;
Chung, D. U.;
Möller, V.;
Madej, T.;
Maali, A.;
Osswald, B.;
De Simone, R.;
Monsefi, N.;
Ziaukas, V.;
Erler, S.;
Perthel, M.;
Wehbe, M. S.;
Ghaffari, N.;
Sandhaus, T.;
Busk, H.;
Schmitto, J. D.;
Bärsch, V.;
Easo, J.;
Albert, M.;
Treede, H.;
Nägele, H.;
Zenker, D.;
Hegazy, Y.;
Gessler, N.;
Knaut, M.;
Reichenspurner, H.;
Willems, S.;
Butter, C.;
Hakmi, S.:
Safety and Efficacy of Laser Lead Extraction in Octo- and Nonagenarians: A Subgroup Analysis from the GALLERY Registry
Sarwari, H.;
Bhadra, O. D.;
Demal, T. J.;
Grundmann, D.;
Waldschmidt, L.;
Sörensen, N.;
Schirmer, J.;
Schofer, N.;
Pecha, S.;
Blankenberg, S.;
Reichenspurner, H.;
Conradi, L.;
Seiffert, M.;
Schäfer, A.:
TAVI Using a Balloon-Expandable Transcatheter Heart Valve in Patients with Aortic Annuli Exceeding Formally Approved Dimensions
Demal, T. J.;
Weimann, J.;
Ojeda, F. M.;
Bhadra, O. D.;
Linder, M.;
Ludwig, S.;
Grundmann, D.;
Voigtländer, L.;
Waldschmidt, L.;
Schirmer, J.;
Schofer, N.;
Blankenberg, S.;
Reichenspurner, H.;
Conradi, L.;
Seiffert, M.;
Schäfer, A.:
Temporal Changes of Patient Characteristics Over 12 Years in a Single-Center Transcatheter Aortic Valve Implantation Cohort
Demal, T. J.;
Detter, C.;
von Kodolitsch, Y.;
Mariscalco, G.;
Gatti, G.;
Peterss, S.;
Büch, J.;
Onorati, F.;
Perrotti, A.;
Fiore, A.;
Pettinari, M.;
Dell'aquila, A. M.;
Pol, M.;
Field, M.;
Vendramin, I.;
Rinaldi, M.;
Lega, J. R.;
Juvonen, T.;
Onorati, F.;
Quintana, E.;
Pinto, A. G.;
Nappi, F.;
Di Perna, D.;
Reichenspurner, H.;
Biancari, F.;
Conradi, L.:
Predictor Analysis for Acute Type A Aortic Dissection in Small Aortic Diameters
Kretzer, J. A.;
Böning, A.;
Feisst, M.;
Rylski, B.;
Arif, R.;
Dohle, D. S.;
Krüger, T.;
Holubec, T.;
Brickwedel, J.;
Pöling, J.;
Jawny, P.;
Etz, C.;
Peterss, S.:
Neurologic Dysfunction after Acute Aortic Dissection Type A (AADA): A Long-Term Analysis of the German Registry for Acute Aortic Dissection Type A (GERAADA)
Weixler, V.;
Brüning, J.;
Kramer, P.;
Goubergrits, L.;
Schulz, A.;
Murin, P.;
Solowjowa, N.;
Kühne, T.;
Berger, F.;
Photiadis, J.:
3D Modeling and Printing for Complex Biventricular Repair of Double Outlet Right Ventricle
Pölzl, L.;
Thielmann, M.;
Cymorek, S.;
Nägele, F.;
Hirsch, J.;
Engler, C.;
Eder, J.;
Graber, M.;
Lohmann, R.;
Abfalterer, H.;
Holfeld, J.;
Grimm, M.;
Ruttmann-Ulmer, E.;
Bonaros, N.;
Gollmann-Tepeköylü, C.:
Impaired Outcome after CABG in Women
Ostovar, R.;
Schröter, F.;
Zinab, F. Seifi;
Fritzsche, D.;
Hartrumpf, M.;
Chopsonidou, S.;
Minden, H. H.;
Lasheen, N.;
Ritter, O.;
Braun, C.;
Dörr, G.;
Albes, J.:
Infective Endocarditis: Do Registry Data Help Improve Treatment Strategies?
