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Background Vital signs are usually recorded once every 8 h in patients at the hospital ward. Early signs of deterioration may therefore be missed. Wireless sensors have been developed that may capture patient deterioration earlier. The objective of this study was to determine whether two wearable patch sensors (SensiumVitals [Sensium Healthcare Ltd., United Kingdom] and HealthPatch [VitalConnect, USA]), a bed-based system (EarlySense [EarlySense Ltd., Israel]), and a patient-worn monitor (Masimo Radius-7 [Masimo Corporation, USA]) can reliably measure heart rate (HR) and respiratory rate (RR) continuously in patients recovering from major surgery. Methods In an observational method comparison study, HR and RR of high-risk surgical patients admitted to a step-down unit were simultaneously recorded with the devices under test and compared with an intensive care unit–grade monitoring system (XPREZZON [Spacelabs Healthcare, USA]) until transition to the ward. Outcome measures were 95% limits of agreement and bias. Clarke Error Grid analysis was performed to assess the ability to assist with correct treatment decisions. In addition, data loss and duration of data gaps were analyzed. Results Twenty-five high-risk surgical patients were included. More than 700 h of data were available for analysis. For HR, bias and limits of agreement were 1.0 (–6.3, 8.4), 1.3 (–0.5, 3.3), –1.4 (–5.1, 2.3), and –0.4 (–4.0, 3.1) for SensiumVitals, HealthPatch, EarlySense, and Masimo, respectively. For RR, these values were –0.8 (–7.4, 5.6), 0.4 (–3.9, 4.7), and 0.2 (–4.7, 4.4) respectively. HealthPatch overestimated RR, with a bias of 4.4 (limits: –4.4 to 13.3) breaths/minute. Data loss from wireless transmission varied from 13% (83 of 633 h) to 34% (122 of 360 h) for RR and 6% (47 of 727 h) to 27% (182 of 664 h) for HR. Conclusions All sensors were highly accurate for HR. For RR, the EarlySense, SensiumVitals sensor, and Masimo Radius-7 were reasonably accurate for RR. The accuracy for RR of the HealthPatch sensor was outside acceptable limits. Trend monitoring with wearable sensors could be valuable to timely detect patient deterioration. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Bei geriatrischen Patienten ist ein mechanischer Ileus einer der haufigsten Grunde fur eine Vorstellung im Krankenhaus und in 50 % der Falle Grund fur eine notfallmasige Operation. Diagnostik und Therapie des mechanischen Ileus haben sich in den vergangenen Jahren verandert. Neue Therapiekonzepte sollten hinsichtlich des alternden Patientenkollektivs kritisch gepruft werden. Ziel der Arbeit ist das Herausarbeiten moglicher Verbesserungsansatze in der Therapie des mechanischen Ileus bei geriatrischen Patienten. Retrospektiv wurden die Daten von 132 Patienten untersucht, die am Universitatsklinikum Bonn aufgrund eines mechanischen Ileus operiert wurden. Es wurden 2 Kohorten gebildet (50- bis 70-jahrige oder >80-jahrige Patienten) und die Dauer von Triage bis zur Operation, die Atiologie des Ileus, die Notwendigkeit einer Darmresektion, Notwendigkeit einer Stomaanlage sowie postoperative Komplikationen verglichen. Die Datenanalyse erfolgte mit dem Fisher-Test oder einem Student-t-Test. Die Dauer von Triage im Notfallzentrum bis zum Schnitt im Operationssaal betrug bei Patienten zwischen 50 und 70 Jahren 18,23 ± 0,79 h vs. 43,38 ± 12,08 h bei >80-Jahrigen (p = 0,0111). Bei alteren Patienten war in 58,9 %, eine Darmresektion notwendig vs. 35,3 % bei den jungeren (p = 0,0401). Die Rate schwerwiegender Komplikationen (Dindo/Clavien >IIIB) war mit 50 % bei alteren Patienten im Vergleich zu 12,7 % bei jungeren erhoht (p = 0,0002). Die Dauer des Aufenthalts auf der Intensivstation war bei Patienten >80 Jahren langer, als bei Patienten zwischen 50 und 70 Jahren (93,97 ± 17,36 h vs. 26,11 ± 3,73 h; p

Aim: We investigated the significance of PD-L2 DNA methylation in gastric adenocarcinomas. Methods: We analyzed the methylation at different CpG sites within the PD-L2-encoding gene PDCD1LG2 with regard to correlations and associations with gene expression, clinicopathological parameters, molecular features and immune cell infiltrates in two publicly available cohorts (The Cancer Genome Atlas and Singapore cohorts) of a total of 594 gastric adenocarcinoma patients. Results: PD-L2 methylation is significantly associated with transcriptional activity, survival, Epstein–Barr virus infection, PD-L2 gene amplification, CD8+ T-cell infiltration, microsatellite instability and high mutational load (tumor mutational burden, hypermutation). Conclusion: PD-L2 methylation is associated with known predictive biomarkers of response to anti-PD-1 immunotherapies.

