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, Yonne Peters, Marco J. Bruno, Peter D. Siersema, Arjun Dave Koch
Published: 14 September 2021
Abstract:
Background and study aims Several techniques exist for the eradication of Barrett’s esophagus (BE); however, all have limitations regarding successful conversion to squamous epithelium and a complication profile. We aimed to assess the feasibility and safety of a new non-thermal device, the EndoRotor, for the eradication of BE as a first-line ablation technique. Patients and methods Patients with BE were prospectively included in 2 tertiary referral centers in The Netherlands. Inclusion criteria: BE-length 2-5cm, with low-grade dysplasia, high-grade dysplasia or residual BE after endoscopic resection (ER) of a lesion containing early neoplasia. Exclusion criteria: previous ER >50% circumference, or previous ablation therapy. Follow-up endoscopy was performed after 3 months. Outcomes were the percentage of endoscopically visible BE surface regression and complications. Results Thirty patients (25 male, age 66 years [IQR: 59–73], median BE C0M3) were included. Eighteen patients underwent ER prior to ablation. Median percentage BE ablated was 100% (IQR: 94-100). Median visual BE surface regression at three-months follow-up was 80% (IQR: 68–95). Multiple residual Barrett’s islands were commonly seen. Six patients(20%) had a treatment-related complication requiring intervention, including one perforation(3%), one postprocedural hemorrhage(3%), and four strictures(13%). Post-procedural pain was reported in 18 patients(60%). Conclusions For the endoscopic ablation of BE, the EndoRotor procedure was found to be technically demanding with a longer procedure time compared to established ablation techniques and a high complication rate. Based on these results, we do not recommend the EndoRotor as a first-line ablation technique for the eradication of BE.
, Jari Halonen, Annastiina Husso, Helli Väänänen, Leena T. Berg
The Thoracic and Cardiovascular Surgeon; https://doi.org/10.1055/s-0041-1731767

Abstract:
Background Incisional negative pressure wound therapy has been described as an effective method to prevent wound infections after open heart surgery in several publications. However, most studies have examined relatively small patient groups, only a few were randomized, and some have manufacturer-sponsorship. Most of the studies have utilized Prevena; there are only a few reports describing the PICO incisional negative pressure wound therapy system. Methods We conducted a prospective cohort study involving a propensity score-matched analysis to evaluate the effect of PICO incisional negative pressure wound therapy after coronary artery bypass grafting. A total of 180 high-risk patients with obesity or diabetes were included in the study group. The control group included 772 high-risk patients operated before the initiation of the study protocol. Results The rates of deep sternal wound infections in the PICO group and in the control group were 3.9 and 3.1%, respectively. The rates of superficial wound infections needing operative treatment were 3.1 and 0.8%, respectively. After propensity score matching with two groups of 174 patients, the incidence of both deep and superficial infections remained slightly elevated in the PICO group. None of the infections were due to technical difficulties or early interruption of the treatment. Conclusion It seems that incisional negative pressure wound therapy with PICO is not effective in preventing wound infections after coronary artery bypass grafting. The main difference in this study compared with previous reports is the relatively low incidence of infections in our control group.
Melanie Deipenbrock, Francesca Scotti, Boris Mo, ,
Published: 14 September 2021
Abstract:
Orthosiphon stamineus leaves (Java tea) extract is traditionally used for the treatment of urinary tract infections. According to recent in vitro data, animal infection studies, and transcriptomic investigations, polymethoxylated flavones from Java tea exert antiadhesive activity against uropathogenic Escherichia coli (UPEC). This antiadhesive activity has been shown to reduce bladder and kidney lesion in a mice infection model. As no data on the antivirulent activity of Java tea intake on humans are available, a biomedical study was performed on 20 healthy volunteers who self-administered Orthosiphon infusion (4 × 3 g per day, orally) for 7 days. The herbal material used for the study conformed to the specification of the European Pharmacopoeia, and ultra high-performance liquid chromatography (UHPLC) of the infusion showed rosmarinic acid, caffeic acid, and cichoric acid to be the main compounds aside from polymethoxylated flavones. Rosmarinic acid was quantified in the tea preparations with 243 ± 22 µg/mL, indicating sufficient reproducibility of the preparation of the infusion. Urine samples were obtained during the biomedical study on day 1 (control urine, prior to Java tea intake), 3, 6 and 8. Antiadhesive activity of the urine samples was quantified by flowcytometric assay using pre-treated UPEC NU14 and human T24 bladder cells. Pooled urine samples indicated significant inhibition of bacterial adhesion on day 3, 6 and 8. The urine samples had no influence on the invasion of UPEC into host cells. Bacterial proliferation was slightly reduced after 24 h incubation with the urine samples. Gene expression analysis (qPCR) revealed strong induction of fitness and motility gene fliC and downregulation of hemin uptake system chuT. These data correlate with previously reported datasets from in vitro transcriptomic analysis. Increased bacterial motility was monitored using a motility assay in soft agar with UPEC UTI89. The intake of Java tea had no effect on the concentration of Tamm-Horsfall Protein in the urine samples. The present study explains the antiadhesive and anti-infective effect of the plant extract by triggering UPEC from a sessile lifestyle into a motile bacterial form, with reduced adhesive capacity.
Susanne Rohrbach‡, Elisabeth Dominik‡, Nikolas Mirow, Sebastian Vogt, Andreas Böning,
The Thoracic and Cardiovascular Surgeon; https://doi.org/10.1055/s-0041-1731772