Diab, M.;
Franz, M.;
Moschovas, A.;
Hamadanchi, A.;
Färber, G.;
Safarov, R.;
Kirov, H.;
Lehmann, T.;
Schulze, C.;
Doenst, T.:
Improving Preoperative Abscess Detection in Infective Endocarditis by Adding High-Sensitivity Troponin I to Transesophageal Echocardiography—A REMOVE Trial Analysis
Stastny, L.;
Hofmann, N.;
Huemer, N.;
Ampferer, A.;
Egger, A.;
Sommerauer, F.;
Wagner, J.;
Martini, J.;
Putnina, L.;
Helbok, R.;
Putzer, G.;
Schneeberger, S.;
Grimm, M.;
Dumfarth, J.:
Assessment Tools in Ex Situ Heart Perfusion: An Evaluation in a Pig Model
Görtz, L. A.;
Resch, U.;
Schmidt, L. M.;
Saynisch, M.;
Müller, S.;
Lackmann, J. W.;
Cappallo, M.;
Hayungs, M.;
Batool, R.;
Bayraktar, S.;
Schmidt, V.;
Krueger, M.;
Artur, L.;
Weber, E.;
Aubin, H.:
3D Spheroid Model for the Investigation of the Inflammatory Role of Smooth Muscle Cells in Cardiovascular Diseases
Gollmann-Tepeköylü, C.;
Lechner, S.;
Hirsch, J.;
Pölzl, L.;
Nägele, F.;
Graber, M.;
Eder, J.;
Grimm, M.;
Tancevski, I.;
Holfeld, J.:
Posttranslational Modifications of Biglycan Orchestrate Inflammation in Calcific Aortic Valve Disease
Vogt, S.;
Ramzan, R.;
Cybulski, P.;
Rhiel, A.;
Weber, P.;
Ruppert, V.;
Irqsusi, M.;
Rohrbach, S.;
Niemann, B.;
Rastan, A.:
Isoform Switching of Cytochrome c Oxidase Is Found in the Event of Permanent Atrial Fibrillation
Göbel, N.;
Stankowski, T.;
Pollari, F.;
Hassan, K.;
Jückstock, H.;
Schubel, J.;
Sellin, C.;
Zielezinski, T.;
Elhmidi, Y.;
Sack, F. U.;
Feyrer, R.;
Dörge, H.;
Hausmann, H.;
Massoudy, P.;
Schmoeckel, M.;
Fischlein, T.;
Fritzsche, D.;
Franke, U.:
Partial versus Complete Sternotomy for Surgical Aortic Valve Replacement: Results of a Multicenter Study
Pitts, L.;
Pasic, M.;
Buz, S.;
Bauer, M.;
Knosalla, C.;
Düsterhöft, V.;
Starck, C.;
Kempfert, J.;
Jacobs, S.;
Falk, V.:
Transposition of the Greater Omentum into the Mediastinum for Treatment of Infected Prosthetic Grafts of the Ascending Aorta and Aortic Arch
Saeed, D.;
Stark, C.;
Loforte, A.;
Zimpfer, D.;
Bernhardt, A.;
Schibilsky, D.;
Riebandt, J.;
Jawad, K.;
Lichtenberg, A.;
Haneya, A.;
Potapov, E.;
Albert, A.;
Otto, W.;
Huenges, K.;
Aubin, H.;
Lewin, D.;
Raweh, A.;
Morshuis, M.;
Jorde, U.;
Reichenspurner, H.;
Borger, M.;
Gummert, J.:
Validation Study of a Survival Predictor Formula for Patients Bridged from Extracorporeal Life Support (ECLS) to Durable Mechanical Circulatory Support Systems: On behalf of Durable MCS after ECLS Study Group
Radwan, M.;
Salewski, C.;
Boburg, R. Sandoval;
Sebastian, S.;
Walther, T.;
Schlensak, C.;
Marinos, S.;
Emrich, F.:
Left Ventricular Assist Devices and their Related Acute Adverse Events: Causes, Outcome, and Management Protocol
Bhadra, O. D.;
Pausch, J.;
Aubin, H.;
Akhyari, P.;
Lichtenberg, A.;
Barten, M.;