Background Hospital stays after major surgery are shorter than ever before. Although enhanced recovery and early discharge have many benefits, some complications will now first manifest themselves in home settings. Remote patient monitoring with wearable sensors in the first days after hospital discharge may capture clinical deterioration earlier but is largely uncharted territory. Objective This study aimed to assess the technical feasibility of patients, discharged after esophagectomy, being remotely monitored at home with a wireless patch sensor and the experiences of these patients. In addition, we determined whether observing vital signs with a wireless patch sensor influences clinical decision making. Methods In an observational feasibility study, vital signs of patients were monitored with a wearable patch sensor (VitalPatch, VitalConnect Inc) during the first 7 days at home after esophagectomy and discharge from hospital. Vital signs trends were shared with the surgical team once a day, and they were asked to check the patient’s condition by phone each morning. Patient experiences were evaluated with a questionnaire, and technical feasibility was analyzed on a daily basis as the percentage of data loss and gap durations. In addition, the number of patients for whom a change in clinical decision was made based on the results of remote vital signs monitoring at home was assessed. Results Patients (N=20) completed 7 days each of home monitoring with the wearable patch sensor. Each of the patients had good recovery at home, and remotely observed vital signs trends did not alter clinical decision making. Patients appreciated that surgeons checked their vital signs daily (mean 4.4/5) and were happy to be called by the surgical team each day (mean 4.5/5). Wearability of the patch was high (mean 4.4/5), and no reports of skin irritation were mentioned. Overall data loss of vital signs measurements at home was 25%; both data loss and gap duration varied considerably among patients. Conclusions Remote monitoring of vital signs combined with telephone support from the surgical team was feasible and well perceived by all patients. Future studies need to evaluate the impact of home monitoring on patient outcome as well as the cost-effectiveness of this new approach.

Zusammenfassung Hintergrund Malignome des Ösophagus zählen zu den häufigsten krebsbedingten Todesursachen. Den einzigen kurativen Therapieansatz stellt die radikale Ösophagektomie, eingebettet in ein multimodales Therapiekonzept, dar. Ziel der Untersuchung war die Analyse von Langzeitentwicklungen in der operativen Therapie des Ösophaguskarzinoms und deren Einflüsse auf das kurz- (1-JÜR), mittel- (5-JÜR) und langfristige (10-JÜR) Überleben. Patienten und Methoden Es wurden retrospektiv 301 Patienten am Universitätsklinikum Bonn untersucht, bei denen zwischen 1989 und 2012 eine Ösophagusresektion durchgeführt wurde. Um mögliche Trends im Management und Veränderungen hinsichtlich der Prognose zu analysieren, wurden 2 Kohorten (Kohorte A: operiert 1989 – 2000, Kohorte B: operiert 2001 – 2012) gebildet und bez. demografischer Daten, Tumorentität, Stadium, Komplikationsrate und Überleben miteinander verglichen. Ergebnisse In der Kohorte B wurden signifikant ältere Patienten in niedrigeren Tumorstadien mit einer größeren Lymphknotenausbeute operiert, eine Zunahme des Adenokarzinoms (AC) war zu beobachten. Während sich die Gesamtmorbidität nicht signifikant veränderte, konnte eine geringere Rate an Anastomoseninsuffizienzen in Kohorte B (5,5%) verglichen mit Kohorte A (12,3%) bei gleichzeitigem Anstieg der kardialen Ereignisse (A: 3,6% vs. B: 12,3%) nachgewiesen werden. Die 30-Tage-Krankenhausmortalität lag bei insgesamt 2,7% und fiel von 5% (Kohorte A) signifikant (p = 0,05) auf 0,7% (Kohorte B). Das mittlere Überleben betrug in der Kohorte A 46 ± 6,5 Monate. In Kohorte B überlebten Patienten mit 53 ± 7,2 Monaten signifikant länger (p = 0,03). In der univariaten Analyse hatten das lokale Tumorstadium, der Resektionsgrad, die Anzahl der befallenen Lymphknoten (LK), der Lymphknotenquotient (LNR) sowie das Auftreten postoperativer Komplikationen einen Einfluss auf das Überleben, wohingegen in der multivariaten Analyse nur noch T-Stadium, R-Status und LNR als unabhängige Prognosefaktoren galten. Schlussfolgerung Patienten, die sich einer onkologischen Ösophagusresektion unterziehen, sind heutzutage älter als noch vor einigen Jahren. Die frühzeitigere Tumordiagnose, eine radikalere Operationstechnik mit radikalerer Lymphknotendissektion und weniger Anastomoseninsuffizienzen sowie eine verbesserte perioperative Medizin scheinen diesen demografischen Nachteil zu kompensieren. Die größte prognostische Bedeutung beim Ösophaguskarzinom hat die LNR.