Abstract:
Objectives Although concomitant surgical ablation can help to reach freedom from atrial fibrillation (FREEAF) even in patients with permanent atrial fibrillation (AF), some cardiac surgeons hesitate to perform concomitant ablation to avoid perioperative risk escalation. Here, we investigated outcome and predicators of therapeutic success of concomitant surgical ablation in an all-comers study. Methods Ablation-naïve patients with formerly accepted permanent AF (FAP, n = 41) or paroxysmal AF (parAF, n = 24) underwent concomitant epicardial bipolar radio frequency ablation and implantable loop recorder (ILR) at two surgical departments. Follow-up examination for 24 months included electrocardiogram, ILR readout, 24h Holter monitoring, echocardiography, and blood sampling. Results Eighty-six percent of parAF and 70% of FAP patients reached FREEAF (month 24). Mortality was low (parAF/FAP: 5.3 ± 0.2%/4.1 ± 0.3%; p < 0.05; EuroScoreII; 6.1 ± 0.7%/6.4 ± 0.4%, p = ns) and no strokes occurred. FREEAF induced atrial reverse remodeling (left atrial [LA] diameter: −6.7 ± 2.2 mm) and improved cardiac function (left ventricular ejection fraction [LVEF]: +7.3 ± 2.8%), while AF resulted in further atrial dilation (+8.0 ± 1.0 mm, p < 0.05) and LVEF reduction (−7.0 ± 1.3%, p < 0.05). Higher LV (odds ratio [OR]: 1.164) and LA diameter (OR: 1.218), age (OR: 1.180) and body mass index (BMI) (OR: 1.503) increased the risk factors of AF recurrence. Patients remaining in sinus rhythm (SR) demonstrated a decrease in BMI, while AF recurrence was associated with stable overweight. Further aging did not reduce FREEAF. Conclusions Long-term SR is achievable by concomitant surgical ablation even in FAP patients. Therefore, it should be offered routinely. Obesity influences therapeutic long-term success but may also offer addressable therapeutic targets to reach higher FREEAF rates.
Published: 14 September 2021
Abstract:
Since its first description in 2004 by Ganz et al. [1], radiofrequency ablation (RFA) has become the standard treatment of flat dysplastic Barrett’s esophagus (BE) after endoscopic resection of all visible lesions. Compared with alternative eradication methods, such as stepwise endoscopic resection, (hybrid) argon plasma coagulation, and cryoablation, RFA is the best validated and most used ablation method that is both effective and relatively safe, and is unanimously recommended by various guidelines. “Moving forward, the optimal management strategy for patients without, after successful or after failed RFA will require individual clinical risk-stratification tools that balance the risks of the procedure, progression, and death related to esophageal cancer against the patient’s age and life expectancy, comorbidities, and the risk of death from other diseases.” RFA achieved complete esophageal resurfacing to normal squamous epithelium after a median of three sessions in 94 % of patients in the Dutch Barrett’s registry [2]. In the Netherlands, the management of patients with early neoplastic BE is uniquely organized, with care centralized in high-volume Barrett’s Expert Centers that follow an agreed treatment protocol, and a data registry maintained since 2008. Studies from other groups have reported lower complete remission rates of BE after RFA. Hence, consensus on a suggested minimum complete ablation rate of BE as a quality parameter remains difficult. The UK registry demonstrated an improvement in the RFA results over time as experience in the method increases [3]. Following their previous RFA outcome study, van Munster et al. [4] present results of an observational study, again based on data from the Dutch Barrett’s Expert Center registry, in this issue of Endoscopy. The study provides a detailed analysis of the characteristics and outcomes of patients with neoplastic BE who had a poor response to RFA therapy. From this registry, 1386 patients who underwent at least one RFA session for treatment of Barrett’s neoplasia were included (73 % with high grade dysplasia or early cancer). A total of 134 patients (10 %) were poor healers but all achieved complete esophageal healing after additional time and intensified reflux therapy with increased doses of proton pump inhibitors. Among the poor healers, 66 % finally achieved complete eradication of BE (CE-BE); however, stricture development was significantly higher compared with patients with normal healing (34 % vs 14 %; P < 0.01). After complete mucosal healing, half of the initially poor healers had achieved more than 50 % squamous regeneration after the first RFA, and all but two of these patients eventually achieved excellent RFA results (97 % CE-BE). Conversely, 74 of the 1386 patients (5 %) had poor squamous regeneration after the first RFA session and 47 of these patients (64 %) did not achieve CE-BE. The residual Barrett’s burden probably explains the observed higher rate of progression to advanced disease in this group of patients with poor squamous regeneration after RFA. The endoscopic definitions of poor healing (active inflammatory changes with mucosal swelling and exudates and/or presence of ulcerations ≥ 3 months after RFA) and poor squamous regeneration (< 50 % BE regression) present challenges in clinical practice as these features are difficult to estimate when unusually shaped Barrett’s areas and large islands remain after RFA. Regenerative and inflammatory alterations after RFA are often hard to distinguish from neoplastic changes. The endoscopic assessment of inflammation and the quantification of squamous regeneration is very operator dependent and subject to bias. The Prague classification that reports the extent of BE by estimating the circumferential and maximal length is often not helpful or not applicable after RFA. Artificial intelligence-based methods promise to reliably quantify the residual area of BE after RFA in three-dimensional reconstruction of the esophageal mucosa [5]. Smart algorithms that support the endoscopist in recognition of inflammation and neoplasia based on the endoscopic appearance and morphology are under clinical evaluation [6]. Current guidelines remain silent on how to manage patients with residual BE despite several RFA attempts. Patients with poor squamous regeneration are mainly also those with poor mucosal healing (91 % in the van Munster study). A pragmatic approach to a poor healing response would be to postpone RFA for at least 6 weeks in order to check the patient’s compliance and maximize the antireflux medication including proton pump inhibitors and additional H2 antagonists. To avoid poor healing, it seems mandatory to control the reflux before embarking on endoscopic treatment. Fortunately, time is on our side in cases of poor response without dysplasia and without worrying endoscopic features. Visible lesions that emerge/resurface after RFA can be treated by endoscopic resection and should not be ablated. Endoscopic surveillance with the option of endoscopic resection seems a reasonable option, at least in frail patients or in those with significant comorbidities and limited life expectancy. In this and other studies, certain risk factors have been identified to predict poor response to RFA: higher body mass index, longer BE length, reflux esophagitis, genetic biomarkers, and poor squamous regeneration after first endoscopic treatment. Most recently, the thickness of the Barrett’s epithelium measured by volumetric laser endomicroscopy has also emerged as a predictor of RFA response. An increase in the mean Barrett’s epithelium thickness of 100 μm resulted in a 12 % lower response to RFA when this was assessed as percentage reduction in Prague score [7]. Whether adaptation of the ablation energy to the thickness of the Barrett’s mucosa would result in higher rates of complete...
Freyr Jóhannsson, Paulina Cherek, Maonian Xu, Óttar Rolfsson,
Published: 14 September 2021
Abstract:
The lichen compound protolichesterinic acid (PA) has an anti-proliferative effect against several cancer cell lines of different origin. This effect cannot be explained by the known inhibitory activity of PA against 5- and 12-lipoxygenases. The aim was therefore to search for mechanisms for the anti-proliferative activity of PA. Two cancer cell lines of different origin, both sensitive to anti-proliferative effects of PA, were selected for this study, T-47D from breast cancer and AsPC-1 from pancreatic cancer. Morphological changes were assessed by transmission electron microscopy, HPLC coupled with TOF spectrometry was used for metabolomics, mitochondrial function was measured using the Agilent Seahorse XFp Real-time ATP assay and glucose/lactate levels by radiometry. Levels of glutathione, NADP/NADPH and reactive oxygen species [ROS] were measured by luminescence. Following exposure to PA both cell lines showed structural changes in mitochondria that were in line with a measured reduction in oxidative phosphorylation and increased glycolysis. These changes were more marked in T-47D, which had poorer mitochondrial function at baseline. PA was processed and expelled from the cells via the mercapturic pathway, which consumes glutathione. Nevertheless, glutathione levels were increased after 24 hours of exposure to PA, implying enhanced synthesis. Redox balance was not much affected and ROS levels were not increased. We conclude that PA is metabolically processed and expelled from cells, leading indirectly to increased glutathione levels with minimal effects on redox balance. The most marked effect was on mitochondrial structure and metabolic function implying that effects of PA may depend on mitochondrial fitness.
Hans Scherübl
DMW - Deutsche Medizinische Wochenschrift, Volume 146, pp 1218-1225; https://doi.org/10.1055/a-1529-4521

Abstract:
Typ-2-Diabetes-mellitus-Patienten sterben heute am häufigsten an Krebs. In Dickdarm, Bauchspeicheldrüse, Gallenblase, Leber, Magen und vielen weiteren Geweben können sich T2D-assoziierte Malignomen bilden. Weitere Faktoren, wie z. B. Tabakkonsum, Bewegungsmangel und Übergewicht, erhöhen das Risiko. Menschen mit Typ-2-Diabetes sollten deshalb frühzeitig und regelmäßig zur Teilnahme an etablierten Krebsfrüherkennungsmaßnahmen eingeladen werden. Type-2-diabetes (T2D) increases the risk for several cancers and cancer has become the major cause of death of T2D-patients. T2D is causally associated with colorectal, pancreatic, gallbladder, biliary, hepatocellular, gastric, esophageal, oral, breast, endometrial, ovary, kidney and thyroid cancers as well as leukemias. When T2D goes along with tobacco smoking, alcohol use, physical inactivity, excess body weight, poor diet, familial risk or certain chronic infections, the cumulative cancer risk rises, and T2D-patients often suffer from cancer disease at younger age. T2D-patients should be encouraged to join cancer screening programmes even at younger age than the average non-diabetic population. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
, Francesco D'Urbano, Francesco Bagolini, Giulia Salerno Trapella, Francesco Quarantotto, Giorgio Cavallesco, Pio Maniscalco
The Thoracic and Cardiovascular Surgeon; https://doi.org/10.1055/s-0041-1731778

