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Background There has been increasing research on posttraumatic stress disorder (PTSD) following childbirth in the last two decades. The literature on predictors of who develops posttraumatic stress symptoms (PSS) suggests that both vulnerability and birth factors have an influence, but many studies measure predictors and outcomes simultaneously. Objective In this context, we aimed to examine indirect and direct effects of predictors of PSS, which were measured longitudinally. Method We assessed women within the first days (n=353), 6 weeks, and 12 months (n=183) after having given birth to a healthy infant. The first assessment included questions on demographics, pregnancy, and birth experience. The second and third assessments contained screenings for postpartum depression, PTSD, and general mental health problems, as well as assessing social support and physical well-being. We analysed our data using structural equation modelling techniques (n=277). Results Our final model showed good fit and was consistent with a diathesis-stress model of PSS. Women who had used antidepressant medication in the 10 years before childbirth had higher PSS at 6 weeks, independent of birth experiences. Subjective birth experience was the early predictor with the highest total effect on later PSS. Interestingly, a probable migration background also had a small but significant effect on PSS via more episiotomies. The null results for social support may have been caused by a ceiling effect. Conclusions Given that we measured predictors at different time points, our results lend important support to the etiological model, namely, that there is a vulnerability pathway and a stress pathway leading to PSS. PSS and other psychological measures stayed very stable between 6 weeks and 1 year postpartum, indicating that it is possible to identify women developing problems early. Highlights of the article Our results are consistent with a diathesis-stress model: vulnerability (antidepressant use in the previous 10 years) influenced posttraumatic stress symptoms at 6 weeks and 1 year, independently of stress (birth-related variables). The strongest predictor of posttraumatic stress symptoms 1 year postpartum was posttraumatic stress symptoms 6 weeks postpartum. This means that women who develop problems could be identified during routinely offered postpartum care. Women with a probable migration background experienced more PSS 1 year after the birth, which was an indirect effect through more episiotomies and more PSS after 6 weeks.

Zusammenfassung Hintergrund Die aktuelle Infektionsgefahr mit SARS-CoV-2 in Schulen wird weiterhin kontrovers diskutiert. Methodik „schugi-MV“ erfasst in strukturierten Begehungen von Schulen in Mecklenburg-Vorpommern (M-V) Daten zum Infektionsgeschehen, Hygienemanagement sowie weiteren Faktoren. Aus den Ergebnissen sollen Empfehlungen für einen sicheren Unterricht abgeleitet werden. In diesem Artikel werden Informationen zu den ersten 10, zwischen dem 18.12.2020 und 20.01.2021 besuchten Schulen vorgestellt. Ergebnisse An den besuchten Schulen lag das Verhältnis der Anzahl Indexfälle bei Erwachsenen und Kindern bei 1:1,25. Die Begehungen zeigten eine große Heterogenität der Schulen und Schulgebäude sowie der dadurch bedingten Möglichkeiten zur Umsetzung von Infektionsschutzmaßnahmen. Schlussfolgerung Basierend auf den vorliegenden, vorläufigen Ergebnissen sind Hygiene- und Infektionsschutzmaßnahmen an den Schulen in M-V nicht standardisierbar, sondern sollten Gestaltungsspielraum lassen.

Zusammenfassung Hintergrund Durch die im Zuge des Ausbruchs der „coronavirus disease 2019“ (COVID-19) im März 2020 erlassenen Kontaktverbote haben Psychotherapeuten deutlich mehr und die meisten von ihnen erstmalig Videobehandlungen (VB) angeboten. Bisher gibt es nur wenig Forschung dazu, wie Therapeuten die VB während der Pandemie erlebt haben, und es liegen keine Studien vor, die mögliche verfahrensspezifische Besonderheiten betrachten. Ziel Es soll analysiert werden, welche subjektiven Erfahrungen Therapeuten unterschiedlicher Richtlinienverfahren mit der Durchführung von VB in Zeiten der COVID-19-Pandemie gemacht haben und welche Vor- und Nachteile sie erlebten. Methoden Es handelt sich um eine „Mixed-methods“-Studie mit einer querschnittlichen Onlineerhebung. Neben quantitativen Daten wurden anhand von 7 offenen Fragen die subjektiven Erfahrungen der Therapeuten mit der Durchführung von VB erhoben und mithilfe der qualitativen Inhaltsanalyse ausgewertet. Die identifizierten Kategorien wurden einer Häufigkeitsanalyse unterzogen. Angaben von 174 ärztlichen oder psychologischen Psychotherapeuten gingen in die Auswertung ein. Ergebnisse Besonders häufig genannte Vorteile waren die örtliche und zeitliche Flexibilität, die Kontinuität des Kontaktes in Pandemiezeiten und die Vermeidung des Infektionsrisikos. Der meistbenannte Nachteil war, dass Sinneseindrücke, Mimik, Gestik, Blickkontakt und nonverbale Kommunikation fehlen. Die meisten, aber nicht alle Patienten nahmen VB gut an. Technische Probleme erschwerten die Umsetzung. Schlussfolgerungen Für viele Therapeuten blieb VB eine „Notlösung“, die nicht auf Dauer angelegt sei. Allerdings könnte VB über die Pandemiezeit hinaus helfen, Versorgungsprobleme (z. B. Unterversorgung auf dem Land) zu lösen. Die Ergebnisse der Studie leisten einen wichtigen Beitrag dazu, Chancen und Risiken der VB für die psychotherapeutische Versorgung abzuwägen sowie mögliche Gefahren und Schwierigkeiten im Auge zu behalten.

