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ZUSAMMENFASSUNGDie Hepatitis B ist bei Kindern, die fast ausschließlich vertikal infiziert werden, zunächst durch eine immuntolerante Phase mit normalen Transaminasen und hoher Viruslast charakterisiert, die im Verlauf von Jahren in die immunreaktive Phase mit erhöhten Transaminasen übergehen kann. In dieser Zeit kann dann eine Serokonversion zu anti-HBe eintreten, die in der Regel mit der Normalisierung der Transaminasen und einer drastischen Reduktion der Viruslast verbunden ist. Die Therapie ist nur in der immunreaktiven Phase indiziert. Man kann mit Peg-Interferon, Entecavir und Tenofovir behandeln. Das Ziel ist die Serokonversion zu anti-HBe, was meist erst nach Jahren erreicht werden kann.Die Hepatitis C wird ebenfalls fast ausschließlich vertikal übertragen und ist zunächst eine wenig aktive Erkrankung. Die Therapie mit alfa-Interferonen ist aufgrund der neuen oral applizierbaren DAAs (direct antiviral agents) obsolet. Für Kinder ab 12 Jahren sind aktuell drei Kombinationen: Ledipasvir und Sofosbuvir für Genotyp 1 und 4 und Ribavirin mit Sofosbuvir für die Genotypen 2 und 3 sowie pangenotypisch Glecaprevir und Pibrentasvir zugelassen. Dieses Jahr ist mit weiteren Zulassungen für die jüngeren Altersgruppen zu rechnen.

Die Objektivierung von Effekten eines anatomischen Betrachtungsschemas auf die Korrektheit von (a) Befunden, (b) Beurteilungen und (c) Selbsteinschatzungen der Auswerter bei Radiographien des Thorax in einer Ebene und die Einschatzung weiterer Einflussfaktoren. Zwanzig Radiologen mit 3 bis 60 Monaten Vollzeiterfahrung in Radiographie werteten 12 Radiographien des Thorax in einer Ebene unterschiedlicher Schwierigkeit mit und ohne Verwendung eines anatomischen Betrachtungsschemas mit mindestens einem Monat Abstand aus (n = 480). Im Konsensus von 3 radiologischen Experten wurden (a) und (b) anhand einer aktuellen Computertomographie ermittelt und die Selbsteinschatzung (c) abgefragt. (a) 21 % der vorhandenen Pathologien wurden ubersehen oder nicht beschrieben. Weitere 20 % wurden zwar erkannt, aber in ihrem Ausmas nicht korrekt erfasst. (b) 62 % der Beurteilungen und 31 % der abgeleiteten klinischen Konsequenz waren falsch und (c) in 39 % der Auswertungen uberschatzten sich die Probanden. Experten waren schneller und besser als Novizen, aber fur die Schemaverwendung ergaben sich daruber hinaus keine nennenswerten Unterschiede (p jeweils >0,5). Der starkste Effekt trat fur einen Vergleich mit dem in der Routine erzeugten Befundbericht auf, der nach gemeinsamer Auswertung von Novizen und Experten entstand und auch den Studienergebnissen der Experten allein in (a), (b) und (c) jeweils deutlich uberlegen war (p jeweils

Sowohl der Fortschritt chirurgischer Techniken als auch die demographische Entwicklung mit der Konsequenz vermehrt multimorbider Patienten fordert und fordert die Radiologie neben einer inzwischen beinahe selbstverstandlichen schnellen und prazisen Diagnostik durch minimal-invasive Unterstutzung bei der Therapie. Die Computertomographie (CT) ist nicht nur bei der Diagnose von Abszessen, aktiven Blutungen oder sonstigen Akutpathologien wichtig, sondern erlaubt auch eine radiologische, minimal-invasive Therapie unter Sichtkontrolle. Fur die Blutungskontrolle oder zur perkutanen transhepatischen Cholangiodrainage (PTCD) ist dies mittels digitaler Subtraktionsangiographie (DSA) bzw. Durchleuchtung moglich. Die Radiologie hat sich bei der Behandlung akuter Notfalle und Komplikationen durch das schonende und meist schnelle minimal-invasive Vorgehen auch in der Therapie etabliert. Vermutlich werden MRT-Interventionen in naher Zukunft zunehmende Bedeutung gewinnen und so das Portfolio erganzen. Die Grundtechniken der interventionellen Radiologie sollten von jedem klinisch im Nachtdienst tatigen Radiologen soweit beherrscht werden, dass zumindest eine medizinisch sichere Uberbruckung bis in den Routinebetrieb gewahrleistet ist. Das volle Portfolio verlangt u. a. aufgrund der Materialvielfalt und der Seltenheit mancher Krankheitsbilder eine jahrelange Expertise und wird daher speziellen Zentren vorbehalten bleiben.