Abstract:
Background Thoracoscopic thymectomy is increasingly performed for the treatment of early stage thymoma. It is characterized by shorter postoperative hospital stay, decreased intraoperative blood loss, and fewer complications compared with transsternal thymectomy. Unilateral video-assisted thoracic surgery (VATS) thymectomy can be easily performed from either side of the thorax, because thymus is located in the middle of mediastinum. However, the side that provides better outcomes remains controversial. The purpose of this study was to compare the efficacy of right and left approaches in performing unilateral thoracoscopic thymectomy for thymoma. Methods Consecutive patients affected by thymoma who underwent VATS thymectomy on either side between February 2001 and March 2020 were enrolled in the study. Clinicopathologic, surgical, and oncological outcomes were retrospectively analyzed and compared among the two surgical approaches. Results Unilateral VATS approaches were performed on 29 patients: 12 (41%) on the left side and 17 (59%) on the right side. The mean age was 63.1 ± 11.3 years and the female/male ratio was 1.73:1. The mean operative time and the hospital stay for the left-side VATS and right-side VATS groups were, respectively, 168 ± 49.5 versus 171 ± 47.9 minutes (p = 0.9) and 3 ± 1.03 days versus 3.65 ± 1.93 days (p = 0.7). Postoperative complications occurred in one patient (3%) for left-side VATS group and one patient (3%) for right-side VATS. The 5-year disease-free survival was comparable between two groups (p = 0.74). Conclusions Unilateral VATS thymectomy in patients with thymoma can be safely and effectively performed by experienced surgeons in either side of the thorax with equivalent oncological outcomes.
Mathias Friebe, Johanna Coenen
DMW - Deutsche Medizinische Wochenschrift, Volume 146, pp 1207-1210; https://doi.org/10.1055/a-1546-4686

Abstract:
Zusammenfassung Anamnese und klinischer Befund Wir berichten über eine 89-jährige Patientin, für die aufgrund einer Bewusstseinsstörung der Notarzt alarmiert wurde. Sie war soporös und zeigte eine deutliche generalisierte Muskelrigidität. Fremdanamnestisch war der fehlerhafte Gebrauch eines Fentanyl-Pflasters zu eruieren. Therapie und Verlauf Durch die Antidot-Gabe von Naloxon kam es zu einer Restitution. Die Notwendigkeit einer repetitiven Gabe bestätigte die Verdachtsdiagnose. Folgerung Die Gabe von Fentanyl über die Haut in Form transdermaler therapeutischer Systeme (TTS) erfreut sich seit Jahren einer zunehmenden Beliebtheit. Bei unsachgemäßer Verabreichung treten Intoxikationen mit den führenden Symptomen Bewusstseinsminderung und Atemdepression auf. Dieser Fallbericht ergänzt das Spektrum um den Rigor der quergestreiften Skelettmuskulatur, der sonst im Zusammenhang mit der intravenösen Applikation beschrieben wird.
DMW - Deutsche Medizinische Wochenschrift, Volume 146, pp 1174-1174; https://doi.org/10.1055/a-1540-3999

Abstract:
2018 wurden in Deutschland insgesamt 23 812 Revisionseingriffe bei Knie-Endoprothesen durchgeführt, ein Anstieg von 20,8 % gegenüber 2008. Die Zahl der primären Knie-Totalendoprothesen (Knie-TEP) stieg im gleichen Zeitraum um 23,8 % auf 188 866. Somit war 2018 bei 12,6 % der Knie-TEP eine Revision erforderlich. Septische Eingriffe nahmen bei allen Revisionen um 51,7 % zu, wobei jüngere Patienten tendenziell häufiger betroffen waren. Die steigende Zahl der Revisionseingriffe bei Knie-TEP zeige, so die Autoren, einen Optimierungsbedarf bei der Behandlung, um die primäre Endoprothese zu verzögern und periprothetische Gelenkinfektionen zu vermeiden. [nu] Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
Johannes B. Dahm
Published: 14 September 2021
Kardiologie up2date, Volume 17, pp 218-218; https://doi.org/10.1055/a-1578-8197

Abstract:
Die viel diskutierten Zweifel an ISAR-REACT-5 kommen auch in der hier vorgelegten Post-hoc Analyse einer Subpopulation der ISAR-REACT-5 Studie zum Ausdruck: Bei ISAR-REACT-5 handelt es sich entgegen dem häufig wahrgenommen Eindruck nicht um eine Vergleichsstudie zwischen Ticagrelor und Prasugrel. In ISAR-REACT-5 wurde die Gabe der untersuchten Plättchenhemmer unterschiedlich gehandhabt, was zu dem nicht unerheblichen Bias führte, dass in der Prasugrelgruppe hochsignifikant mehr blutungsgefährdete Patienten vor PCI ausgeschlossen und ausgerechnet wurden (PRASUGREL wurde erst NACH Randomisierung gegeben) als in der Ticagrelor-Gruppe, in der die Randomisierung bereits VOR der Koronarangiographie/PCI erfolgte. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
Katharina Franke
Published: 14 September 2021
Kardiologie up2date, Volume 17, pp 212-212; https://doi.org/10.1055/a-1578-8240

Abstract:
In der Schwangerschaft ist nicht nur das Risiko für kardiovaskulären Erkrankungen wie Bluthochdruck, Thrombembolie oder Kardiomyopathie erhöht, sondern es steigt auch die Inzidenz von arteriellen Dissektionen. In einer US-amerikanischen Studie konnte das Dissektionsrisiko in einer großen Kohorte von Frauen vor, während und nach der Entbindung genauer beleuchtet werden. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
, Kseniya Belyaeva, Veronika Gen', Lina Nikitina, Andrei Afonin
Published: 14 September 2021
Abstract:
Oxalylacetylenes act as dielectrophiles in the annulation of quinolines with highly functionalized 1,3-oxazine cycle decorated by the ethynyl, oxalyl, ester and aryl substituents. The annulation proceeds under mild condition (room temperature, without catalysts) in 2:1 mode with respect to acetylene and quinoline to deliver 1,3-oxazinoquinolines in 45-88% yields. A beneficial feature of the reaction is that, in contrast to results on the reaction of quinolines with trifluoroacetylacetylenes in the presence of water, where H2O acted as a third electrophile, this reaction well tolerates the aqueous medium. This reaction tolerates also isoquinoline and phenanthridine.
Friederike Maechler
Krankenhaushygiene up2date, Volume 16, pp 299-312; https://doi.org/10.1055/a-1184-9310

Abstract:
Der Artikel geht ein auf die Definition, die Epidemiologie der Kolonisation und Infektionen mit gramnegativen Erregern (MRGN) und nennt die Faktoren, welche die Verbreitung im Krankenhaus im Nichtausbruchsfall begünstigen. In Teil 2 des Artikels in der folgenden Ausgabe werden Präventionsmöglichkeiten dargestellt [1]. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
Veronique R. H. Van der Voort, Leon M. G. Moons, Wilmar de Graaf, Ruud W. M. Schrauwen, Wouter L. Hazen, Tom C. J. Seerden, Frank P. Vleggaar, Paul Didden
Published: 14 September 2021
Abstract:
Background Suboptimal lifting increases complexity of endoscopic mucosal resection (EMR) for benign colorectal polyps. Cap-assisted EMR (EMR-C) may allow fibrotic polyp tissue to be captured in the snare. This study evaluated the efficacy and safety of EMR-C for benign nonlifting colorectal polyps. Methods This was a multicenter study, which prospectively registered all EMR-C procedures (2016–2018) for presumed benign nonlifting colorectal polyps. Results 70 nonlifting polyps with a median size of 25 mm (interquartile range [IQR] 15–40) were treated with EMR-C. Complete polyp removal was achieved in 68 (97.1 %), including 47 (67.1 %) with EMR-C alone. Overall, 66 polyps showed benign histology, and endoscopic follow-up after a median of 6 months (IQR 6–10) showed recurrence in 19.7 %. First (n = 10) and second (n = 2) benign recurrences were all treated endoscopically. Deep mural injury type III–V occurred in 7.4 % and was treated successfully with clips. Conclusion EMR-C may be an alternative therapeutic option for removal of benign nonlifting polyp tissue. Although recurrence still occurs, repeat endoscopic therapy usually leads to complete polyp clearance.
Huan Du, Tong Xu, Huan Yi, Xinmei Xu, Chengcheng Zhao, Yiman Ge, ,
Published: 14 September 2021
Abstract:
The dried stem bark of Berberis kansuensis is a commonly used Tibetan herbal medicine for the treatment of diabetes. Its main chemical components are alkaloids, such as berberine, magnoflorine and jatrorrhizine. However, the role of gut microbiota in the in vivo metabolism of these chemical components has not been fully elucidated. In this study, an ultra-high performance liquid chromatography method coupled with Orbitrap mass spectrometry (UHPLC-Orbitrap-MS) technology was applied to detect and identify prototype components and metabolites in rat intestinal contents and serum samples after oral administration of a B. kansuensis extract. A total of 16 prototype components and 40 metabolites were identified. The primary metabolic pathways of the chemical components from B. kansuensis extract were demethylation, desaturation, deglycosylation, reduction, hydroxylation, and other conjugation reactions including sulfation, glucuronidation, glycosidation, and methylation. By comparing the differences of metabolites between diabetic and pseudo-germ-free diabetic rats, we found that the metabolic transformation of some chemical components in B. kansuensis extract such as bufotenin, ferulic acid 4-O-β-D-glucopyranoside, magnoflorine, and 8-oxyberberine, was affected by the gut microbiota. The results revealed that the gut microbiota can affect the metabolic transformation of chemical constituents in B. kansuensis extract. These findings can enhance our understanding of the active ingredients of B. kansuensis extract and the key role of the gut microbiota on them.
Published: 14 September 2021
Abstract:
Medicinal plants play an important dual role in the context of the heterologous expression of high-value pharmaceutical products. On the one hand, the classical biochemical and modern omics approaches allowed for the discovery of various genes encoding biosynthetic pathways in medicinal plants. Recombinant DNA technology enabled introducing these genes and regulatory elements into host organisms and enhancing the heterologous production of the corresponding secondary metabolites. On the other hand, the transient expression of foreign DNA in plants facilitated the production of numerous proteins of pharmaceutical importance. This review summarizes several success stories of the engineering of plant metabolic pathways in heterologous hosts. Likewise, a few examples of recombinant protein expression in plants for therapeutic purposes are also highlighted. Therefore, the importance of medicinal plants has grown immensely as sources for valuable products of low and high molecular weight. The next step ahead for bioengineering is to achieve more success stories of industrial-scale production of secondary plant metabolites in microbial systems and to fully exploit plant cell factoriesʼ commercial potential for recombinant proteins.
Cornel Sieber
DMW - Deutsche Medizinische Wochenschrift, Volume 146, pp 1169-1170; https://doi.org/10.1055/a-1219-5803