While minimally invasive liver surgery has been increasingly adopted at least for minor resections, experience with robotic liver surgery is still limited to a few highly specialized centers. Due to the fear of abdominal adhesions, a history of prior surgeries is still used as an argument for open approaches. Clinical data of all consecutive robotic resections at our center, using the da Vinci Xi surgical system, between April, 2018 and December, 2020, were collected and analyzed as part of a prospective, post-marketing observational study (DRKS00017229). Prior abdominal surgeries were specified according to the surgical approach and localization. Baseline and perioperative outcome criteria were compared between patients with prior surgeries (PS) and patients with no prior surgeries (NPS) in univariate and multivariate analyses. Out of the 126 patients undergoing robotic liver resections, 59% had a history of abdominal surgeries, which were most often colorectal resections (28%) followed by liver resections (20%). Patients with NPS were more likely to undergo robotic liver resection for hepatocellular carcinoma or benign tumors, and to have underlying liver cirrhosis when compared to patients with PS. Other baseline characteristics as well as the extent of resections were similar. Duration of surgery (258 min), conversion rates (6%), and postoperative complications rates (21% Clavien–Dindo ≥ 3) showed no differences between NPS and PS. A subgroup of patients with a history of prior liver surgery showed a longer duration of surgery in univariate analysis. However, this was not confirmed in multivariate analysis which instead revealed tumor entity and liver cirrhosis as independently correlated with duration of surgery. We propose robotic liver resection to be safe and feasible, including in patients with prior abdominal surgeries. Each patient should be evaluated for a minimally invasive procedure regardless of a history of previous operations.

ZusammenfassungFlexible Fertigungsprozesse in der Umformtechnik ermöglichen es, schnell und effizient auf veränderliche Rahmenbedingungen beispielsweise durch Kundenwünsche und rechtliche Anforderungen reagieren zu können. Besonders die inkrementellen Umformverfahren der Massivumformung zeichnen sich durch eine hohe Flexibilität aus, da die Prozesse gut anpassbar sind und die verwendeten Anlagen und Werkzeuge in einem geringeren Maße auf ein spezifisches Bauteil hin ausgelegt werden.Der hier vorgestellte Fügeprozess mittels Radial-Walzen ist geeignet, hybride Bauteile form- und kraftschlüssig miteinander zu verbinden. So lassen sich die spezifischen Vorteile verschiedener Werkstoffe kombinieren und Nutzungs- sowie Leichtbaupotenziale können gezielt genutzt werden. Die in diesem Prozess entstehende charakteristische umlaufende Kerbe in der Wellenkomponente bildet eine Schwachstelle der gefügten Bauteile, da es dort unter Last zu einer Spannungskonzentration kommt, welche die Bildung eines Risses begünstigt. Dieser Herausforderung wird mit einer Kombination der Ausnutzung der Kaltverfestigung des gewählten Werkstoffs (1.7225) und gezielt eingebrachter Druckeigenspannungen in der Kerbe begegnet. Hier liegt der Fokus auf den Druckeigenspannungen, die das Potenzial aufweisen, sich verlängernd auf die Lebensdauer auszuwirken. Sie lassen sich gezielt über eine günstige Wahl des Walzpfads zur Herstellung der Fügeverbindung beeinflussen, wie sowohl in numerischen Analysen als auch durch Eigenspannungsmessungen an Realbauteilen gezeigt wird. Es können sehr hohe Eigenspannungen in der kritischen Zone des Kerbgrunds eingebracht werden, die einen deutlichen Einfluss auf die Lebensdauer haben, wie auch die Lebensdauerberechnungen mittels des Örtlichen Konzepts deutlich zeigen.

Alpha2 receptor agonists (alpha2-agonists) are useful sedative and analgesic agents in sheep, but have adverse pulmonary effects, which are reportedly similar between different alpha2-agonists. This randomized crossover study compared pulmonary function after intravenous administration of an alpha2-agonist, either xylazine or an equipotent dose of medetomidine in 34 female sheep anaesthetized twice. Pulmonary function was assessed using spirometry, volumetric capnography, arterial blood gas analysis 1 min prior to, and 5 and 10 min after administration of the allocated alpha 2 agonist drug. Pulmonary structural changes were subsequently assessed using computed tomography (CT). Tachypnoea or hypoxaemia prompted reversal with atipamezole and exclusion of data. Data were analysed for a fixed effect of drug using a mixed effect linear model with significance set at p 2), and lower dynamic compliance, tidal volume, CO2 elimination and end tidal CO2 tension and arterial oxygen tension than medetomidine. This was associated with a significantly lower % of aerated tissue and higher % poorly and non-aerated tissue in CT images of sheep receiving xylazine versus medetomidine. In conclusion, xylazine administration produced marked decreases in pulmonary function, in ventilated isoflurane anaesthetized sheep, when compared to an equipotent dose of medetomidine when administered as an intravenous bolus supporting the use of medetomidine when alpha2-agonists are required.

Zusammenfassung Hintergrund Sowohl für die Erforschung von Therapeuteneffekten als auch für die Aus- und Weiterbildung ist es von hoher Bedeutung, interpersonelle Fähigkeiten von Psychotherapeuten zu messen. Eines der wenigen dafür zur Verfügung stehenden Instrumente ist die Facilitative-interpersonal-skills(FIS)-Übung. Ziele der Arbeit 1. Vorstellung der FIS-Übung, 2. Prüfung der psychometrischen und deskriptiven Eigenschaften und 3. Untersuchung der Zusammenhänge des FIS-Gesamtwerts mit Alter, Geschlecht und Ausbildungsstand der Testteilnehmer. Material und Methoden In die Querschnittsuntersuchung wurden Psychologiestudierende und Psychologen in psychotherapeutischer Ausbildung eingeschlossen. Die Teilnehmer sollten in der FIS-Übung auf herausfordernde Therapiesituationen, die in 13 Videoclips nachgestellt sind, verbal reagieren. Die audioaufgezeichneten Reaktionen wurden von je 3 geschulten Ratern eingeschätzt. Ergebnisse Der durchschnittliche FIS-Gesamtwert der 115 Studienteilnehmer (Alter: M = 31,97 Jahre, SD ± 7,94 Jahre; weiblich: n = 90, 78,3 %; in psychotherapeutischer Ausbildung: n = 72, 66,1 %) betrug 3,24 (SD ± 0,42). Die Reliabilität erwies sich als gut (Intraklassen-Korrelationskoeffizient[ICC]2FIS-Gesamtwert = 0,69; Cronbachs α = 0,958). Unter den Videoclips befanden sich 3 signifikant leichtere und 4 schwierigere. Über die Clips hinweg wurden sowohl ein Lern- als auch ein Ermüdungseffekt ersichtlich. Ausbildungskandidaten erzielten signifikant höhere Werte als Psychologiestudierende. Diskussion Die FIS-Übung erwies sich in einer größeren Stichprobe als reliabel. Es sollten mindestens 3 und maximal 9 Clips eingesetzt werden, die je nach Ausbildungsstand der Durchführenden und Clip-Schwierigkeit ausgewählt werden können. Die FIS-Übung ist zur standardisierten, empirisch fundierten Messung interpersoneller therapeutischer Fähigkeiten in Forschung und in der Aus- und Weiterbildung von großem Nutzen.