Im Durchschnitt steigen Schockraumzahlen und applizierte CT-Dosis bei sinkender Verletzungsschwere, weshalb die bisherige Vorgehensweise hinterfragt werden sollte. Fur schwerstverletzte Patienten mit einem Injury Severity Score (ISS) ≥16 ist gesichert, dass die Ganzkorper-CT (GK-CT) im Vergleich zur selektiven CT-Diagnostik die Mortalitat um etwa ein Viertel senkt. Dabei ist der ISS ein guter Indikator fur die Verletzungsschwere. Da dieser aber erst nach der Diagnostik bestimmt werden kann, hilft er nicht bei der primaren Einschatzung. Es erscheint sinnvoll, neben der bisherigen zeitoptimierten GK-CT mit hochster diagnostischer Prazision ein zweites CT-Protokoll zu etablieren, welches eine deutlich niedrigere Dosis appliziert. Unter bereits laufender Reanimation leistet die GK-CT in aller Regel entweder einen wesentlichen Beitrag zur zielgerichteten Therapie oder aber zur Rechtfertigung der Einstellung von Wiederbelebungsmasnahmen. Die GK-CT-Befundung sollte mehrfach vorgenommen werden und zumindest im Akutszenario nach dem ABCDE-Schema erfolgen. Im Schockraum ist zunachst zu entscheiden, ob eine Einstufung als Polytrauma erfolgt bzw. beibehalten wird. Falls ja, so sollte jede Institution neben der bisherigen Maximalvariante auch ein dosisreduziertes GK-CT-LD-Protokoll vorhalten. Dieses bietet sich fur stabile und orientierte Patienten an, welche die CT vor allem aufgrund schwerer Unfallanamnese erhalten. Die GK-CT ist auch unter Reanimation problemlos durchfuhrbar und sowohl medizinisch als auch ethisch von hohem Wert. Die Befundung und Kommunikation sollten gemas „diagnose first what kills first“ strukturiert sein.

Der plotzliche Brust- und der plotzliche Unterleibsschmerz gehoren zu den haufigsten Grunden, die Patienten in die Notaufnahme fuhren. Das heterogene Feld der moglichen, zum Teil schwerwiegenden Diagnosen erfordert eine strukturierte und zugige interdisziplinare Abklarung, um die Patienten zeitnah einer adaquaten Therapie zufuhren zu konnen. Die Kenntnis der ublichen Verdachtigen des plotzlichen Brust- und Unterleibsschmerzes ermoglicht dem Radiologen die schnelle Auswahl der geeigneten bildgebenden Methode, die eine Diagnosestellung ohne Zeitverzogerung erlaubt. Neben Schmerzlokalisation und -charakter fliesen Alter, Geschlecht, etwaige Vorerkrankungen und Laborergebnisse in die differenzialdiagnostischen Uberlegungen mit ein. Der erreichte technische Stand der Computertomographie (CT) sichert inzwischen durch die exzellente raumliche und zeitliche Auflosung eine Abklarung der meisten Diagnosen. Im Abdomen sollte aber der Ultraschall weiterhin zumindest zur primaren Evaluation eingesetzt werden. Nur wenn anschliesend noch ein weiterer Bedarf an abdomineller Bildgebung bestehen bleibt, so erfolgt die Abklarung ebenfalls mittels CT. Die Magnetresonanztomographie (MRT) kommt im Notfallsetting des Unterleibsschmerzes kaum zum Einsatz. Falls doch, dann meistens, um die Strahlenexposition bei Kindern oder Schwangeren zu vermeiden. Die Kenntnis der ublichen Diagnosen, die den plotzlichen Brust- oder Unterleibsschmerz hervorrufen, sowie der geeigneten Untersuchungsverfahren und der klassischen radiologischen Zeichen sind essenziell, um Fehler und Zeitverzogerungen in der Notfalldiagnostik des plotzlichen Brust- und Unterleibsschmerzes zu vermeiden.