Schäfer, A.;
Alassar, Y.;
Reichenspurner, H.;
Bernhardt, A. M.:
LVAD Explantation Using a Double-Patch Technique
Heise, E.;
Franz, M.;
Aburahma, K.;
Iablonskii, P.;
Bobylev, D.;
Saipbaev, A.;
Schwerk, N.;
Sommer, W.;
Greer, M.;
Avsar, M.;
Warnecke, G.;
Haverich, A.;
Kühn, C.;
Salman, J.;
Ius, F.:
Nine-Year Experience with Perioperative Desensitization in Patients with Preformed Donor-Specific Antibodies in Lung Transplantation
Oehler, D.;
Immohr, M. B.;
Bruno, R.;
Sigetti, D.;
Haschemi, J.;
Aubin, H.;
Tudorache, I.;
Westenfeld, R.;
Bönner, F.;
Kelm, M.;
Lichtenberg, A.;
Boeken, U.:
Treatment and Outcome of COVID-19 after Heart Transplantation: Update from a German Transplant Center
Brenner, P.;
Reichart, B.;
Längin, M.;
Bender, M.;
Mayr, T.;
Güthoff, S.;
Michel, S.;
Buchholz, S.;
Radan, J.;
Mokelke, M.;
Buttgereit, I.;
Neumann, E.;
Klymiuk, N.;
Wolf, E.;
Walz, C.;
Reimann, K.;
Ayares, D.;
Hagl, C.;
Steen, S.;
Abicht, J. M.:
State of the Art and Major Progress in Preclinical and Clinical Cardiac Xenotransplantation
Heise, E.;
Franz, M.;
Greer, M.;
Aburahma, K.;
Natanov, R.;
Iablonskii, P.;
Saipbaev, A.;
Welte, T.;
Haverich, A.;
Salman, J.;
Kühn, C.;
Ius, F.:
Lung Transplantation in Patients with Irreversible Lung Injury Due to SARS-CoV-2: A Single-Center Experience
Hua, X.;
Fuhrmann, R.;
Sinning, C.;
Holst, T.;
Pecha, S.;
Al Assar, Y.;
Sill, B.;
Girdauskas, E.;
Reichenspurner, H.;
Petersen, J.:
Assessment of Cardiac Performance by Global Longitudinal Strain after Aortic Valve Surgery in Severe Aortic Regurgitation
Salzmann, S.;
Laferton, J.;
Shedden-Mora, M.;
Horn, N.;
Gärtner, L.;
Schröder, L.;
Rau, J.;
Schade-Brittinger, C.;
Murmann, K.;
Rastan, A.;
Andrási, T.;
Böning, A.;
Salzmann-Djufri, M.;
Löwe, B.;
Brickwedel, J.;
Albus, C.;
Wahlers, T.;
Hamm, A.;
Hilker, L.;
Albert, W.;
Zimmermann, T.;
Ismail, I.;
Strauß, B.;
Doenst, T.;
Schedlowski, M.;
Moosdorf, R.;
Rief, W.:
Pre-surgery Optimization of Patients’ Expectations to Improve Outcome in Heart Surgery: Study Protocol of the Randomized Controlled Multicenter PSY-HEART-II Trial
Kucherenko, M.;
Kukucka, M.;
Sang, P.;
Hegemann, N.;
Hennig, F.;
Yeter, R.;
Gransar, T.;
Mladenow, A.;
Emmerich, A.;
Grune, J.;
Falk, V.;
Kübler, W. M.;
Knosalla, C.:
Ultrasound Assessment of Pulmonary Artery Stiffness in Pulmonary Hypertension due to Left Heart Disease (PH-LHD)
Pölzl, L.;
Sterzinger, P.;
Lohmann, R.;
Eder, J.;
Nägele, F.;
Holfeld, J.;
Hirsch, J.;
Graber, M.;
Ruttmann-Ulmer, E.;
Bonaros, N.;
Grimm, M.;
Engler, C.;
Gollmann-Tepeköylü, C.:
High-Sensitivity Troponin T and Creatine Kinase MB Predict Mortality after Cardiac Surgery
Immohr, M. B.;
Hettlich, V.;
Aubin, H.;
Dalyanoglu, H.;
Brandenburger, T.;
Kindgen-Milles, D.;
Tudorache, I.;
Akhyari, P.;