Bisherige Forschungsarbeiten berichten wenig einheitliche Befunde zum Einfluss von Therapeutenmerkmalen auf Therapieabbruche (Drop-outs). Zudem mangelt es an vergleichbaren Operationalisierungen von Therapieabbruchen. Ziel des Review war die Identifizierung von einflussreichen Therapeutenmerkmalen, die mit Therapieabbruchen zusammenhangen. Weiterhin wurden die Operationalisierungen von Therapieabbruchen in den vergangenen 20 Jahren untersucht. Die Literatursuche erfolgte via PsycARTICLES, PsycINFO, PSYNDEX und OVID MEDLINE. Extrahiert wurden die Operationalisierung des Konstrukts Therapieabbruch, Abbruchquoten, die erhobenen Therapeutenmerkmale sowie die verwendeten Erhebungsinstrumente. Das Verzerrungsrisiko der Studien wurde anhand des Tools Quality in Prognostic Studies (QUIPS) analysiert. Es konnten 23 relevante Studien mit 20.034 Patienten und 1826 Therapeuten identifiziert werden. Das Alter, das Geschlecht und die therapeutische Erfahrung hatten keinen Effekt auf den Therapieabbruch. In einigen Studien zeigte sich ein Einfluss ethnischer und kultureller Variablen. Psychologische Therapeutenvariablen wie Personlichkeitseigenschaften wurden bislang wenig untersucht. Die dahingehenden Ergebnisse konnen noch nicht abschliesend beurteilt werden. Eine einheitliche Operationalisierung fur Therapieabbruche existiert nicht. Zukunftigen Untersuchungen wird empfohlen, die Auswahl an moglichen Pradiktoren umfassender zu gestalten und sowohl Therapeuten‑, Patienten- als auch Prozessvariablen zu berucksichtigen. Zudem sollte sich nicht auf eine Operationalisierung des Konstrukts Therapieabbruch festgelegt werden, sondern stattdessen sollten mehrere Varianten gleichzeitig verwendet werden, um die Effekte der Operationalisierung auf das Ergebnis in Sensitivitatsanalysen zu untersuchen.

Background Laparoscopic techniques have become the standard approach for most liver resections. Clinical studies providing conclusive evidence which patients benefit most from minimal-invasive surgery remain limited. Methods We retrospectively analyzed data of all consecutive cases of laparoscopic liver resection between 2015 and 2018 at our center. We compared patients with and without prior abdominal surgeries with respect to postoperative complications (Clavien-Dindo score), length of operation, length of ICU stay and length of hospitalization in univariate and multivariate analyses. Results Within the study period 319 patients underwent laparoscopic liver resections, 44% of which had a history of abdominal surgeries. Pre-operative characteristics were similar to patients without prior surgeries. Both groups showed comparable rates of post-operative complications (Clavien-Dindo score ≥3a; 12% in patients without vs. 16% with prior surgeries, p = 0,322). There were no significant differences in length of surgery or length of stay in the ICU or in the hospital. Conclusion Our data suggest that history of prior abdominal surgery is not a risk factor for post-operative complications after laparoscopic liver resection. We conclude that prior abdominal surgery should not be considered a contra-indication for laparoscopic approach in liver resection.

Summary Background Patients with inflammatory diseases, such as rheumatoid arthritis, often receive glucocorticoids, but long-term use can produce adverse effects. Evidence from randomised controlled trials to guide tapering of oral glucocorticoids is scarce. We investigated a scheme for tapering oral glucocorticoids compared with continuing low-dose oral glucocorticoids in patients with rheumatoid arthritis. Methods The Steroid EliMination In Rheumatoid Arthritis (SEMIRA) trial was a double-blind, multicentre, two parallel-arm, randomised controlled trial done at 39 centres from six countries (France, Germany, Italy, Russia, Serbia, and Tunisia). Adult patients with rheumatoid arthritis receiving tocilizumab and glucocorticoids 5–15 mg per day for 24 weeks or more were eligible for inclusion if they had received prednisone 5 mg per day for 4 weeks or more and had stable low disease activaity, confirmed by a Disease Activity Score for 28 joints–erythrocyte sedimentation rate (DAS28-ESR) of 3·2 or less 4–6 weeks before and on the day of randomisation. Patients were randomly assigned 1:1 to either continue masked prednisone 5 mg per day for 24 weeks or to taper masked prednisone reaching 0 mg per day at week 16. All patients received tocilizumab (162 mg subcutaneously every week or 8 mg/kg intravenously every 4 weeks) with or without csDMARDs maintained at stable doses during the entire 24-week study. The primary outcome was the difference in mean DAS28-ESR change from baseline to week 24, with a difference of more than 0·6 defined as clinically relevant between the continued-prednisone group and the tapered-prednisone group. The trial is registered with ClinicalTrials.gov , NCT02573012 . Findings Between Oct 21, 2015, and June 9, 2017, 421 patients were screened and 259 (200 [77%] women and 59 [23%] men) were recruited onto the trial. In all 128 patients assigned to the continued-prednisone regimen, disease activity control was superior to that in all 131 patients assigned to the tapered-prednisone regimen; the estimated mean change in DAS28-ESR from baseline to week 24 was 0·54 (95% CI 0·35–0·73) with tapered prednisone and −0·08 (–0·27 to 0·12) with continued prednisone (difference 0·61 [0·35–0·88]; p Interpretation In patients who achieved low disease activity with tocilizumab and at least 24 weeks of glucocorticoid treatment, continuing glucocorticoids at 5 mg per day for 24 weeks provided safe and better disease control than tapering glucocorticoids, although two-thirds of patients were able to safely taper their glucocorticoid dose. Funding F Hoffmann-La Roche.