Intraosseous vascular access is a commonly conducted procedure especially in pediatric resuscitation. Very high success rates for intraosseous (IO) devices are reported. Aim of the study was to describe the rates of malposition of intraosseous needles (ION) in pediatric cadavers via post-mortem computed tomography (PMCT).212 consecutive pediatric cadavers underwent PMCT, of which 38 cadavers had visible ION and were included in the study. They were divided into two subgroups depending on their age (n = 22 infant cadavers (age1 year) and n = 16 child cadavers (age ≥1 year)). Two independent readers evaluated the number and position of ION.In 22 infant cadavers 34 ION were found. Malposition of at least one ION was visible in 14 subjects (64%), among which 7 cadavers (32%) even had no correctly placed ION, thus being without established vascular access. Overall, 16 of the 34 used ION devices (47%) were in malposition. 23 ION were found in 16 child cadavers. In 8 subjects (50%) at least one ION was malpositioned, among which 3 cadavers (19%) had no correctly placed ION, resulting in a complete absence of vascular access. Overall, 9 of the 23 ION devices (39%) were malpositioned.Our study showed relatively high malposition rates for ION devices in pediatric cadavers which was not to be assumed regarding the success rates of 80% and higher in previous literature. This should be clarified by further studies in living patients.

Children with recurrent abdominal pain may be suffering from a

Chronic hepatitis B and C are viral diseases affecting millions of people worldwide. The prevalence in children is comparably low, and the dominating route of infection in industrialized countries is vertical transmission. In many countries, a vaccination program for hepatitis B has been established, and the prevalence is decreasing. No vaccination exists to date to prevent hepatitis C due to its high variable genome. Despite of a rather benign spontaneous course of the disease during childhood and adolescence, there is a considerable lifetime risk of progressive liver disease, liver cirrhosis, and the development of a hepatocellular carcinoma (HCC), which may eventually reduce life expectancy. Thus, careful long-term monitoring has to be performed, and appropriate treatment options, which unfortunately are not entirely curative for chronic hepatitis B, have to be considered. Remarkable advances have been made in therapeutic approaches during the past 10 years for chronic hepatitis C, and considerable rates of cure have been yielded with the current standard of care. The development of novel treatment regimen is going fast and may continuously further improve the response rate.

Affective experience is inherently dynamic and short-term changes in affect are supposed to offer important insights into well-being. Past years have shown a tremendous rise in investigations into the relation between affect dynamics and well-being. The indicators that have been introduced to capture unique dynamical aspects of affect, however, have been criticised for being purely statistical measures without theoretical foundation and were shown to have little added value for explaining well-being over and above mean levels of affect. To address these concerns, we applied our newly developed theory-based MIVA model to data on daily affective experience. The MIVA model allows estimating parameters for anchoring, reactivity, and regulation based on affective states in combination with daily events. Everyday affective experience was measured with a high temporal resolution, multiple indicators of well-being (e.g. life satisfaction, depression) were assessed, and the incremental value of the MIVA model parameters in predicting well-being was determined. The MIVA model parameters reflect essential processes that accounted for observed fluctuations in affective experience. Incremental validity for predicting well-being over and above mean levels of affect, however, was low. Together, our results suggest that research on affect dynamics needs to identify how affect dynamics can be assessed more validly.

