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Thrombo LUX ( TLX)-Score was compared with hypotonic shock response ( HSR) and extent of shape change ( ESC) in 99 samples from 42 platelet concentrates. Tests were performed in parallel and duplicate. Mean values for TLX Score, HSR and ESC were 30·3 ± 3·8%, 69·0 ± 12·2% and 23·2 ± 4·9%, respectively. We found no significant correlation between TLX Score and HSR or ESC ( r = −0·158, P = 0·118 and r = −115, P = 0·255, respectively), whereas HSR and ESC correlated significantly ( r = 0·351, P < 0·001). As TLX Score did not show significant correlation with HSR and ESC, the value of TLX for platelet quality testing remains unclear. Studies comparing these parameters with transfusion outcome are needed. [ABSTRACT FROM AUTHOR]

Thrombo LUX ( TLX)-Score was compared with hypotonic shock response ( HSR) and extent of shape change ( ESC) in 99 samples from 42 platelet concentrates. Tests were performed in parallel and duplicate. Mean values for TLX Score, HSR and ESC were 30·3 ± 3·8%, 69·0 ± 12·2% and 23·2 ± 4·9%, respectively. We found no significant correlation between TLX Score and HSR or ESC ( r = −0·158, P = 0·118 and r = −115, P = 0·255, respectively), whereas HSR and ESC correlated significantly ( r = 0·351, P < 0·001). As TLX Score did not show significant correlation with HSR and ESC, the value of TLX for platelet quality testing remains unclear. Studies comparing these parameters with transfusion outcome are needed. [ABSTRACT FROM AUTHOR]

The increased risk of thrombosis and bleeding with an active tumor disease is known as the so-called "thrombo-hemorrhagic syndrome", which places high demands on anticoagulation. There are currently 4 randomized, prospective studies on the use of new, non-vitamin K dependent oral anticoagulants (NOAC) for the treatment of venous thromboembolism (VTE) that have occurred in oncology. The FXa inhibitors rivaroxaban, edoxaban and twice apixaban were each used in individual studies versus the standard therapeutic agent dalteparin. Since there is no direct head-to-head comparison of the FXa inhibitors mentioned within a study, the largest study - always compared to dalteparin - was evaluated for each NOAC. The studies were analyzed with regard to their effectiveness, safety, fatal bleeding rates, the risk of gastrointestinal bleeding (GIB) and other differences using descriptive statistics. With dalteparin, the mean VTE recurrence rate was approximately 9% over a 6-month treatment period. All three FXa inhibitors were not inferior to dalteparin in terms of potency. The VTE recurrence rate was - 2.3% lower in edoxaban and apixaban-treated patients and - 5.0% in rivaroxaban-treated patients. In terms of safety, there was an increased rate of severe bleeding (both + 2.4%) for rivaroxaban and edoxaban compared to dalteparin; in particular, the number of GIBs was significantly increased. In contrast, the number of severe bleeding was not increased for apixaban, as was the case for various bleeding types including GIB. In the Apixaban study, the overall rate of severe GIB, which accounted for about 50% of all severe bleeding, and that of clinically relevant non-severe bleeding, were the lowest. The FXa inhibitors are not inferior to the standard therapy with dalteparin in the VTE recurrence rate in oncological patients. The GIB rate appears to be an important predictive factor for the safety of this group of substances, so that tumor location, gastrointestinal risk factors and other individual criteria should be given greater consideration in future therapy decisions for or against an FXa inhibitor., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Nitrous oxide (N 2 O) is a strong greenhouse gas and causal for stratospheric ozone depletion. During biological nitrogen removal in wastewater treatment plants (WWTP), high N 2 O fluxes to the atmosphere can occur, typically exhibiting a seasonal emission pattern. Attempts to explain the peak emission phases in winter and spring using physico-chemical process data from WWTP were so far unsuccessful and new approaches are required. The complex and diverse microbial community of activated sludge used in biological treatment systems also exhibit substantial seasonal patterns. However, a potentially causal link between the seasonal patterns of microbial diversity and N 2 O emissions has not yet been investigated. Here we show that in a full-scale WWTP nitrification failure and N 2 O peak emissions, bad settleability of the activated sludge and a turbid effluent strongly correlate with a significant reduction in the microbial community diversity and shifts in community composition. During episodes of impaired performance, we observed a significant reduction in abundance for filamentous and nitrite oxidizing bacteria in all affected reactors. In some reactors that did not exhibit nitrification and settling failures, we observed a stable microbial community and no drastic loss of species. Standard engineering approaches to stabilize nitrification, such as increasing the aerobic sludge age and oxygen availability failed to improve the plant performance on this particular WWTP and replacing the activated sludge was the only measure applied by the operators to recover treatment performance in affected reactors. Our results demonstrate that disturbances of the sludge microbiome affect key structural and functional microbial groups, which lead to seasonal N 2 O emission patterns. To reduce N 2 O emissions from WWTP, it is therefore crucial to understand the drivers that lead to the microbial population dynamics in the activated sludge., Competing Interests: The authors declare no competing interest., (© 2021 The Author(s). Published by Elsevier Ltd.)