Steadily aging populations result in a growing need for research regarding age-related brain alterations and neurodegenerative pathologies. By allowing a good translation of results to humans, nonhuman primates, such as the gray mouse lemur Microcebus murinus, have gained attention in this field. Our aim was to examine correlations between atrophy-induced brain alterations and age, with special focus on sex differences in mouse lemurs. For cerebral volumetric measurements, in vivo magnetic resonance imaging was performed on 59 animals (28♀♀/31♂♂) aged between 1.0 to 11.9 years. Volumes of different brain regions, cortical thicknesses, and ventricular expansions were evaluated. Analyses revealed significant brain atrophies with increasing age, particularly around the caudate nucleus, the thalamus, and frontal, parietal, and temporo-occipital regions. Especially old females showed a strong decline in cingulate cortex thickness and had higher values of ventricular expansion, whereas cortical thickness of the splenium and occipital regions decreased mainly in males. Our study, thus, provides first evidence for sex-specific, age-related brain alterations in a nonhuman primate, suggesting that mouse lemurs can help elucidating the mechanism underlying sex disparities in cerebral aging, for which there is mixed evidence in humans.

Minimally invasive techniques have been broadly introduced to liver surgery during the last couple of years. In this study, we aimed to report the incidence and potential risk factors for incisional hernia (IH) as well as health-related quality of life (HRQoL) after laparoscopic liver resections (LLR). All patients undergoing LLR between January 2014 and June 2017 were contacted for an outpatient hernia examination. In all eligible patients, photo documentation of the scar was performed and IH was evaluated by clinical examination and by ultrasound. Patients also completed a questionnaire to evaluate IH-specific symptoms and HRQoL. Obtained results were retrospectively analyzed with regard to patients’ characteristics, perioperative outcomes and applied minimally invasive techniques, such as multi-incision laparoscopic liver surgery or hand-assisted/single-incision laparoscopic surgery (HALS/SILS). Of 184 patients undergoing surgery, 161 (87.5%) met the inclusion criteria and 49 patients (26.6%) participated in this study. After a median time of 26 months (range 19–50 months) after surgery, we observed an overall incidence of IH of 12%. Five of 6 patients were overweight or obese (BMI ≥ 25) and 5 of 6 hernias were located at the umbilical site. Univariate analysis suggested the performance status at time of operation (ASA score ≥ 3; HR 5.616, 95% CI 1.012–31.157, p = 0.048) and the approach (HALS/SILS, HR 6.571, 95% CI 1.097–39.379, p = 0.039) as potential risk factors for IH. A higher frequency of hernia-related physical restrictions (HRR; p = 0.058) and a decreased physical functioning (p = 0.17) were noted in patients with IH; however, both being short of statistical significance. Advantages of laparoscopic surgery with regard to low rates of IH can be translated to minimally invasive liver surgery. Even though there are low rates of IH, patients with poor performance status at the time of operation should be monitored closely. While patients’ characteristics are hard to influence, it might be worth focusing on surgical factors such as the approach and the closure of the umbilical site to further minimize the rate of IH.

In Fourier transform infrared (FTIR) spectral imaging spatially distributed spectra of 2D surfaces are registered simultaneously using FTIR spectrometers equipped with array detectors. Scanning methods such as near-field FTIR spectroscopy are a promising alternative providing both, higher spatial resolution, and sensitivity. However, serial recording severely limits their imaging application due to long acquisition times involved and the resulting stability issues. In this work we demonstrate different strategies to compress the FTIR measurement already at the data acquisition stage to significantly reduce the measurement time. Corresponding reconstruction schemes and their hardware implementation will be discussed.

Purpose This is an official S3-guideline of the German Society of Gynaecology and Obstetrics (DGGG), the Austrian Society of Gynaecology and Obstetrics (ÖGGG) and the Swiss Society of Gynaecology and Obstetrics (SGGG). The guideline contains evidence-based information and recommendations on indications, complications, methods and care associated with delivery by caesarean section for all medical specialties involved as well as for pregnant women. Methods This guideline has adapted information and recommendations issued in the NICE Caesarean Birth guideline. This guideline also considers additional issues prioritised by the Cochrane Institute and the Institute for Research in Operative Medicine (IFOM). The evaluation of evidence was based on the system developed by the Scottish Intercollegiate Guidelines Network (SIGN). A multi-part nominal group process moderated by the AWMF was used to compile this S3-level guideline. Recommendations Recommendations on consultations, indications and the process of performing a caesarean section as well as the care provided to the mother and neonate were drawn up.