Abstract:
Das „Hinübergehen“ (lat. Transitio) von Kindern und jungen Erwachsenen mit chronischen Krankheiten zu einer erwachsenenorientierten Gesundheitsversorgung ist herausfordernd. Die Wichtigkeit der Transitionsmedizin ist unbestritten, da gerade in dieser vulnerablen Lebensphase bei ungenügender Betreuung häufig auch der Grundstein für spätere gesundheitliche Komplikationen gelegt wird. Dies ist umso fataler, da heute aufgrund der Fortschritte in der Medizin Kinder mit chronischen Erkrankungen zu einem erfreulich hohen Prozentsatz eine große Lebensspanne besitzen. Die Betroffenen müssen somit Verantwortung für eine lebenslange Therapie ihrer Erkrankung mit und ohne Beeinträchtigungen übernehmen. Neben den betreuenden Fachleuten im Gesundheitswesen müssen auch die Eltern lernen, Verantwortung für die medizinischen und psychosozialen Belange an die Kinder zu übertragen. Damit diese Transition gut verläuft und keine „Bruchstellen“ entstehen, bedarf es nicht nur fachlich speziell geschulter Ärztinnen und Ärzte mit ihren Teams, sondern eben auch einer engen und individuell angepassten Kommunikations- und Betreuungsstruktur. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
Kirsten Minden, Martina Niewerth, Susanne Schalm
DMW - Deutsche Medizinische Wochenschrift, Volume 146, pp 1184-1191; https://doi.org/10.1055/a-1332-9041

Abstract:
Das Jugend- und junge Erwachsenenalter stellt eine besondere Risikophase für Verlauf und Prognose rheumatischer Erkrankungen dar. Etwa die Hälfte der jungen Rheumatiker bricht in dieser lebensprägenden Zeit vorübergehend oder dauerhaft die regelmäßige fachspezifische Versorgung ab [1] [2] [3]. Worauf in der medizinischen Betreuung rheumakranker Jugendlicher und junger Erwachsener zu achten ist, wird in diesem Beitrag dargestellt. Adolescence and young adulthood represent a vulnerable phase of life, especially for young people with a chronic rheumatic disease. On the one hand, the chronic disease can impair the biopsychosocial development of young people. On the other hand, risk behaviour common in adolescence and young adulthood can negatively influence the course and outcome of the rheumatic disease. In this challenging and future health-determining phase, up to half of the young people with chronic rheumatic diseases temporarily or permanently drop out of specialized care and are therefore particularly at risk of adverse outcomes. To ensure continuity of care and the best possible outcomes for those affected, young people need education, support, and guidance. They must be prepared to be appropriately responsible and capable of managing their own health and well-being as adults. The key principles to be considered in the care of adolescents and young adults with rheumatic diseases and what is known so far about transitional care in rheumatology are presented in this paper. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
Elmar Kuhn‡, , , , Parwis Baradaran Rahmanian, Matti Adam, Victor Mauri, Tanja Rudolph, Stephan Baldus, Thorsten Wahlers
The Thoracic and Cardiovascular Surgeon; https://doi.org/10.1055/s-0041-1735476

Abstract:
Objective This study aimed to assess short-term outcomes of patients with failed aortic valve bioprosthesis undergoing valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) or redo surgical aortic valve replacement (rSAVR). Methods Between 2009 and 2019, 90 patients who underwent ViV-TAVR (n = 73) or rSAVR (n = 17) due to failed aortic valve bioprosthesis fulfilled the inclusion criteria. Groups were compared regarding clinical end points, including in-hospital all-cause mortality. Patients with endocarditis and in a need of combined cardiac surgery were excluded from the study. Results ViV-TAVR patients were older (78.0 ± 7.4 vs. 62.1 ± 16.2 years, p = 0.012) and showed a higher prevalence of baseline comorbidities such as atrial fibrillation, diabetes mellitus, hyperlipidemia, and arterial hypertension. In-hospital all-cause mortality was higher for rSAVR than in the ViV-TAVR group (17.6 vs. 0%, p < 0.001), whereas intensive care unit stay was more often complicated by blood transfusions for rSAVR patients without differences in cerebrovascular events. The paravalvular leak was detected in 52.1% ViV-TAVR patients compared with 0% among rSAVR patients (p < 0.001). Conclusion ViV-TAVR can be a safe and feasible alternative treatment option in patients with degenerated aortic valve bioprosthesis. The choice of treatment should include the patient's individual characteristics considering ViV-TAVR as a standard of care.
, James P. Manning, Aurora G. Vincent, , ,
Published: 14 September 2021
Facial Plastic Surgery; https://doi.org/10.1055/s-0041-1735560

Abstract:
Calvarial defects are commonly encountered after neurosurgical procedures, trauma, and ablative procedures of advanced head neck cancers. The goals of cranioplasty are to provide a protective barrier for the intracranial contents, to restore form, and prevent syndrome of the trephined. Autologous and alloplastic techniques are available, each with their advantages and drawbacks. A multitude of materials are available for cranioplasty, and proper timing of reconstruction with attention to the overlying skin envelope is important in minimizing complications.
, Mingon Son, Tairin Kawasaki, Misato Ito,
Published: 14 September 2021
Abstract:
A photoinduced dehydrogenative homo-coupling reaction of alkylarenes is reported. Gaseous hydrogen is evolved as the sole byproduct and neither oxidants nor hydrogen acceptors are required. The present reaction offers an environmentally benign and atom-economical means for forming sterically strained C–C single bonds. It also gives a remarkable example of photo-driven reactions overcoming a considerable rise in energy.
Abhishek Padhi, Ekta Gupta, Gaurav Singh, Shama Parveen, Arshi Islam, Bansidhar Tarai
Journal of Laboratory Physicians; https://doi.org/10.1055/s-0041-1734017