In rural areas, breast cancer-affected patients still do not receive sufficient psycho-oncological care that addresses their specific needs. As a partial solution, telemedicine and web-based applications (eHealth) can add value to their psycho-oncological care as part of self-management regardless of personnel resources, geographical distance from providers, and time constraints. Thus far, however, those supportive aspects of psycho-oncological care are lacking in German-speaking rural areas. For this reason a web-based intervention was developed. Based on the results of a representative cross-sectional and the current literature, we developed a manual and program called Make It Training (Mindfulness and skills based distress reduction in oncology) which was programmed for the websetting. The interactive web-based intervention with 8 sessions integrates different media, including tutorial videos, audio, personal skills box and individual exercises to enhance knowledge about specific disease-related themes. The intervention derives from mindfulness and conveys psychoeducational elements and cognitive behavioural skills with the themes of emotion management, resources, stress management, and self-compassion. The acceptance testing (N=35) showed considerable acceptance and satisfaction. 87% of the patients would recommend the Make it Training to other patient. Prospectively, this training could convey effective strategies for coping with disease-related burden. The Make It Training is an innovative self-management program that can be used for the stepped-care approach and be implemented in rural areas and thereby enhance current outpatient care., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Compared to the general population, cancer patients are at increased risk for venous thromboembolism with significant impact on morbidity and mortality. Appropriate prophylaxis as well as early diagnosis and treatment are therefore mandatory. However, anticoagulation of cancer patients is associated with an increased risk of bleeding and recurrence. To meet these challenges, national and international guidelines for the prevention and treatment of venous thromboembolism in patients with cancer have been published. We provide a summary of these specific recommendations., Competing Interests: S. Struve: Beratertätigkeit für Boehringer Ingelheim.J. Ringwald: Vortrags-/Beratertätigkeiten für Boehringer Ingelheim, Pfizer, Bristol Myers Squibb, Daiichi Sankyo. Vortragstätigkeiten für Bayer Healthcare und Leo Pharma., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: RNA viruses are associated with a high frequency of mutations because of the missing proofreading function of polymerases, such as reverse transcriptase. Between 2007 and 2010, six blood donations with false-negative nucleic acid technology (NAT) results were reported in Germany. Therefore, NAT screening in two viral genome regions was introduced by our blood donation service in 2010 on a voluntary basis and became mandatory in Germany since the beginning of 2015., Study Design and Methods: Blood donor screening was done using, in parallel, the German Red Cross (GRC) HIV-1 CE long terminate repeats (LTR) PCR kit and the GRC HIV-1 gag CE PCR kit. In total, 7 million blood donations were screened during the study period from 2010 to 2014 with the GRC dual-target human immunodeficiency virus 1 (HIV-1) NAT system. Additionally, three suspicious specimens were analyzed by four monotargeted NAT assays and by five dual-target NAT assays., Results: Three of 7 million donations tested negative using the 5'LTR-polymerase chain reaction, but they were positive if amplification was performed in the gag region. HIV antibodies were detected in all three donations. Nucleic acid sequence analysis identified a deletion of 22 bases within the 5'LTR probe binding region. Three different ltr-based monotargeted assays missed two donations, except for a low-reactive result obtained by one of the assays. In total, the detection rates for HIV-1-positive donations were 37.5% (3/8) for monotargeted assays and 100% (10/10) for dual-target assays., Conclusion: The current data demonstrate that dual-target NAT systems reduce the risk of false-negative HIV-1 NAT screening results., (© 2018 AABB.)