Kurzfristige negative Folgen psychischer Beanspruchung stellen unmittelbare Auswirkungen psychischer Belastung dar. Inwieweit sich diese im Verlaufe eines Arbeitstages entwickeln und eine vermittelnde Rolle in der Beziehung von Arbeitsintensitat als quantitative Anforderung und Erholung einnehmen, wurde bei 47 StrasenbahnfahrerInnen untersucht. Psychische Ermudung und Stress wurden alle zwei Stunden wahrend eines kompletten Arbeitstages mittels Tagebuch-Befragung erfasst. Im Ergebnis zeigte sich ein signifikanter Anstieg der Ermudung uber die Arbeitsschicht hinweg bis zum Arbeitsende. Auserdem zeigte sich ein Zusammenhang zwischen Arbeitsintensitat und Erholungsunfahigkeit. Dabei wird die Beziehung zwischen Arbeitsintensitat und Erholungsunfahigkeit ab Mitte der Arbeitsschicht komplett durch das Ermudungserleben vermittelt. Die Ergebnisse weisen auf die haufig angenommene, aber bislang kaum untersuchte vermittelnde Rolle kurzfristiger Beanspruchungsfolgen fur die Entstehung von Erholungsbeeintrachtigungen hin. Praktische Relevanz Fahrer im offentlichen Personennahverkehr stellen seit jeher eine Berufsgruppe dar, die durch hohe Arbeitsunfahigkeitsraten auffallt. Die vorliegenden Ergebnisse zeigen Ansatzpunkte fur die Arbeitsgestaltung auf. Diese umfassen die Verminderung von zu hoher Arbeitsintensitat und die Gewahrung ausreichender Erholungsmoglichkeiten. Eine solche Arbeitsgestaltung sollte den in dieser Untersuchung gefundenen Anstieg von Ermudung uber die Arbeitsschicht weitestgehend verhindern und damit Unfallrisiken sowie gesundheitliche Beeintrachtigen fur die Fahrer deutlich verringern.

Background In recent years, laparoscopic liver resection has elicited growing attention as a safe procedure for various forms of hepatic resection. In the context of an aging population, this study aims to evaluate outcomes in elderly patients (>70 y) compared with younger patients (≤70 y). Methods All consecutive patients undergoing minimally invasive liver resections between December 2013 and January 2018 at the Department of Surgery, Charite–Universitatsmedizin Berlin, were included in this analysis. Patients’ characteristics, such as body mass index, American Society of Anesthesiologists classification, as well as underlying liver disease and function, were examined and the perioperative outcomes of patients aged >70 y (group 1; G1) contrasted with patients aged ≤ 70 y (group 2; G2). Results Of 250 patients, 67 were >70 y old (G1) and 183 were ≤70 y old (G2). Patients in G1 were characterized by a higher body mass index (27.6 kg/m2 versus 24.9 kg/m2; P = 0.004) and impaired physical states (American Society of Anesthesiologists score III/IV; 60% versus 37%; P = 0.002) when compared with group 2. G1 also exhibited higher rates of primary and secondary hepatic malignancies (G1: n = 62; 92.5%; G2: n = 115, 62.8%; P = 0.031) in addition to higher rates of cirrhosis (G1: n = 30, 44.8%; G2: n = 38, 20.8%; P = Conclusions Minimally invasive liver resection is a feasible and safe procedure in elderly patients despite this age group exhibiting a higher rate of primary and secondary malignancy and cirrhosis, as well as an overall more severely compromised physical health when compared with patients under the age of 70 y. Therefore, it stands to reason that patients in poorer general health might particularly benefit from a minimally invasive approach.

The basic question as to whether male laboratory mice should be singly or group housed represents a major animal welfare concern within current laboratory animal legislation and husbandry. To better understand the behavioural and physiological mechanisms underlying this issue, we conducted two longitudinal experiments using C57BL/6J mice. In the first experiment (N = 32), we explored social behaviour of pair housed males from weaning to adulthood. We took weekly measures of agonistic, socio-exploratory and affiliative behaviours within two different contexts, i.e. in the undisturbed home cage and immediately after cage cleaning. In the second experiment (N = 36), we investigated whether separation of male pairs into single housing at different ages (35, 56 or 77 days of age) affected welfare-related measures such as faecal corticosterone metabolites (FCMs) and anxiety-like behaviours. In the first experiment we found that levels of agonistic behaviour were higher after cage cleaning than in the undisturbed cage as expected, but did not significantly change with age in either context. Instead, affiliative behaviour increased with age in the undisturbed home cage. In the second experiment, social separation did not affect levels of FCMs or anxiety-like behaviours at any age point. Taken together, this study shows that pair housed male mice can maintain low levels of aggression across a long period of their life and perform increasing levels of sociopositive behaviours which may serve to promote stable social relations. At the same time, our results suggest that male mice can quickly adapt to separation into single housing at different ages, from adolescence to adulthood. These findings are in line with the behavioural ecology of wild male mice, which suggests that both solitary and group living represent two alternative strategies.

Here we report a case of severe growth retardation and neurologic abnormalities in a female gray mouse lemur (Microcebus murinus), a small NHP species for which the genomic sequence recently became available. The female lemur we present here died on postnatal day 125. This lemur had impaired development of motor skills and showed severe ataxia and tremors. In addition, hearing seemed normal whereas ophthalmic examination revealed incipient bilateral cataracts, abnormal pigmentation in the lens of the left eye, and a missing optokinetic nystagmus, which indicated impaired vision. Most prominently, the lemur showed severe growth retardation. Necropsy revealed maldevelopment of the left reproductive organs and unilateral dilation of the right lateral ventricle, which was confirmed on brain MRI. Brain histology further revealed large, bilateral areas of vacuolation within the brainstem, but immunohistochemistry indicated no sign of pathologic prion protein deposition. Full genomic sequencing of the lemur revealed a probably pathologic mutation in LARGE2 of the LARGE gene family, which has been associated with congenital muscular dystrophies. However, potentially functional mutations in other genes were also present. The observed behavioral and motor signs in the presented animal might have been linked to spongiform degeneration and resulting brainstem dysfunction and progressive muscle weakness. The macroscopic developmental abnormalities and ophthalmic findings might be genetic in origin and linked to the mutation in LARGE2.