Lichtenberg, A.;
Boeken, U.:
Early Veno-Venous Extracorporeal Membrane Oxygenation after Intubation Increases Outcome in Critically Ill COVID-19 Patients
Kuzmin, B.;
Movsisyan, A.;
Azizzadeh, F.;
Praetsch, F.;
Keyser, O.;
Fadel, M.;
Slottosch, I.;
Scholz, F.;
Wippermann, J.;
Scherner, M.:
Death Predictors in Patients with COVID-19 on Venovenous ECMO
Hettlich, V. H.;
Immohr, M. B.;
Brandenburger, T.;
Kindgen-Milles, D.;
Feldt, T.;
Akhyari, P.;
Igor, T.;
Aubin, H.;
Dalyanoglu, H.;
Lichtenberg, A.;
Boeken, U.:
Life Beyond ECMO: A Six-Month Follow-Up After ECMO Support for Therapy-Refractive ARDS in Case of SARS-CoV-2 Infection
Immohr, M. B.;
Hettlich, V.;
Aubin, H.;
Dalyanoglu, H.;
Ballázs, C.;
Kindgen-Milles, D.;
Tudorache, I.;
Lichtenberg, A.;
Akhyari, P.;
Boeken, U.:
Outcome of Veno-Venous Extracorporeal Membrane Oxygenation in Obese COVID-19 Patients Is Not Inferior to Normal Weight Patients
Saemann, L.;
Hoorn, F.;
Georgevici, A. I.;
Korkmaz-Icöz, S.;
Veres, G.;
Guo, Y.;
Simm, A.;
Karck, M.;
Wenzel, F.;
Szabó, G.:
Ex Situ Perfusion with Histidine-Tryptophan-Ketoglutarate-N Improves Myocardial Microvascular Circulation and Diastolic Dysfunction of Porcine Donor Hearts
Dieterlen, M. T.;
Schütte, P.;
Klaeske, K.;
Wiesner, K.;
Kang, J.;
Ginther, A.;
Bovet, M.;
Ossmann, S.;
Dix, M.;
Borger, M. A.;
Hoyer, A.:
Comparable Grade of Kidney Injury in DelNido and HTK Cardioplegia after 90-Minute Cardiopulmonary Bypass
Aburahma, K.;
Franz, M.;
Julia, C.;
Heise, E.;
Saipbaev, A.;
Mueller, C.;
Kühn, C.;
Haverich, A.;
Warnecke, G.;
Avsar, M.;
Schwerk, N.;
Salman, J.;
Bobylev, D.;
Ius, F.:
Nine-Year Experience with Treatment of Early Donor Specific Anti-HLA Antibodies in Pediatric Lung Transplant Recipients
Ludwig, S.;
Ben, A. W.;
Coisne, A.;
Ruge, H.;
Bleiziffer, S.;
Weimann, J.;
Duncan, A.;
Nickenig, G.;
Hausleiter, J.;
Adam, M.;
Dumonteil, N.;
Sondergaard, L.;
Garatti, A.;
Schmidt, T.;
Gry, D.;
Maurizio, T.;
Walther, T.;
Kempfert, J.;
Obadia, J. F.;
Reardon, M.;
Andreas, M.;
Denti, P.;
Praz, F.;
Von, B. R.S.;
Blankenberg, S.;
Reichenspurner, H.;
Modine, T.;
Conradi, L.:
2-Year Outcomes after Transcatheter Mitral Valve Replacement: Results from the CHOICE-MI Registry
Marin-Cuartas, M.;
De Waha, S.;
Naumann, S.;
Deo, V.S.;
Noack, T.;
Hoyer, A.;
Holzhey, D.;
Leontyev, S.;
Saeed, D.;
Misfeld, M.;
Ender, J.;
Abdel-Wahab, M.;
Desch, S.;
Thiele, H.;
Borger, M.;
Kiefer, P.:
Incidence and Outcomes of Emergent Intraprocedural Surgical Conversion during Transcatheter Aortic Valve Implantation: Insights from a Multicentric Germany-Wide Analysis
Schäfer, A.;
Bhadra, O. D.;
Conradi, L.;
Westermann, D.;
Reichenspurner, H.;
De Backer, O.;
Sondergaard, L.;
Qureshi, W. T.;
Kakouros, N.;
Amat-Santos, I.;