Abstract:
Introduction Delhi is hyperendemic for dengue virus (DENV) where all the four DENV have previously been reported. A constant vigilance of circulating DENV serotypes is important in surveillance, since the introduction of a new variant to areas affected by preexisting serotypes constitutes a risk factor for dengue hemorrhagic fever and dengue shock syndrome. Objectives This retrospective study was performed with an objective to determine the circulating serotype and genotype of DENV in acute phase blood samples of patients who have reported to a tertiary liver care hospital in New Delhi during the last 2 years (2017–2018). Methods The data of clinician-initiated testing for dengue nonstructural protein 1 (NS1) antigen (Ag) was searched in the institutional hospital information system. The serum sample of dengue NS1 Ag-positive cases confirmed by enzyme-linked immunosorbent assay (ELISA; PANBIO, Gyeonggi-do, ROK) and a fever duration of less than 5 days were retrieved from the laboratory archive. The DENV serotyping on these sample was performed by reverse transcriptase polymerase chain reaction (RT-PCR). Sequencing and phylogenetic analysis was done for the capsid premembrane (CprM) region to determine the genotype. Results A total of 440 acute-phase samples were received. Twenty one (4.77%) were positive for dengue NS1 Ag with a mean age of 35.1 years and male-to-female ratio of 1.1:1. Eight cases (38.09%) were positive by dengue RT-PCR and all belonged to DENV-3 serotypes. Phylogenetic tree analysis revealed DENV-3 clustered to genotype III with 100% homology with 2008 Indian subcontinent strain. Conclusion This study revealed circulation of DENV-3, genotype III in Delhi from 2017 to 2018, similar to the 2008 viral type. Virological surveillance is an important exercise to be done for viral infections with public threat and outbreak potential.
Johannes B. Dahm
Published: 14 September 2021
Kardiologie up2date, Volume 17, pp 212-212; https://doi.org/10.1055/a-1578-8134

Abstract:
Anhaltspunkte für eine erhöhte Vulnerabilität für spontane Koronardissektionen bei prämenopausalen Frauen finden sich auch in einer ganzen Reihe kasuistischer Beschreibungen (mit häufig problematischen Ergebnissen bei interventionellem Vorgehen) in der Literatur. Ein systematischer Review der vorliegenden Daten könnte hier mehr Klarheit bringen. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
Orkun Baloglu, Lauren K. Flagg, Ahmad Suleiman, Vedant Gupta, Jamie A. Fast, Lu Wang, Sarah Worley, Hemant S. Agarwal
Journal of Pediatric Intensive Care; https://doi.org/10.1055/s-0041-1735873

Abstract:
Fluid overload has been associated with increased oxygen requirement, prolonged duration of mechanical ventilation, and longer length of hospital stay in children hospitalized with pulmonary diseases. Critically ill infants with bronchiolitis admitted to the pediatric intensive care unit (PICU) also tend to develop fluid overload and there is limited information of its role on noninvasive respiratory support. Thus, our primary objective was to study the association of fluid overload in patients with bronchiolitis admitted to the PICU with respiratory support escalation (RSE) and need for endotracheal intubation (ETI). Infants ≤24 months of age with bronchiolitis and admitted to the PICU between 9/2009 and 6/2015 were retrospectively studied. Demographic variables, clinical characteristics including type of respiratory support and need for ETI were evaluated. Fluid overload as assessed by net fluid intake and output (net fluid balance), cumulative fluid balance (CFB) (mL/kg), and percentage fluid overload (FO%), was compared between patients requiring and not requiring RSE and among patients requiring ETI and not requiring ETI at 0 (PICU admission), 12, 24, 36, 48, 72, 96, and 120 hours. One-hundred sixty four of 283 patients with bronchiolitis admitted to the PICU qualified for our study. Thirty-four of 164 (21%) patients required escalation of respiratory support within 5 days of PICU admission and of these 34 patients, 11 patients required ETI. Univariate analysis by Kruskal-Wallis test of fluid overload as assessed by net fluid balance, CFB, and FO% between 34 patients requiring and 130 patients not requiring RSE and among 11 patients requiring ETI and 153 patients not requiring ETI, at 0, 12, 24, 36, 48, 72, 96 and 120 hours did not reveal any significant difference (p >0.05) at any time interval. Multivariable logistic regression analysis revealed higher PRISM score (odds ratio [OR]: 4.95, 95% confidence interval [95% CI]: 1.79–13.66; p = 0.002), longer hours on high flow nasal cannula (OR: 4.86, 95% CI: 1.68–14.03; p = 0.003) and longer hours on noninvasive ventilation (OR: 11.16, 95% CI: 3.36–36.98; p < 0.001) were associated with RSE. Fluid overload as assessed by net fluid balance, CFB, and FO% was not associated with RSE or need for ETI in critically ill bronchiolitis patients admitted to the PICU. Further prospective studies involving larger number of patients with bronchiolitis are needed to corroborate our findings.
, Steven Dayan
Published: 14 September 2021
Facial Plastic Surgery; https://doi.org/10.1055/s-0041-1735561

Abstract:
Rhinoplasty is arguably the most complex and intricate surgery performed by facial plastic surgeons. Nasal tip refinement of a broad nasal tip has remained the most challenging part of rhinoplasty as sophisticated techniques are critical to achieve aesthetically pleasing and structurally sound nasal tips that can withstand the contractile forces of healing. Successful tip refinement relies on an in-depth preoperative and intraoperative understanding of the patient's nasal anatomy, well developed arsenal of techniques, the experience of the surgeon, and the aesthetic desires of the patient. Although the approach to gain access to the nasal tip so as to successfully reshape the tip has been a topic of debate over many years, the aim of this article is to outline and demonstrate how the broad nasal tip can be successfully recontoured through an endonasal approach using nondestructive techniques that have been effectively used in open rhinoplasty. We believe that there continues to be a place for endonasal tip rhinoplasty especially in this era in which patients desire less invasive procedures with shorter healing time.
Nicolin Datz, Olga Kordonouri, Thomas Danne
DMW - Deutsche Medizinische Wochenschrift, Volume 146, pp 1200-1205; https://doi.org/10.1055/a-1332-4603