The aim was to determine the effects of vatinoxan on dexmedetomidine plasma concentrations and effects on cardiovascular and intestinal tissue pharmacodynamics. In a prospective randomized study, six horses were premedicated intravenously with dexmedetomidine 3.5 µg kg-1 followed by a constant-rate infusion of 7 µg kg-1 h-1 (group DEX) and six horses with dexmedetomidine of the same dose (bolus and constant-rate infusion) combined with vatinoxan 130 µg kg-1 followed by 40 µg kg-1 h-1 (group VAT). Anaesthesia was induced with ketamine and diazepam and maintained with isoflurane. Venous blood samples were withdrawn before and at predefined points in time after drug application. During sedation and anaesthesia, cardiopulmonary variables, gastrointestinal tissue perfusion and oxygenation were recorded. Data were analysed using two-way-ANOVA, unpaired-t-test and Dunnett's-t-test (p < 0.05). Group VAT had significantly higher oxygen delivery and lower oxygen extraction ratio, venous admixture, alveolar dead space and alveolar-arterial-oxygen difference. Tissue perfusion of buccal mucosa was reduced during anaesthesia in group DEX. Plasma concentrations of dexmedetomidine in group VAT (n = 6) and group DEX (n = 5) were comparable between groups. In the present pilot study, co-administration of vatinoxan with dexmedetomidine did not alter plasma concentrations of dexmedetomidine but ameliorated tissue perfusion and global oxygenation variables.

BackgroundA long duration of untreated illness (DUI) is an unfavorable prognostic factor in anorexia nervosa and often associated with chronic illness progression. The FABIANA- checklist, developed using a qualitative multi-informant approach, includes factors influencing treatment initiation which are potentially modifiable and are mentioned as being relevant by patients with AN. The study focusses on the development and evaluation of the FABIANA-Checklist and aims at providing descriptive data on DUI in a German sample.MethodsAfter cognitive pretest and revision, dimensionality of the 18-item version of the FABIANA-checklist was tested by Principal Component Analysis (PCA). For item validation we assessed support from social environment (FSozU), support in the health care system (PACIC-5A), illness perception and coping (BIPQ).ResultsWe included a sample of female patients (N=75), aged >14 years ( M = 21.4 years) with AN. Average BMI was 15.5 kg/m 2 , age of onset was 19.2 years and average DUI was 2.25 years. PCA yielded six components explaining 62.64% of the total variance. Overall internal consistency was acceptable (Cronbach’s α= .76) and construct validity was satisfactory for 14 items. Two consistent components emerged: primary care perceived as supportive and competent (23.33%) and emotional and practical support from relatives (9.98%). With regard to the other components, the heterogeneity of the items led to unsatisfactory internal consistency, single item loading and partly ambiguous interpretability. Analysis on item level indicated that practical and emotional support from the social environment seems to be particularly important for treatment initiation.ConclusionsThe FABIANA-checklist is a valid instrument to assess factors involved in the process of treatment initiation of patients with AN. Psychometrics and dimensionality testing suggests that experienced emotional and practical support from the primary health care system and close relatives are strongly involved factors. Nevertheless, the results point out that a differentiated consideration on item level is useful. To quantify the relative importance of the factors assessed and to derive recommendations on early-intervention approaches, the predictive effect of the FABIANA-items on the DUI will be determined in a subsequent study which will further include the perspective of relatives and primary caregivers in addition to the patient perspective.Trial registrationClinical Trials.gov Identifier: NCT03713541: https://clinicaltrials.gov/ct2/show/NCT03713541

Background A long duration of untreated illness (DUI) is an unfavorable prognostic factor in anorexia nervosa (AN) and is associated with chronic illness progression. Although previous preventive measures aimed at reducing DUI and thus improving short- and long-term treatment outcomes have been partially successful, a better understanding of the factors involved in the sensitive phase prior to treatment initiation is needed. To date, there is no validated instrument available to assess these factors specifically for patients with AN. The FABIANA-project (Facilitators and barriers in anorexia nervosa treatment initiation) aims at identifying predictors of the DUI in order to target preventive measures better in the future. As part of this project, the FABIANA-checklist was developed, based on a multi-informant perspective and a multimodal bottom-up approach. The present study focusses on the process of item generation, item selection and psychometric validation of the checklist. Methods Based upon a previous qualitative study, an initial set of 73 items was generated for the most frequently mentioned facilitators and barriers of treatment initiation in AN. After a process of consensual rating and cognitive pre-testing, the resulting 25-item version of the FABIANA-checklist was provided to a sample of female patients (N = 75), aged ≥ 14 years with AN that underwent their first psychotherapeutic treatment in the last 12 months. After item analysis, dimensionality of the final version of the FABIANA-checklist was tested by Principal Component Analysis (PCA). We evaluated construct validity assuming correlations with related constructs, such as perceived social support (F-SozU), support in the health care system (PACIC-5A), illness perception and coping (BIPQ). Results We included 54 adult and 21 adolescent patients with AN, aged on average 21.4 years. Average BMI was 15.5 kg/m2, age of onset was 19.2 years and average DUI was 2.25 years. After item analysis, 7 items were excluded. The PCA of the 18-item-FABIANA-checklist yielded six components explaining 62.64% of the total variance. Overall internal consistency was acceptable (Cronbach’s α = .76) and construct validity was satisfactory for 14 out of 18 items. Two consistent components emerged: “primary care perceived as supportive and competent” (23.33%) and “emotional and practical support from relatives” (9.98%). With regard to the other components, the heterogeneity of the items led to unsatisfactory internal consistency, single item loading and in part ambiguous interpretability. Conclusions The FABIANA-checklist is a valid instrument to assess factors involved in the process of treatment initiation of patients with AN. Psychometrics and dimensionality testing suggests that experienced emotional and practical support from the primary health care system and close relatives are main components. The results indicate that a differentiated assessment at item level is appropriate. In order to quantify the relative importance of the factors and to derive recommendations on early-intervention approaches, the predictive effect of the FABIANA-items on the DUI will be determined in a subsequent study which will further include the perspective of relatives and primary caregivers. Trial registration Clinical Trials.gov Identifier: NCT03713541: https://clinicaltrials.gov/ct2/show/NCT03713541. Supplementary Information The online version contains supplementary material available at 10.1186/s40337-021-00490-w., Plain English summary Early treatment contributes to a more favorable illness course and an improved prognosis in patients with anorexia nervosa (AN). The current study presents the development of the FABIANA checklist, which aims to assess factors which influence duration of untreated illness. The FABIANA checklist was developed on the basis of interviews with patients, their relatives and primary care practitioners. It provides data from the first use of the checklist in a German sample of 75 patients with AN. The results of our study suggest that the FABIANA-checklist is a valid instrument to assess factors involved in the process of treatment initiation. Emotional and practical support from the primary health care system and close relatives were the most consistent components. A follow-up study will investigate the relationship between the FABIANA-items and the DUI in order to guide the conception of effective secondary prevention measures. Supplementary Information The online version contains supplementary material available at 10.1186/s40337-021-00490-w.