Background HCV-specific DAAs have transformed treatment of chronic HCV, but few studies have evaluated these therapies in children. Methods Patients aged 12–17 years old with chronic GT1 HCV were enrolled into an open-label study to receive 12 weeks of LDV/SOF 90 mg/400 mg once daily, and those with HCV GT2 or GT3 to receive SOF (400 mg once daily) + RBV (15 mg/kg/day) for 12 (GT2) or 24 weeks (GT3), respectively. Primary efficacy endpoint was SVR12. Safety was assessed by adverse events and clinical/laboratory data. Pharmacokinetic (PK) sampling was conducted to confirm the appropriateness of the doses. Results 150 adolescents (100 GT1, 13 GT2 and 37 GT3) were enrolled and treated. The majority were female (56%), white (90%), treatment naive (81%), and vertically infected (80%). The mean age was 15 years (range 12–17). LDV, SOF and GS-331007 (primary metabolite) exposures were within the range of adult exposures observed in the SOF and LDV/SOF phase 2/3 studies. The SVR12 rate was 98% in GT1, 100% in GT2 and 97% in GT3; all 3 patients who were considered not to have achieved SVR12 were lost to follow-up. No adverse event (AE) leading to study drug discontinuation or serious AEs have been reported. Conclusion In adolescents, LDV/SOF for 12 weeks and SOF + RBV for 12 or 24 weeks, resulted in a SVR12 rate of 97–100% with no virologic failures. These regimens were well tolerated, demonstrating their potential as an important treatment option for children with HCV infection.

BackgroundHuman breast milk has a high microRNA (miRNA) content. It remains unknown whether and how milk miRNAs might affect intestinal gene regulation and homeostasis of the developing microbiome after initiation of enteral nutrition. However, this requires that relevant milk miRNA amounts survive gastrointestinal passage, are taken up by cells, and become available to the RNA interference (RNAi) machinery. It seems important to dissect the fate of these miRNAs after oral ingestion and gastrointestinal passage.ObjectiveOur goal was to analyze the potential transmissibility of milk miRNAs via the gastrointestinal system in neonate humans and a porcine modelin vivoto contribute to the discussion whether milk miRNAs could influence gene regulation in neonates and thus might vertically transmit developmental relevant signals.DesignWe performed cross-species profiling of miRNAs via deep-sequencing and utilized dietary xenobiotic taxon-specific milk miRNA (xenomiRs) as tracers in human and porcine neonates, followed by functional studies in primary human fetal intestinal epithelial cells (HIEC-6) using Ad5-mediated miRNA-gene transfer.ResultsMammals share many milk miRNAs yet exhibit taxon-specific miRNA fingerprints. We traced bovine-specific miRNAs from formula-nutrition in human preterm stool and 9 days after onset of enteral feeding in intestinal cells of preterm piglets. Thereafter, several xenomiRs accumulated in the intestinal cells. Moreover, few hours after introducing enteral feeding in preterm piglets with supplemented reporter miRNAs (cel-miR-39-5p/-3p), we observed their enrichment in blood serum and in AGO2-immunocomplexes from intestinal biopsies.ConclusionsMilk-derived miRNAs survived gastrointestinal passage in human and porcine neonates. Bovine-specific miRNAs accumulated in intestinal cells of preterm piglets after enteral feeding with bovine colostrum/formula. In piglets, colostrum supplementation with cel-miR-39-5p/-3p resulted in increased blood levels of cel-miR-39-3p and argonaute RISC catalytic component 2 (AGO2) loading in intestinal cells. This suggests the possibility of vertical transmission of miRNA signaling from milk through the neonatal digestive tract.