Abstract:
Beim Transfer in die Erwachsenenversorgung verlieren 40 % der Jugendlichen mit einem Typ-1-Diabetes den Kontakt zur Spezialmedizin, mit einem deutlich ansteigenden Risiko für eine schlechtere glykämische Kontrolle und Folgeerkrankungen. Transitionsprogramme sind nicht flächendeckend effektiv, und der zunehmende Einsatz moderner Technologien in der Kinderdiabetologie erschwert den Übergang, wie dieser Beitrag aufzeigt. Approximately 40 % of adolescents with type 1 diabetes lose contact with specialty care at transfer to adult care, with a marked increase in risk for poor outcomes. Adolescents showed a 2,5-fold increased risk of an HbA1c level > 9 % after transfer, compared with adolescents who remained in pediatric care. While the use of modern technologies is rapidly increasing in pediatric diabetology, fewer resources are available to address the rapidly changing digital transformation of type 1 diabetes therapy in adult diabetology, not least because of the large number of patients with type 2 diabetes who require care. Therefore, in the transition from children with type 1 diabetes to adult medicine, disparities in resource provision for training and interpretation of new diabetes technologies now add to the problems that have been known for many years. One possible solution would be the creation of regional treatment centers with pediatric and internal medicine care for people with intensive diabetes therapy and use of diabetes technology, as well as the use of telemedicine capabilities. International comparisons show that in centers where pediatric and internal medicine diabetes teams provide age-appropriate care within the same treatment facility, the transition is much less complicated and people with type 1 diabetes benefit from shared experience in the use of diabetes technologies across the lifespan. However, the implementation of such concepts under the framework of the German health care system requires a rethinking among the involved stakeholders and does not seem promising without pressure from the affected people with type 1 diabetes. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
U. Förster-Ruhrmann‡, A. G. Beule‡, S. Becker, A. M. Chaker, T. Huppertz, J. Hagemann, T. K. Hoffmann, S. Dazert, T. Deitmer, H. Wrede, et al.
Published: 14 September 2021
Abstract:
Zusammenfassung Hintergrund Die chronische Rhinosinusitis mit Nasenpolypen (CRSwNP) ist eine multifaktorielle entzündliche Erkrankung, oftmals auf der Grundlage einer Typ-2-Inflammation. Für die Behandlung von Patienten mit einer schweren Ausprägung ohne ausreichendes Ansprechen auf die Standardtherapie mit topischen nasalen Steroiden und/oder Zustand nach endonasaler Operation sind als Biologika aktuell Dupilumab und Omalizumab für die Therapie zugelassen. Nachdem wir in einer früheren Publikation für Dupilumab bereits entsprechende Hinweise gegeben haben, ist das Ziel der vorliegenden Arbeit die Standardisierung von Patienteninformation und -aufklärung vor einer Therapie mit Omalizumab. Methoden Auf Grundlage des aktuellen Wissensstandes zur Immunologie der CRSwNP und zu den erwünschten und möglichen unerwünschten Wirkungen von Omalizumab werden Empfehlungen für die Patienteninformation entwickelt. Ergebnisse Basierend auf der internationalen Literatur, der aktuellen Fachinformation und Erfahrungen aus der praktischen Anwendung und den derzeitigen Pharmakovigilanz-Daten hat ein Expertengremium Empfehlungen für die Patienteninformation und -aufklärung zur Anwendung von Omalizumab bei CRSwNP entwickelt und auf dieser Grundlage einen Patienteninformations- und Aufklärungsbogen erstellt. Schlussfolgerung Die Information und Einwilligung des Patienten wird vor der Verordnung bzw. Verabreichung von allen Biologika, damit auch Omalizumab, empfohlen. Das vorliegende Positionspapier enthält wichtige Informationen zur praktischen Umsetzung und einen Vorschlag für eine Patienteninformation.
, Robbert A. van Haselen, Lex Rutten, Chetna Deep Lamba, Gerhard Bleul †, Susanne Ulbrich-Zürni
Published: 14 September 2021
Abstract:
Case reports have been of central importance to the development of homeopathy over the past 200 years. With a special focus on homeopathy, we give an overview on guidelines and tools that may help to improve the quality of case reports. Reporting guidelines such as CARE (Case Report), HOM-CASE (Homeopathic Clinical Case Reports), and the WissHom Documentation Standard help to improve the quality of reporting and strengthen the scientific value of a case report. Additional scientific tools such as prospective outcome assessment, prognostic factor research, cognition-based medicine, and the Modified Naranjo Criteria for Homeopathy (MONARCH) score may be helpful in improving case documentation and evaluation.
Peter Q. Luong, Claudia I. Cabrera, Nirav Patil, Hammad Khan, Carlito Lagman, Thomas A. Ostergard, Gary Huang, Nicholas C. Bambikidas,
Annals of Otology and Neurotology; https://doi.org/10.1055/s-0041-1735394

Abstract:
Objective It is difficult to predict how hearing loss will progress with vestibular schwannomas (VSs) and to determine the optimal time for hearing preservation interventions. This study investigated the relationship between cochlear intensity on T2-weighted magnetic resonance imaging and hearing loss in VS patients over time. Design Retrospective cohort study. Setting Single major academic center. Participants Patients with a diagnosis of VS from 2007 to 2018. Main Outcome Measures Pure tone average (PTA) and cochlear-to-pontine relative signal intensity (RSI) measured at two time points. Results Fifty patients were included in the final analysis. For both affected and unaffected ears, the trend in PTA increased from baseline to follow-up. For affected ears, the trend in RSI increased from baseline to follow-up, while for the unaffected ears RSI decreased. There was a significant positive correlation between the initial RSI value in the ipsilateral ear when compared with the change in PTA from baseline to follow-up (r = 0.28, p = 0.048). Conclusion There is a trend between initial RSI and how hearing changes in the affected ears of patients with VS. Additional studies are needed to explore how this relationship may be better used to predict hearing loss.
Andrea Scioscia, Jaskaran Rakkar, , Rod Ghassemzadeh, Melinda F. Hamilton,
Journal of Pediatric Intensive Care; https://doi.org/10.1055/s-0041-1735868

Abstract:
The COVID-19 pandemic has pushed medical educators and learners to adapt to virtual learning (VL) in an expedited manner. The effect of VL for critical care education has not yet been evaluated. In a quantitative analysis of survey data and attendance records, we sought to determine the association of VL with conference attendance and work-life balance. Attending physicians, fellows, and advanced practice providers (APP) at a pediatric critical care department at a quaternary children's hospital participated in the study. Attendance records were obtained before and after the adaption of a VL platform. In addition, an electronic, anonymous survey to evaluate current satisfaction and the strengths and weaknesses of VL as well as its impact on work-life balance was administered. In total, 31 learners (17 attending physicians, 13 fellows, and 1 APP) completed the survey. A total of 83.9% (26/31) of participants were satisfied, and 77.4% (24/31) found VL to be similar or more engaging than non-VL. However, 6.5% (2/31) of learners reported difficulty in using the new platform, 87% (27/31) of participants supported VL as an effective learning tool, and 83.3% (25/30) reported a positive impact on work-life balance. Additionally, median monthly conference attendance increased significantly from 85 to 114 attendees per month (p < 0.05). Our results suggest that a virtual model has advantages for overall attendance and work-life balance. We anticipate VL will continue to be an integral part of medical education. Future work evaluating the impact of VL on interdepartmental and interinstitutional collaborations is needed.
Anja Kühn, Christian Fuchs, Klaus Hahnenkamp
DMW - Deutsche Medizinische Wochenschrift, Volume 146, pp 1211-1217; https://doi.org/10.1055/a-1287-5112

Abstract:
Die intraabdominelle Hypertension und das abdominelle Kompartmentsyndrom werden nicht immer erkannt. Dabei stellen sie ein häufiges Problem bei Intensivpatienten dar und gehen mit erhöhter Mortalität und Morbidität sowie verlängerter Intensivtherapie einher. Zur Diagnosestellung ist die Blasendruckmessung als Goldstandard eine nichtinvasive, kostengünstige, einfach bettseitig durchführbare und sichere Methode. An elevated intra-abdominal pressure (IAP) above 12 mmHg is a pathological finding in critically ill patients. IAP are classified into different degrees of intra-abdominal hypertension and, in the presence of associated organ failure, as abdominal compartment syndrome. Both disease entities represent an underestimated factor in intensive care patients and are associated with increased mortality and prolonged intensive care and hospital stay. The measurement of intra-abdominal pressure in critically ill patients in intensive care units is not widely established and there is often considerable uncertainty regarding measurement conditions and methods. If risk factors are present, intra-abdominal pressure should be monitored every 4 hours. Bladder pressure measurement is the gold standard for determining intra-abdominal pressure. The measurement is a non-invasive, cost-effective, easy to perform bedside and safe method for the patient. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
Detlef Kirsten, Ulrike de Vries, Ulrich Costabel, Dirk Koschel, Francesco Bonella, Andreas Günther, Jürgen Behr, Martin Claussen, Stefan Schwarz, Antje Prasse, et al.
Published: 14 September 2021
Abstract:
Background Quality of life (QoL) is significantly impaired in patients with pulmonary fibrosis, however reliable tools to assess QoL issues specific for this group of patients are still missing. We thus aimed to develop a new questionnaire called “Quality of life in patients with idiopathic pulmonary fibrosis” (QPF) to measure QoL in patients with fibrotic idiopathic interstitial pneumonias (IIP). Methods An item pool was created on the basis of a German expert group with support of patients suffering from pulmonary fibrosis. In a 1st step, this version of the questionnaire was completed by 52 patients with idiopathic pulmonary fibrosis (IPF) or non-specific interstitial pneumonia (NSIP). Following this, an item- and an exploratory factor analysis was carried out and a 2nd version created. In a multicenter validation study in a one-group pre-post design, the questionnaire was filled in by 200 patients with IIP (IPF = 190, iNSIP = 10) at 2 time points with an interval of 6 months. Cross-validation was carried out with the St. Georges Respiratory Questionnaire (SGRQ). Results The mean age of the patients was 71.0 years (50–90 years), 82.5 % were male. Item analysis revealed that most of Cronbach alpha and selectivity values of QPF-scales could be considered as sufficient (e. g. QPF-scale “condition” [alpha = 0.827], “impairment” [alpha = 0.882]). At scale level, there were significant differences in terms of a deterioration or improvement in the QPF-condition and QPF-breathlessness scales and also in the SGRQ-activity scale. Analysis of construct validation of QPF and SGRQ showed moderate correlations between both questionnaires. A deterioration in health status from the patient’s and doctorʼs perspective was seen in the scales “impairment”, “shortness of breath” and “health status” of the QPF. The QPF was able to detect a change in the patientʼs mood (“condition” scale) in the course of treatment. Conclusion This newly developed questionnaire maps the special needs of the patients well. The QPF is suitable for screening of quality of life as well as for supplementing the medical history and for monitoring the course of disease in fibrotic IIPs.
Lei Heng, Mingyu Wang, Mingquan Wang, Li Li, Shanshan Zhu
The Thoracic and Cardiovascular Surgeon; https://doi.org/10.1055/s-0041-1731788