Background An early psychotherapeutic treatment of anorexia nervosa (AN) is crucial for a good prognosis. In order to improve treatment initiation, knowledge about facilitators and barriers to treatment is needed. Objective Against this background, we aimed to identify facilitators and barriers from the perspectives of patients, carers and professionals using a qualitative approach. Method To this end, semi-structured interviews were conducted in triads of female patients with AN aged 14 years and older at the beginning of their first psychotherapeutic treatment, their carers, and referring health care professionals. A modified Grounded Theory approach was used for analysis. Results In total, 22 interviews were conducted (n = 6 adults, n = 4 adolescents, 4 full triads). The duration of untreated AN ranged between 30 days and 25.85 years (M = 3.06 ± 8.01 years). A wide spectrum of facilitators and barriers within the patient, the social environment, the health care system and the society were identified. Most prominent factors were ‘recognizing and addressing’ by close others, ‘waiting times and availability’ and ‘recommendations and referrals’ by health care professionals. ‘Positive role models for treatment’ were perceived as a specific facilitative social influence. Facilitators were more frequently mentioned than barriers and most of the factors seem to hold potential for modifiability. Conclusion Overall, the findings suggest that early intervention approaches for AN should not only address patients and the health care system, but may also involve carers and successfully treated former patients. Trial registration ClinicalTrials.gov Identifier: NCT03713541.

Altered pupillary function may reflect nonconvulsive status epilepticus (NCSE). Neurological pupil index (NPi) assessed by automated pupillometry is a surrogate marker of global pupillary function. We aimed to assess NPi changes in relation to NCSE treatment response. In this prospective observational study, serial automated pupillometry was performed in 68 NCSE episodes. In accordance with local standards, patients were treated with clonazepam (1–2 mg), levetiracetam (40 mg/kg), and lacosamide (5 mg/kg) in a stepwise approach under continuous electroencephalography monitoring until NCSE was terminated. Patients with refractory NCSE received individualized regimens. NPi was assessed bilaterally before and after each treatment step. For statistical analysis, the lower NPi of both sides (minNPi) was used. Nonparametric testing for matched samples and Cohen’s d to estimate effect size were performed. Principal component analysis was applied to assess the contribution of baseline minNPi, age, sex, and NCSE duration to treatment outcome. In 97.1% of 68 episodes, NCSE could be terminated; in 16.2%, NCSE was refractory. In 85.3% of episodes, an abnormal baseline minNPi ≤ 4.0 was obtained. After NCSE termination, minNPi increased significantly (p

Pesticides in agricultural surface water runoff cause a major threat to freshwater systems. Installation of filter systems or constructed wetlands in areas of preferential run-off is a possible measure for pesticides abatement. To develop such systems, combinations of filter materials suitable for retention of both hydrophilic and hydrophobic organic pesticides were tested for pesticide removal in planted microcosms. The retention of six pesticides frequently detected in surface waters (bentazone, MCPA, metalaxyl, propiconazole, pencycuron, and imidacloprid) was evaluated in unplanted and planted pot experiments with novel bed material mixtures consisting of pumice, vermiculite, water super-absorbent polymer (SAP) for retention of ionic and water soluble pesticides, and synthetic hydrophobic wool for adsorption of hydrophobic pesticides. The novel materials were compared to soil with high organic matter content. The highest retention of the pesticides was observed in the soil, with a considerable translocation of pesticides into the plants, and low leaching potential, in particular for the hydrophobic compounds. However, due to the high retention of pesticides in soil, environmental risks related to their long term mobilization cannot be excluded. Mixtures of pumice and vermiculite with SAP resulted in high retention of i) water and ii) both hydrophilic and hydrophobic pesticides but with much lower leaching potential compared to the mineral systems without SAP. Mixtures of such materials may provide near natural treatment options in riparian strips and also for treatment of rainwater runoff without the need for water containment systems.

Atom Probe Tomography (APT) is currently a well-established technique to analyse the composition of solid materials including metals, semiconductors and ceramics with up to near-atomic resolution. Using an aqueous glucose solution, we now extended the technique to frozen solutions. While the mass signals of the common glucose fragments CxHy and CxOyHz overlap with (H2O)nH from water, we achieved stoichiometrically correct values via signal deconvolution. Density functional theory (DFT) calculations were performed to investigate the stability of the detected pyranose fragments. This paper demonstrates APT’s capabilities to achieve sub-nanometre resolution in tracing whole glucose molecules in a frozen solution by using cryogenic workflows. We use a solution of defined concentration to investigate the chemical resolution capabilities as a step toward the measurement of biological molecules. Due to the evaporation of nearly intact glucose molecules, their position within the measured 3D volume of the solution can be determined with sub-nanometre resolution. Our analyses take analytical techniques to a new level, since chemical characterization methods for cryogenically-frozen solutions or biological materials are limited., Deutsche Forschungsgemeinschaft, Projekt DEAL

BACKGROUND Current literature about the effects of patients' expectations on relevant outcome measures is still conflicting and incomplete. The aim of this prospective observational study was to assess the influence of expectations and the fulfillment of expectations on postoperative pain intensity and pain relief. Furthermore, clinical characteristics influencing expectations and the fulfillment of expectations were explored. METHODS Patients undergoing elective orthopedic surgery were assessed using two standardized self-report questionnaires on the day before surgery and the third postoperative day. One hundred and seventy patients from 21 to 93 years (average age 64.6, SD 14.0 years; 55% female) were consecutively included. RESULTS While expectations of pain intensity did not correlate with pain experience after surgery, the fulfillment of expectations was associated with postoperative pain experience. Patients whose expectations were fulfilled were found to be more satisfied with the overall treatment as compared to those whose expectations were not fulfilled. Higher levels of expected pain were associated with higher fear of surgery and fear of postoperative pain. Preoperative pain intensity, length of treatment before the surgery, fear of surgery, helplessness and fear of postoperative pain were associated with higher postoperative pain intensity. Lower levels of preoperative fear of surgery and fear of postoperative pain were found to correlate with the fulfillment of pain relief. CONCLUSIONS Our study indicates that postoperative pain and satisfaction with the treatment are associated with the degree of fulfillment of expectations rather than the expected pain itself.