The new German laws on organ donation of 2019 and 2020 intend to increase the organ donation rate. They include the optimization of organizational structures, the introduction of an online registry to document the patient's will and measures to improve information of the public. To date, little is known about clinicians' perspectives on these new laws.We conducted a two-stage sequential-mixed-method study. As part of an online survey, 1235 physicians from more than 90 hospitals throughout Germany participated.Many clinicians name structural deficits as causes for the low donation rate in Germany. Less than half of the physicians who are exposed to organ donors regularly consider themselves to be adequately educated about organ donation. Physicians' educational discussions with patients have a significant influence on patients' decision-making but are rarely provided by doctors. In the decision-making situation, relatives are often overwhelmed because they have dealt with the topics of death and organ donation too little during their lifetime. General practitioners play a key role in educating and informing the population. Only a few respondents expect a positive impact on the organ donation rate by the introduction of an online donation registry.With the latest legislation, the most relevant structural deficits named by physicians have been addressed. An additional increase in organ donation rate could be achieved through professionalized care for relatives. A more frequent public discussion about death and organ donation could facilitate decision-making by relatives in individual cases.HINTERGRUND: Die neuen Gesetze zur Organspende von 2019 und 2020 umfassen Regelungen zur Steigerung der Organspenderate. Dazu zählen Strukturverbesserungen, die Einführung eines Online-Registers zur Dokumentation der Entscheidung zur Organspende und die verbesserte Aufklärung der Bevölkerung. Zur Einschätzung der Maßnahmen durch unmittelbar betroffene klinisch tätige Ärzte ist bislang wenig bekannt.Es wurde eine zweistufige Sequential-mixed-method-Studie durchgeführt. Im Rahmen einer Online-Umfrage nahmen deutschlandweit 1235 Ärzte von über 90 Kliniken teil.Klinisch tätige Ärzte benennen größtenteils strukturelle Defizite als Ursachen für die niedrige Spenderrate in Deutschland. Weniger als die Hälfte der Ärzte, die mit Organspende in Kontakt kommen, findet sich ausreichend über Organspende ausgebildet. Ärztliche Aufklärungsgespräche haben wesentlichen Einfluss auf die Entscheidungsfindung von Patienten, werden aber kaum geführt. Da Patienten und Angehörige sich zu Lebzeiten zu wenig mit den Themen Tod und Organspende auseinandersetzten, führt die individuelle Entscheidungssituation oft zu Überforderung. Hausärzten kommt eine Schüsselrolle bei der Aufklärung zu. Von der Einführung eines Online-Registers erwarten nur wenige Befragte einen Einfluss auf die Organspenderate.Mit der neuesten Gesetzgebung wurde ein Großteil der von Ärzten benannten strukturellen Defizite aufgegriffen. Eine zusätzliche Steigerung der Organspenderate könnte durch professionalisierte Angehörigenbetreuung erreicht werden. Eine stärkere Thematisierung von Tod und Organspende in der Gesellschaft könnte im individuellen Fall die Entscheidungsfindung von Angehörigen erleichtern.

We assessed the performance of a rapid antigen test (RAT) in everyday clinical practice. Between 1 November 2020 until 1 April 2021 all in-patients at the Helios University Hospital Wuppertal, Germany, as well as the accompanying relatives at the Children’s Hospital received a SARS-CoV-2 RAT and a SARS-CoV-2 RT-PCR prior to admission. Out of 3686 patients, 22 (0.6%) subjects were tested positive by RT-PCR and RAT, and 3591 (97.4%) were negative by both methods, showing discordant results: RT-PCR+/RAT− in 58 (1.6%) and RT-PCR−/RAT+ in 15 patients (0.4%). Overall sensitivity and specificity of RAT was 27.5% (95%CI 18.1–38.6%) and 99.6% (95%CI 99.3–99.8%), respectively. The sensitivity was slightly higher in adults (30.4%, 95%CI 18.8–90.9%) than in pediatric subjects (20.8%, 95%CI 7.1–42.2%). False negative RAT had a statistically higher Ct-value (p < 0.001) compared to true positive values, and overall sensitivity increased to 80% [59.3–93.2%] with Ct value < 30. While the sensitivity of the RAT was poor compared with the RT-PCR, the specificity was excellent. However, the sensitivity increased with lower Ct value, and with the right anamnesis the RAT can be a quick and easy approach to distinguish people who are infectious with SARS-CoV-2 from noninfectious people, enabling appropriate triage in clinical practice while waiting for the RT-PCR result.