Abstract:
Objectives Thoracic surgery often causes postoperative delirium (POD) in geriatric patients. This study aimed to explore the effect of ultrasound-guided continuous thoracic paravertebral block (UG-TPVB) on POD in geriatric patients undergoing pulmonary resection. Methods Total 128 patients who underwent pulmonary resection were randomly allocated to either the conventional patient-controlled analgesia (PCA) group or the UG-TPVB group (n = 64 per group). The consumption of opioid agents (propofol and remifentanil), postoperative hospital stay, postoperative pulmonary atelectasis, postoperative nausea/vomiting, and postoperative itchiness were recorded. The diagnosis of delirium was dependent on the Nursing Delirium Screening Scale. The postoperative pain was assessed by visual analogue scale (VAS) score. The serum levels of interleukin (IL)-1β, IL-6, and tumor necrosis factor-α were used to evaluate the postoperative neuroinflammation. Results The consumption of propofol and remifentanil, postoperative hospital stay, postoperative pulmonary atelectasis, postoperative nausea/vomiting, and postoperative itchiness in the UG-TPVB group were lower than that in the PCA group. Compared with the PCA group, the prevalence of POD was decreased in the UG-TPVB group. In addition, use of UG-TPVB not only reduced postoperative pain (VAS score) but also decreased postoperative neuroinflammation compared with PCA in geriatric patients undergoing pulmonary resection. Conclusions This study determined the benefits of UG-TPVB over PCA, providing an effectiveness approach to alleviate POD in geriatric patients undergoing pulmonary resection.
DMW - Deutsche Medizinische Wochenschrift, Volume 146, pp 1174-1174; https://doi.org/10.1055/a-1540-3971

Abstract:
Die vorzeitige Sterblichkeit durch alle Ursachen und durch Herz-Kreislauf-Erkrankungen (CVD) ist bei Personen mit Diabetes höher. Nach den Ergebnissen dieser Kohortenstudie mit 7459 Diabetikern (Durchschnittsalter 56 Jahre) war Radfahren im Vergleich zu Nicht-Radfahren mit einer mindestens 24 % niedrigeren Gesamtmortalität verbunden, unabhängig von anderen Arten körperlicher Aktivität und mutmaßlichen Störfaktoren. Auch Teilnehmer, die erst während der Studiendauer mit dem Radfahren begannen, hatten ein deutlich geringeres Risiko für die Gesamt- und CVD-Mortalität im Vergleich zu Personen, die nicht regelmäßig mit dem Rad fahren. [nu] Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
Christopher Kloth, Thomas Breining, Horst Brunner
DMW - Deutsche Medizinische Wochenschrift, Volume 146, pp 1181-1182; https://doi.org/10.1055/a-1536-2367

Abstract:
Wir berichten über eine 47-jährige Patientin, die klinisch durch rezidivierende Synkopen auffällig wurde. In der orientierend durchgeführten Echokardiografie zeigte sich eine Mitralinsuffizienz ersten Grades sowie eine ca. 7 cm große echoreiche Raumforderung im linken Vorhof. Zur weiteren Klärung der Raumforderung wurde eine zusätzliche kontrastangehobene Herz-CT durchgeführt. Die Computertomografie zeigt einen pathologischen Befund. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
Karin Reimers, Dieter Müller
Krankenhaushygiene up2date, Volume 16, pp 249-256; https://doi.org/10.1055/a-1391-5892

Abstract:
„Es ist eine wichtige ärztliche Aufgabe, für einen ausreichenden Impfschutz bei den betreuten Personen zu sorgen.“ [1] – so die Ständige Impfkommission (STIKO) beim Robert Koch-Institut. Impfungen helfen, Infektionskrankheiten zu verhindern. Die in Deutschland zugelassenen Impfstoffe sind hochwirksam, nebenwirkungsarm und leicht zu verabreichen – wenn man korrekt vorgeht und „Stolperfallen“ vermeidet. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
DMW - Deutsche Medizinische Wochenschrift, Volume 146, pp 1178-1178; https://doi.org/10.1055/a-1545-2057

Abstract:
Nach Ausbruch der Corona-Pandemie zeigte sich schnell, dass schwere SARS-CoV-2-Infektionen mit einem gesteigerten Risiko für thromboembolische Ereignisse assoziiert sind. Ein thromboinflammatorischer Status mit endothelialer Dysfunktion und Hyperkoagulabilität führt zu mikro- und makrovaskulären Thrombosen. Beobachtungsstudien legten nahe, dass eine intensivierte Antikoagulation nützlich sein könnte. Die ACTION-Studie belegt dies für stationäre Patienten mit hohen D-Dimeren nicht. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
DMW - Deutsche Medizinische Wochenschrift, Volume 146, pp 1178-1179; https://doi.org/10.1055/a-1467-3178

Abstract:
Die Klassifikation und Risikostratifizierung akuter myeloischer Leukämien und myelodysplastischer Syndrome hängen maßgeblich von genetischen Veränderungen ab. Die konventionelle Zytogenetik ist ein essenzieller Baustein im diagnostischen Prozess. Zum Nachweis der vielfältigen Aberrationen sind verschiedene Methoden notwendig. Demgegenüber stellt die Gesamtgenomsequenzierung eine unibasierte Technik dar, die sich retrospektiv und prospektiv als machbar, zuverlässig und mindestens gleichwertig erwies. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
Published: 14 September 2021
Abstract:
Background EPI3 is an observational study of a representative sample of general practitioners (GPs) and patients in France, demonstrating that patient characteristics differ according to the prescribing preferences of their GPs for homeopathy. For selected conditions (musculoskeletal disorders, sleep disorders, anxiety/depression, upper respiratory tract infections), progression of symptoms and adverse events over follow-up in the homeopathy preference group did not significantly differ from other practice preferences, but there was a two-fold to four-fold lower usage of conventional medicines. The EPI3 study's validity was challenged due to absence of head-to-head comparison of medicines to conclude on a causal association between homeopathy and outcomes. Methods A critical review of the nine EPI3 publications was conducted, focusing on generalizability, selection bias, outcome measurements and confounding. Results The conceptual framework of EPI3 rests on a systemic construct, i.e., the homeopathic treatment concept assessed using the type of GP prescribing preference, taking into account the clinical, human and social aspects. The enrollment process enhanced the generalizability of findings. Validated instruments for outcome measurements were used for three conditions, and control of confounding was rigorous. Conclusion EPI3 was conducted according to best practices. Homeopathy prescribing preference met specific patient needs with less use of conventional medicines and without an apparent loss in therapeutic opportunity.
, Marc Albert, Thorsten Lewalter, Taoufik Ouarrak, Jochen Senges, Thorsten Hanke, Nicolas Doll, on behalf of the CASE-AF Investigators
The Thoracic and Cardiovascular Surgeon; https://doi.org/10.1055/s-0041-1730969