Vorgeschichte: Eine 29-jährige Patientin wurde uns aufgrund unklarer chronischer, linksbetonter Kopfschmerzen sowie einem cervikalem Druckgefühl und einem Gewichtsverlust von 17 Kilogramm zugewiesen. Die Beschwerden traten erstmalig sieben Monate zuvor auf. Vorerkrankungen waren bis dato nicht[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Rheumatologiekongress 2020, 48. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh), 34. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh)

The use of millions of mice in scientific studies worldwide emphasises the continuing need for a reduction of sample sizes, however, not at the expense of scientific validity. Split-plot designs have been suggested to enhance statistical power while allowing a reduction of animal numbers in comparison to traditional experimental designs. Recently, a promising approach of a split-plot design has been implemented and proven useful using mixed-strain housing of at least three different mouse strains. However, the impact of co-housing different strains of mice in one cage on animal welfare has still to be defined. This study aimed at comparing the effects of mixed-strain and same-strain housing of female C57BL/6J and DBA/2N mice on welfare and behaviour in two experimental phases. In a first phase, mice were housed in either mixed- or same-strain pairs. Home cage behaviour, activity rhythm, body weight, and faecal corticosterone metabolites were assessed. Furthermore, tests for anxiety-like and exploratory behaviour as well as spatial learning were performed. In a second phase, sociability was investigated in newly formed mixed-strain quartets. Mixed-strain housing did not induce alterations in anxiety, locomotion, learning, stereotypic behaviour, and stress hormone levels. However, changes in social behaviours and activity rhythm were observed. Increased agonistic and decreased socio-positive behaviours might point towards mild impacts on welfare in C57BL/6J mice under co-housing conditions. Altogether, scientific research may greatly benefit from co-housing mice of different strains within the same cages (e.g. for the realisation of a split-plot design), provided that strains are carefully selected for compatibility.

Background Strangulating small intestinal lesions in the horse have increased morbidity and mortality compared to nonstrangulating obstructions due to mucosal barrier disruption and subsequent endotoxaemia. Objectives To investigate protective effects of dexmedetomidine on small intestinal ischaemia-reperfusion injury in the horse. Study design Randomised, controlled, experimental study. Methods Eighteen systemically healthy horses were randomly assigned to three groups: control, preconditioning, and post-conditioning. During isoflurane anaesthesia, complete ischaemia was induced in a 1-m segment of jejunum for 90 minutes. Horses in the preconditioning and post-conditioning groups received dexmedetomidine (3.5 µg/kg followed by 7 µg/kg/h) before (preconditioning) or after beginning ischaemia (post-conditioning), and during reperfusion. Jejunal biopsies were collected before ischaemia (baseline-1), at the end of the ischaemic period (ischaemia), and 30 minutes after reperfusion (reperfusion-1). Additional biopsies were taken 24 hours after reperfusion from ischaemia-reperfusion-injured jejunum (reperfusion-2). Epithelial injury was scored histologically, and morphometric analyses were used to calculate villus surface area (VSA) denuded of epithelium. Data were analysed using analysis of variance, Kruskal-Wallis and Wilcoxon two-sample tests. Results In the control group, epithelial injury scores and percentage of VSA denudation for ischaemia-reperfusion-injured jejunum were higher compared to baseline-1 at all time points. The ischaemia and both reperfusion samples from the pre- and post-conditioning groups had lower epithelial injury scores and percentage of VSA epithelial denudation compared to the control group, with no difference from baseline-1 at any time point for the preconditioning group. Main limitations Preconditioning has limited application in the clinical setting with naturally occurring strangulating small intestinal lesions. Conclusions Dexmedetomidine was protective for small intestinal ischaemia-reperfusion injury in the horse when administered before or during ischaemia.

Background: Despite recent advances in the field of laparoscopic liver surgery, intrahepatic cholangiocarcinoma (iCC) as an entity has been nearly exempted from the new approaches because of propos...

International audience; Aluminum (Al) can be taken up from food, packaging, or the environment and thus reaches the human gastrointestinal tract. Its toxic potential after oral uptake is still discussed. The fate of different solid and ionic Al species during the passage through the digestive tract is the focus of this research, as well as the cellular effects caused by these different Al species. The present study combines the physicochemical processing of three recently studied Al species (metallic Al0, mineral Al2O3, and soluble AlCl3) in artificial digestion fluids with in vitro cell systems for the human intestinal barrier. Inductively coupled plasma mass spectrometry (ICP-MS) and small-angle X-ray scattering (SAXS) methods were used to characterize the Al species in the artificial digestion fluids and in cell culture medium for proliferating and differentiated intestinal Caco-2 cells. Cytotoxicity testing and cellular impedance measurements were applied to address the effects of digested Al species on cell viability and cell proliferation. Microarray-based transcriptome analyses and quantitative real-time PCR were conducted to obtain a deeper insight into cellular mechanisms of action and generated indications for cellular oxidative stress and an influence on xenobiotic metabolism, connected with alterations in associated signaling pathways. These cellular responses, which were predominantly caused by formerly ionic Al species and only at very high concentrations, were not impacted by artificial digestion. A two-directional conversion of Al between ionic species and solid particles occurred throughout all segments of the gastrointestinal tract, as evidenced by the presence of nanoscaled particles. Nevertheless, this presence did not increase the toxicity of the respective Al species.