Kaneko, T.;
Teles, R.;
Nolasco, T.;
Abecasis, M.;
Werner, N.;
Sacha, J.;
Trani, C.;
Mangieri, A.;
Regueiro, A.;
Biancari, F.;
Niemelä, M.;
Giannini, F.;
Buono, A.;
Bruno, F.;
Savontaus, M.;
Ielasi, A.;
Ferraro, P.;
Biondi-Zoccai, G.;
Morello, A.;
Giordano, A.:
Procedural Success in Transaxillary Transcatheter Aortic Valve Implantation According to Type of Transcatheter Heart Valve: Results from the Multicenter TAXI Registry
Beyer, M.;
Muller, D.;
De Marco, F.;
Badhwar, V.;
Obadia, J. F.;
Praz, F.;
Modine, T.;
Tonino, P.;
Dahle, G.;
Cerillo, A.;
Reichenspurner, H.;
Conradi, L.:
Secondary Retensioning of a Tethered Device for Transapical Transcatheter Mitral Valve Implantation
Serio, D.;
Renker, M.;
Blumenstein, J.;
Möllmann, H.;
Eckel, C.;
Grothusen, C.;
Tiyerili, V.;
Choi, Y. H.;
Hamm, C.;
Kim, W. K.;
Charitos, E.:
An Investigation on the Factors that Affect Sizing in Two Generations of Self-Expandable Transcatheter Valves and Their Influence on Paravalvular Regurgitation (PVR)
Jashnieh, P.;
Münch, P.;
Schmidt, V.;
Kozin, I.;
Gehlweiler, K.;
Chekhoeva, A.;
Gräf, M.;
Soler, S.;
Bartok, E.;
Lichtenberg, A.;
Weber, E.;
Aubin, H.:
Decellularized Aortic Valve Tissue Induces Inflammatory Chemokine/Cytokine Secretion of Smooth Muscle Cells
Schiffer, M.;
Carls, E.;
Hildebrand, S.;
De La Fuente, J. M.;
Hesse, M.;
Geisen, C.;
Pfeifer, A.;
Bakhtiary, F.;
Fleischmann, B. K.;
Roell, W.:
Reduction of Post-Infarct Ventricular Tachycardia by Transplantation of Transgenic Cardiac Fibroblasts
Guenther, S.;
Cheaban, R.;
Höpner, L.;
Weinrautner, N.;
Kirschning, T.;
Al-Khalil, R.;
Brünger, F.;
Serrano, R.;
Barndt, I.;
Wiemer, M.;
Rudloff, M.;
Helms, S.;
Gummert, J.;
Schramm, R.:
Six-Month Outcomes after Extracorporeal Membrane Oxygenation Therapy for Severe COVID-19-Related Pulmonary Failure
Silaschi, M.;
Cattelaens, F.;
Alirezaei, H.;
Vogelhuber, J.;
Sugiura, A.;
Tanaka, T.;
Sudo, M.;
Zimmer, S.;
Nickenig, G.;
Weber, M.;
Bakhtiary, F.;
Wilde, N.:
Propensity Score Matched Comparison of Transcatheter Edge-to-Edge Mitral Valve Repair versus Minimally invasive Mitral Valve Surgery
Conradi, L.;
Petronio, A. S.;
Ruge, H.;
Labrousse, L.;
Walther, T.;
Reuthebuch, O.;
Praz, F.;
Zierer, A.;
Kempfert, J.;
Nia, P. Sardari;
Bleiziffer, S.;
Dahle, G.;
Lutter, G.;
Dumonteil, N.:
Periprocedural Outcomes of Transcatheter Mitral Valve Implantation Using a Tethered Device in a Post-market Follow-up Study
Silaschi, M.;
Wilde, N.;
Alirezaei, H.;
Vogelhuber, J.;
Sugiura, A.;
Tanaka, T.;
Sudo, M.;
Kavsur, R.;
Cattelaens, F.;
Ahmad, A. El-Sayed;
Fehske, W.;
Zimmer, S.;
Nickenig, G.;
Bakhtiary, F.;
Weber, M.:
Transcatheter Tricuspid Valve Repair versus Minimally Invasive Beating-Heart Tricuspid Valve Surgery in High-Risk Patients