Currently, the only approved hepatitis C virus (HCV) treatment for children aged

To evaluate injuries of the sternoclavicular region as indicator injury for relevant concomitant injuries and to evaluate the modalities of initial imaging. We hypothesised a high incidence of concomitant injuries as well as a deficiency of X-ray as the initial gold standard. We retrospectively analysed patients suffering from injuries of the sternoclavicular region between 2002 and 2017. We analysed amongst injury type and severity, initial imaging (X-ray vs. CT scan of the sternoclavicular region vs. whole-body scan), and complement of imaging with regard to defined concomitant injury localisations and the resulting necessity and urgency of surgery. We included n = 61 patients. The mean ISS was 13.5 ± 17, n = 13 (21.3%) cases were classified as “severely injured” (ISS ≥ 16). N = 29 (47.5%) achieved an initial X-ray, n = 10 (16.4%) an initial CT scan of the sternoclavicular region, and n = 22 (36%) an initial whole-body CT scan. Initial imaging correlated significantly with ISS. In n = 21 (72.4%) cases of the X-ray group a significant complement from X-ray to CT scan of the sternoclavicular region was indicated (p ≤ 0.001). N = 31 (50.8%) patients suffered from concomitant injuries. N = 39 (63.9%) of all patients underwent any kind of surgery, thereof n = 23 (37.7%) related to their sternoclavicular injuries. Injuries of the sternoclavicular complex are indicators for the presence of multiple injuries. A CT scan of the sternoclavicular region including ipsilateral apex of the lung and upper rib cage comprised a large proportion of concomitant injuries. Mapping those injuries during initial imaging improves treatment process, avoids underdiagnostic, and decreases uncertainties.

Background Alcohol-induced hangover constitutes a significant, yet understudied, global hazard and a large socio-economic burden. Old folk wisdoms such as “Beer before wine and you'll feel fine; wine before beer and you'll feel queer” exist in many languages. However, whether these concepts in fact reduce hangover severity is unclear. Objectives The aim of this study was to investigate the influence of the combination and order of beer and wine consumption on hangover intensity. Methods In this multiarm, parallel randomized controlled matched-triplet crossover open-label interventional trial, participants were matched into triplets and randomly assigned according to age, gender, body composition, alcohol drinking habits, and hangover frequency. Study group 1 consumed beer up to a breath alcohol concentration (BrAC) ≥0.05% and then wine to BrAC ≥0.11% (vice versa for study group 2). Control group subjects consumed either only beer or only wine. On a second intervention day (crossover) ≥1 wk later, study-group subjects were switched to the opposite drinking order. Control-group subjects who drank only beer on the first intervention received only wine on the second study day (and vice versa). Primary endpoint was hangover severity assessed by Acute Hangover Scale rating on the day following each intervention. Secondary endpoints were factors associated with hangover intensity. Results Ninety participants aged 19–40 y (mean age 23.9), 50% female, were included (study group 1 n = 31, study group 2 n = 31, controls n = 28). Neither type nor order of consumed alcoholic beverages significantly affected hangover intensity (P > 0.05). Multivariate regression analyses revealed perceived drunkenness and vomiting as the strongest predictors for hangover intensity. Conclusions Our findings dispel the traditional myths “Grape or grain but never the twain” and “Beer before wine and you'll feel fine; wine before beer and you'll feel queer” regarding moderate-to-severe alcohol intoxication, whereas subjective signs of progressive intoxication were confirmed as accurate predictors of hangover severity. This trial was prospectively registered at the Witten/Herdecke University Ethics Committee as 140/2016 and retrospectively registered at the German Clinical Trials Register as DRKS00015285.

Die Beteiligung des Abdomens stellt insbesondere bei polytraumatisierten Patienten ein relevantes Verletzungsmuster dar. Meist entstehen typische, oft aber heterogene Organbeteiligungen, deren Kenntnis im Rahmen einer zielgerichteten Diagnostik und Therapie essenziell ist. In Form eines Reviews erfolgt jeweils die Darstellung typischer Arten traumatischer Abdominalverletzungen mit der zugehorigen radiologischen Diagnostik und ggf. Therapie. Erfahrungen und Fallbeispiele aus einem uberregionalen Traumazentrum werden dargestellt und mit den Ergebnissen einer Medline-Literaturrecherche sowie anhand relevanter Bereiche der S3-Leitlinie „Polytrauma“ diskutiert. Traumatische Abdominalverletzungen werden in stumpfe und penetrierende Verletzungen unterteilt. Unter den stumpfen Verletzungen fuhrt die Beteiligung der Milz vor Leber- und Nierenverletzungen. Beim penetrierenden Trauma sind die Hohlorgane am haufigsten betroffen. Diagnostisch sind die Sonographie und die Multidetektor-Computertomographie (MDCT) am bedeutsamsten. Seit Jahren besteht ein Trend zu konservativem Management sowie zur interventionellen Blutungskontrolle. Eine prazisere radiologische Diagnostik erlaubt hierbei eine genauere Klassifikation und Indikationsstellung zur weiteren Therapie. Die Fortschritte in der Radiologie resultieren in einem stetig zunehmenden Stellenwert der Radiologie im Management des traumatischen akuten Abdomens. Diese muss sich fachgebietsubergreifend mit den relevanten Traumamechanismen und Verletzungsmustern des Schwerverletzten auseinandersetzen, um einen optimalen Behandlungsablauf zu unterstutzen.