Background Recurrent mucocutaneous infections caused by PVL-positive Staphylococcus (S.) aureus strains represent an increasing problem in Germany. Although there have been several outbreaks at day care centers and in urban communities in recent years, there are currently no diagnostic algorithms or treatment recommendations for these particular infections in Germany. Methods We performed a literature search in the PubMed/MEDLINE database with the goal of developing an algorithm for diagnosis and treatment of these infections. National and international recommendations were also considered. Results Panton-Valentine leukocidin (PVL) is a pore-forming protein produced by certain S. aureus strains. Both methicillin-susceptible (MSSA) and methicillin-resistant S. aureus (MRSA) strains may carry the lukS-lukF gene responsible for PVL production. The clinical presentation of infections caused by PVL-positive S. aureus ranges from isolated recurrent abscesses to extensive furunculosis. Despite adequate treatment of primary infections, approximately 40 % of patients develop recurrent disease. The choice of treatment regimen is guided by the clinical presentation of the infection. In addition, some scientific literature recommends bacteriological screening of patients and their contacts, followed by decolonization of affected individuals. Conclusions The present article focuses on the pathogenesis and risk factors of recurrent mucocutaneous infections caused by PVL-positive S. aureus strains and proposes a diagnostic and therapeutic algorithm for optimal patient care.

Background and objectivesIntermittent vital signs measurements are the current standard on hospital wards, typically recorded once every 8 hours. Early signs of deterioration may therefore be missed. Recent innovations have resulted in ‘wearable’ sensors, which may capture patient deterioration at an earlier stage. The objective of this study was to determine whether a wireless ‘patch’ sensor is able to reliably measure respiratory and heart rate continuously in high-risk surgical patients. The secondary objective was to explore the potential of the wireless sensor to serve as a safety monitor.DesignIn an observational methods comparisons study, patients were measured with both the wireless sensor and bedside routine standard for at least 24 hours.SettingUniversity teaching hospital, single centre.ParticipantsTwenty-five postoperative surgical patients admitted to a step-down unit.Outcome measuresPrimary outcome measures were limits of agreement and bias of heart rate and respiratory rate. Secondary outcome measures were sensor reliability, defined as time until first occurrence of data loss.Results1568 hours of vital signs data were analysed. Bias and 95% limits of agreement for heart rate were −1.1 (−8.8 to 6.5) beats per minute. For respiration rate, bias was −2.3 breaths per minute with wide limits of agreement (−15.8 to 11.2 breaths per minute). Median filtering over a 15 min period improved limits of agreement of both respiration and heart rate. 63% of the measurements were performed without data loss greater than 2 min. Overall data loss was limited (6% of time).ConclusionsThe wireless sensor is capable of accurately measuring heart rate, but accuracy for respiratory rate was outside acceptable limits. Remote monitoring has the potential to contribute to early recognition of physiological decline in high-risk patients. Future studies should focus on the ability to detect patient deterioration on low care environments and at home after discharge.

Polyamines are essential poly-cations with vital functions in all cellular systems. Their levels are controlled by intricate regulatory feedback mechanisms. Abnormally high levels of polyamines have been linked to cancer. A rate-limiting enzyme in the biosynthesis of polyamines in fungi and higher eukaryotes is ornithine-decarboxylase (ODC). Its levels are largely controlled posttranslationally via ubiquitin-independent degradation mediated by ODC antizyme (OAZ). The latter is a critical polyamine sensor in a feedback control mechanism that adjusts cellular polyamine levels. Here, we describe an approach employing quantitative western blot analyses that provides in vivo evidence for cotranslational polyamine-sensing by nascent OAZ in yeast. In addition, we describe an in vitro method to detect polyamine binding by antizyme.

Of all pathogenic mitochondrial DNA (mtDNA) mutations in humans, ∼25% is de novo, although the occurrence in oocytes has never been directly assessed. We used next-generation sequencing to detect point mutations directly in the mtDNA of 3–15 individual mature oocytes and three somatic tissues from eight zebrafish females. Various statistical and biological filters allowed reliable detection of de novo variants with heteroplasmy ≥1.5%. In total, we detected 38 de novo base substitutions, but no insertions or deletions. These 38 de novo mutations were present in 19 of 103 mature oocytes, indicating that ∼20% of the mature oocytes carry at least one de novo mutation with heteroplasmy ≥1.5%. This frequency of de novo mutations is close to that deducted from the reported error rate of polymerase gamma, the mitochondrial replication enzyme, implying that mtDNA replication errors made during oogenesis are a likely explanation. Substantial variation in the mutation prevalence among mature oocytes can be explained by the highly variable mtDNA copy number, since we previously reported that ∼20% of the primordial germ cells have a mtDNA copy number of ≤73 and would lead to detectable mutation loads. In conclusion, replication errors made during oogenesis are an important source of de novo mtDNA base substitutions and their location and heteroplasmy level determine their significance.