Introduction: A large number of refugees suffer from mental disorders such as post-traumatic stress disorder (PTSD). In the context of a special quota project, 1100 Yazidi women from Northern Iraq who had suffered extreme violence by the so-called Islamic State (IS) were brought to Germany to receive specialized treatment. This study aims to investigate the psychological burden and trauma-related symptoms of these female IS-victims from the perspectives of their care providers. Material and methods: Care providers with various professional backgrounds ( N = 96) were asked to complete a self-developed questionnaire on a Likert-type scale ranging from 1 (very low) to 7 (very high) analyzing the psychological burden and trauma-related symptoms of the IS-traumatized women since their arrival in Germany. We controlled for potential confounders, namely the care providers' personal experiences of trauma and flight, by using chi-square tests. Results: The mean psychological burden for the whole period in Germany as perceived by care providers was M = 5.51 ( SD = 0.94). As the main factors of distress the care providers reported: worries about family members in Iraq ( M = 6.69; SD = 0.69), worries about relatives' possibilities to be granted asylum in Germany ( M = 6.62; SD = 0.68), and uncertainties regarding their future ( M = 5.89; SD = 1.02). The most prominent trauma-related psychological symptoms were nightmares ( M = 6.43; SD = 0.54). The care providers reported that somatic complaints have been present among the refugees in the following manifestation: pain ( M = 6.24; SD = 1.08), gastrointestinal complaints ( M = 4.62; SD = 1.62), and dizziness ( M = 4.40; SD = 1.59). The care providers' personal experiences of trauma and flight had no significant influence on their response behavior. Discussion: Care providers working with IS-traumatized female refugees evaluate the psychological burden and trauma-related somatic and psychological symptom loads of their clients as very high. The results of this study provide important information about the perceptions of care providers working in a refugee-services context and may provide insights for the progression of specialized treatment programs and interventions for highly traumatized refugees and culture-sensitive training programs for their care providers.

Background: Over the last decade, a growing body of studies regarding the application of eHealth and various digital interventions has been published and are widely used in the psycho-oncological care. However, the effectiveness of eHealth applications in psycho-oncological care is still questioned due to missing considerations regarding evidence-based studies on the demands and needs in cancer-affected patients., Objective: This cross-sectional study aimed to explore the cancer-affected women's needs and wishes for psycho-oncological content topics in eHealth applications and whether women with cancer differ in their content topics and eHealth preferences regarding their experienced psychological burden., Methods: Patients were recruited via an electronic online survey through social media, special patient Internet platforms, and patient networks (both inpatients and outpatients, University Hospital Tuebingen, Germany). Participant demographics, preferences for eHealth and psycho-oncological content topics, and their experienced psychological burden of distress, quality of life, and need for psychosocial support were evaluated., Results: Of the 1172 patients who responded, 716 were included in the study. The highest preference for psycho-oncological content topics reached anxiety, ability to cope, quality of life, depressive feelings, and adjustment toward a new life situation. eHealth applications such as Web-based applications, websites, blogs, info email, and consultation hotline were considered to be suitable to convey these content topics. Psychological burden did not influence the preference rates according to psycho-oncological content and eHealth applications., Conclusions: Psycho-oncological eHealth applications may be very beneficial for women with cancer, especially when they address psycho-oncological content topics like anxiety, ability to cope, depressive feelings, self-esteem, or adjustment to a new life situation. The findings of this study indicate that psycho-oncological eHealth applications are a promising medium to improve the psychosocial care and enhance individual disease management and engagement among women with cancer., (©Johanna Ringwald, Lennart Marwedel, Florian Junne, Katrin Ziser, Norbert Schäffeler, Lena Gerstner, Markus Wallwiener, Sara Yvonne Brucker, Martin Hautzinger, Stephan Zipfel, Martin Teufel. Originally published in JMIR Cancer (http://cancer.jmir.org), 24.11.2017.)