Abstract:
Background The aim of this study was to describe outcomes of patients undergoing surgical ablation for atrial fibrillation (AF) as either stand-alone or concomitant cardiosurgical procedures in Germany. Methods Patients with AF undergoing concomitant or stand-alone surgical ablation were included in the registry. Cardiac surgery centers across Germany were invited to participate and sought to enroll 1,000 consecutive patients. Data was obtained through electronic case report forms. The protocol mandated follow-up interviews at 1 year. Results Between January 2017 and April 2020, 17 centers enrolled 1,000 consecutive patients. Among concomitant surgical patients (n = 899), paroxysmal AF was reported in 55.4% patients. Epicardial radio frequency (RF) bilateral pulmonary vein isolation (PVI) with excision of the left atrial appendage (LAA) was the most common operative strategy. In the stand-alone cohort (n = 101), persistent AF forms were reported in 84.1% of patients. Moderate-to-severe symptoms were reported in 85.1%. Sixty-seven patients had previously underwent at least two failed catheter ablative procedures. Thoracoscopic epicardial RF bilateral PVI and completion of a “box-lesion” with LAA closure were frequently preformed. Major cardiac and cerebrovascular complications occurred in 38 patients (4.3%) in the concomitant group. No deaths were reported in the stand-alone group. At discharge, sinus rhythm was achieved in 88.1% of stand-alone and 63.4% concomitant patients. Conclusion The CArdioSurgEry Atrial Fibrillation registry provides insights into surgical strategies for AF ablation in a considerable cohort across Germany. This in-hospital data demonstrates that concomitant and stand-alone ablation during cardiac surgery is safe and effective with low complication rates.
DMW - Deutsche Medizinische Wochenschrift, Volume 146, pp 1174-1174; https://doi.org/10.1055/a-1540-4027

Abstract:
Wie regelmäßige körperliche Bewegung das Risiko für viele chronische Krankheiten senkt, ist bisher unbekannt. Dänische Forscher fanden erstmals Hinweise, dass Sport auf die DNA im Skelettmuskel wirkt und so seine positive Wirkung entfalten könnte. Sechs Wochen körperliche Betätigung führten bei jungen Männern zu Veränderungen in der epigenetischen Information von Skelettmuskelzellen, d. h. durch körperliche Betätigung wurde zwar nicht die Erbinformation selbst verändert, sondern die Genregulation. Durch die Aktivierung von Genen sezernieren die Skelettmuskelzellen bestimmte Faktoren, die auf das Gehirn wirken. [nu] Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
Katharina Franke
Published: 14 September 2021
Kardiologie up2date, Volume 17, pp 213-213; https://doi.org/10.1055/a-1578-8341

Abstract:
Seit einigen Jahren ist bekannt, dass das so genannte Remnant-Cholesterin eine bedeutsame Rolle bei der Risikoprädiktion von kardiovaskulären Erkrankungen spielt. Eine Post-hoc-Analyse einer spanischen Studie ergab jetzt, dass das Remnant-Cholesterin in einer Kohorte adipöser Personen hierbei sogar dem LDL-Cholesterin überlegen war. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
, Jan Wintrich, Michael Böhm
Published: 14 September 2021
Kardiologie up2date, Volume 17, pp 267-279; https://doi.org/10.1055/a-1383-1015

Abstract:
Die Behandlung der chronischen Herzinsuffizienz (HI) hat sich in den letzten 30 Jahren deutlich verändert und zu einer Senkung der Mortalität und der Krankenhausaufnahme bei Patienten mit reduzierter Ejektionsfraktion (HFrEF) geführt. Diese Übersicht diskutiert geplante und laufende Studien, in denen der potenzielle Nutzen sowie unerwünschte Wirkungen alter und neuer pharmakologischer Interventionen untersucht werden. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
Florian Feld, Sebastian Lemmen
Krankenhaushygiene up2date, Volume 16, pp 339-351; https://doi.org/10.1055/a-1214-5349

Abstract:
Eine angekündigte Begehung durch die Aufsichtsbehörden bringt immer ein gewisses Stresspotenzial mit sich. Neben den vorab geforderten Unterlagen wird gerne auch eine praktische Demonstration eines kompletten Aufbereitungsprozesses gewünscht. Solch ein Termin birgt aber auch viele Chancen zur Optimierung der Abläufe, in deren Fokus alleine der Patientenschutz steht. Systematische Strukturmängel und Prozessfehler wären sonst unentdeckt geblieben. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
DMW - Deutsche Medizinische Wochenschrift, Volume 146, pp 1174-1174; https://doi.org/10.1055/a-1540-4013

Abstract:
Die Autoren verglichen 18 Symptome als frühe Anzeichen einer COVID-19-Infektion und kamen zu dem Ergebnis, dass die Frühsymptome in verschiedenen Altersgruppen unterschiedlich sind. Zu den wichtigsten Symptomen für die Früherkennung gehörten: Geruchsverlust, Brustschmerzen, anhaltender Husten, Bauchschmerzen, Blasen an den Füßen, Augenschmerzen und ungewöhnliche Muskelschmerzen. Der Geruchsverlust verlor bei über 60-Jährigen an Bedeutung und war bei über 80-Jährigen nicht relevant. In den Altersgruppen über 60 waren Frühsymptome wie Durchfall von zentraler Bedeutung. Fieber war in keiner Altersgruppe ein Frühsymptom. [nu] Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
Katharina Franke
Published: 14 September 2021
Kardiologie up2date, Volume 17, pp 214-214; https://doi.org/10.1055/a-1578-8416

Abstract:
Wird bei jungen Athleten zu häufig die Diagnose eines kongenitalen Long-QT-Syndroms gestellt? Die Ergebnisse einer aktuellen Studie aus Italien legen nahe, dass Repolarisationsstörungen und QTc-Verlängerungen in einigen Fällen allein durch intensives sportliches Training entstehen. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
DMW - Deutsche Medizinische Wochenschrift, Volume 146, pp 1174-1174; https://doi.org/10.1055/a-1540-3957

Abstract:
Haben Ärztinnen später Kinder oder bleiben häufiger kinderlos als Nicht-Ärztinnen? Die retrospektive Kohortenstudie verglich 5238 kanadische Ärztinnen im reproduktionsfähigen Alter mit 26 640 Nicht-Ärztinnen. Danach scheinen Ärztinnen – besonders ausgeprägt Fachärztinnen – im Vergleich zu Nicht-Ärztinnen das Kinderkriegen zu verschieben. Da sie im höheren Alter schwanger werden, unterscheidet sich ihre Geburtenrate insgesamt aber nicht von der von Nicht-Ärztinnen. Ihr Risiko für altersbedingte ungünstige Schwangerschaften könnte sich dadurch erhöhen. Die Autoren empfehlen Maßnahmen, um Ärztinnen mit Kinderwunsch in allen Karrierestufen zu unterstützen. [nu] Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
Published: 14 September 2021
Kardiologie up2date, Volume 17, pp 210-211; https://doi.org/10.1055/a-1558-8935

Abstract:
Umfangreiches Fachwissen schnell in den Kopf zu bekommen und dort zu behalten: Vor dieser Herausforderung stehen viele Ärztinnen und Ärzte in Weiterbildung. Das neue, adaptive Weiterbildungscurriculum Innere Medizin der eRef bietet hierfür jetzt die Lösung: Mit adaptiven Lernmodulen und computergestützten Fragen bauen Sie schneller und tiefgreifender Ihr Fachwissen auf. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
, Fabian Aus Dem Siepen
Published: 14 September 2021
Kardiologie up2date, Volume 17, pp 235-247; https://doi.org/10.1055/a-1355-0598

Abstract:
„Amyloidosen“ bezeichnet eine Gruppe von Erkrankungen mit verschiedenen Gesichtern. Einige Unterformen sind offenbar deutlich häufiger als angenommen. Mit wenigen einfachen Schritten lässt sich eine Amyloidose sicher und präzise diagnostizieren und die korrekte kausale Behandlung veranlassen. Dieser Beitrag gibt einen Überblick über typische klinische Zeichen, aktuelle diagnostische Algorithmen sowie die Neuerungen der Behandlung. Publication Date:14 September 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KGRüdigerstraße 14, 70469 Stuttgart, Germany
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