To identify distressed patients in oncology using screening questionnaires is quite challenging in clinical routine. Up to now there is no evidence based recommendation which instrument is most suitable and how to put a screening to practice. Using computer based screening tools offers the possibility to automatically analyse patient's data, inform psycho-oncological and medical staff about the results, and use reactive questionnaires. Studies on how to empower patients in decision making in psycho-oncology are rare.Methods Women with breast and gynaecological cancer have been consecutively included in this study (n=103) at time of inpatient surgical treatment in a gynaecological clinic. They answered the computer based screening questionnaire (ePOS-react) for routine distress screening at time of admission. At the end of the tool an individual recommendation concerning psycho-oncological treatment is given ( i) psycho-oncological counselling, ii) brief psycho-oncological contact, iii) no treatment suggestion). The informed patients could choose autonomously either the recommended treatment or an individually more favoured alternative possibility. Additionally, a clinical interview (approx. 30 min) based on the "Psychoonkologische Basisdiagnostik (PO-Bado)" has been carried out for a third-party assessment of patients' need for treatment.Results 68.9% followed the treatment recommendation. 22.3% asked for a more "intense" (e. g. counselling instead of recommended brief contact) and 8,7% for a "less intense" intervention than recommended. The accordance of third-party assessment (clinical interview "PO-Bado") and treatment recommendation is about 72.8%. The accordance of third-party assessment and patient's choice (ePOS-react) is about 58.3%. The latter is smaller because 29.1% asked for a brief psycho-oncological contact for whom from the third-party assessment's perspective no indication for treatment has been existent.Discussion A direct response of the screening result (treatment recommendation) during the computer based screening and asking for a patient's choice leads to an increase of brief psycho-oncological contacts for personal information about psycho-oncological interventions. Compared with a third-party assessment (clinical interview) there is no improvement of the accuracy of the indications. But it improves the transparency for the access to psycho-oncological interventions which may strengthen patient's autonomy and adherence., Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Detection of immature platelets in the circulation may help to dissect thrombocytopenia due to platelet destruction from bone marrow failure (BMF). We prospectively tested the predictive value of immature platelets, measured as immature platelet fraction (IPF) on the XE-5000 (Sysmex, Kobe, Japan) or percentage of reticulated platelets (rPT) on the CD Sapphire (Abbott Diagnostics, Santa Clara, CA, USA) to separate immune thrombocytopenia (ITP) from BMF (leukaemia, myelodysplastic syndrome, aplastic anaemia). We analysed 58 samples of patients with BMF, 47 samples of patients with ITP and 97 controls. Median rPT (CD Sapphire) was increased to 9·0% in ITP and to 10·9% in BMF, compared to 1·9% in controls. Median IPF (XE-5000) was 16·2% in ITP, 10·2% in BMF and 2·5% in controls. We found an inverse correlation between high fractions of immature platelets and low platelet counts in thrombocytopenic samples regardless of the diagnosis. In conclusion, we observed a broad overlap of immature platelets between ITP and BMF, which may be caused by an accelerated release of immature platelets in any thrombocytopenic state and decreased production in many patients with ITP. Despite this, IPF (XE-5000) had some power to discriminate ITP from BMF, whereas rPT (CD Sapphire) was of no predictive value., (© 2017 John Wiley & Sons Ltd.)

Understanding the intermediate- and long-term psychological consequences of genetic testing for cancer patients has led to encouraging research, but a clear consensus of the psychosocial impact and clinical routine for cancer-affected BRCA1 and BRCA2 mutation carriers is still missing. We performed a systematic review of intermediate- and long-term studies investigating the psychological impact like psychological distress, anxiety, and depression in cancer-affected BRCA mutation carriers compared to unaffected mutation carriers. This review included the screening of 1243 studies. Eight intermediate- and long-term studies focusing on distress, anxiety, and depression symptoms among cancer-affected mutation carriers at least six months after the disclosure of genetic testing results were included. Studies reported a great variety of designs, methods, and patient outcomes. We found evidence indicating that cancer-affected mutation carriers experienced a negative effect in relation to psychological well-being in terms of an increase in symptoms of distress, anxiety, and depression in the first months after test disclosure. In the intermediate- and long-term, no significant clinical relevant symptoms occurred. However, none of the included studies used specific measurements, which can clearly identify psychological burdens of cancer-affected mutation carriers. We concluded that current well-implemented distress screening instruments are not sufficient for precisely identifying the psychological burden of genetic testing. Therefore, future studies should implement coping strategies, specific personality structures, the impact of genetic testing, supportive care needs and disease management behaviour to clearly screen for the possible intermediate- and long-term psychological impact of a positive test disclosure.

Background: Oral anticoagulation with dabigatran was shown to be effective for stroke prevention in patients with nonvalvular atrial fibrillation without the need for laboratory monitoring. However, a recent publication based on data of the Randomized Evaluation of Long-Term Anticoagulation Therapy study reported that ischemic stroke and bleeding outcomes are correlated with dabigatran plasma concentration (DPC). DPC was determined at a prespecified time point and correlated with cardiovascular events at any time during follow-up. Because of the known variability of DPC, among others depending on renal function, this approach might compromise data evaluation. We report on dabigatran plasma levels in acute cerebrovascular events., Methods: Consecutive patients with acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) while taking dabigatran were retrospectively identified if admission DPC was available. DPC was determined using the diluted thrombin time (Hemoclot (HYPHEN BioMed, Neuville sur Oise, France)). Creatinine clearance (CrCl) was determined by measuring creatinine in plasma and 24-hour urine., Results: Fifteen AIS and 4 ICH patients were included. Median DPC on admission was significantly higher in ICH patients than in AIS patients (135 ng/mL [interquartile range {IQR} 79-218] and 69.1 ng/mL [IQR 20.6-85.0], respectively; P = .035). Increased CrCl (values above published normal range) was correlated with lower median DPC (60 ng/mL [IQR 10-69] versus 100 ng/mL [IQR 79-157] in patients with normal CrCl, P = .01)., Conclusions: Higher DPC was found in ICH patients than in AIS patients in temporal proximity to the event. Both decreased and increased renal functions seem to have an important influence on DPC., (Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.)