Objectives Research involving the nose reveals important information regarding the morphology and physiology of the epithelium and its molecular response to agents. The role of nasal epithelial cells and other cell subsets within the nasal epithelium play an interesting translational split between experimental and clinical research studying respiratory disorders or pathogen reactions. With an additional technical manuscript including a detailed description of important technical aspects, tips, tricks, and nuances for a successful culturing of primary, human nasal epithelial cells (NAEPCs), we here aim to improve the process of communication between experimentalists and physicians, supporting the purpose of a fruitful work for future translational projects. Methods Based on previous work on various complex culture models of subject-derived NAEPCs, this additional manuscript harmonizes previously published facts combined with own experiences for a trouble-free implementation in laboratories. Results A well-designed experimental question is essential prior to the establishment of different NAEPCs culture models. The correct method of cell extraction from the nasal cavity is essential and represent an important basis for successful culture work. Prior enzymatic processing of biopsy specimens, cell culture materials, collagenization procedure, culture conditions, and choice of culture medium are some important practical notes that increase the quality of the culture. Moreover, protocols on imaging techniques including histologic and electron microscopy must be adapted for NAEPC culture. Adapted flow cytometric protocols and transepithelial electrical resistance measurements can add valuable information. Outlook A successful culturing of NAEPCs can provide an important basis for genetic studies and the implementation of omics-science, which is increasingly receiving broad attention in the scientific community. The common aim of in vitro ‘mini-noses’ will be a breakthrough in laboratories aiming to perform research under in vivo conditions. Here, organoid models are interesting models presenting a basis for translational studies.

Background Reverse transcription of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (+)RNA genome and subgenomic RNAs (sgRNAs) and subsequent quantitative polymerase chain reaction (RT-qPCR) is the reliable diagnostic gold standard for COVID-19 diagnosis and the identification of potential spreaders. Apart from clinical relevance and containment, for specific questions, it might be of interest to (re)investigate cases with low SARS-CoV-2 load, where RT-qPCR alone can deliver conflicting results, even though these cases might neither be clinically relevant nor significant for containment measures, because they might probably not be infectious. In order to expand the diagnostic bandwidth for non-routine questions, particularly for the reliable discrimination between negative and false-negative specimens associated with high CT values, we combined the RT-qPCR workflow with subsequent pyrosequencing of a S-gene amplicon. This expansion can help to confirm SARS-CoV-2 infections without the demand of confirmative antibody testing, which requires to summon patients again for blood sampling few to several weeks after symptom onset. Results We successfully established a combined RT-qPCR and S-gene pyrosequencing method which can be optionally exploited after routine diagnostics. This allows a reliable interpretation of RT-qPCR results in specimens with relatively low viral loads and close to the detection limits of qPCR. After laboratory implementation, we tested the combined method in a large pediatric cohort from two German medical centers (n=769). Pyrosequencing after RT-qPCR enabled us to uncover 5 previously unrecognized cases of pediatric SARS-CoV-2-associated diseases, mainly exhibiting mild and heterogeneous presentation—apart from a single case of multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2, who was hospitalized in the course of the study. Conclusions The proposed protocol allows a specific and sensitive confirmation of SARS-CoV-2 infections close to the detection limits of RT-qPCR. The tested biotinylated primers do not negatively affect the RT-qPCR pipeline and thus can be optionally applied to enable deeper inspection of RT-qPCR results by subsequent pyrosequencing. Moreover, due to the incremental transmission of SARS-CoV-2 variants of concern, we note that the used strategy can uncover (Spike) P681H allowing the pre-selection of SARS-CoV-2 B.1.1.7 candidate specimens for deep sequencing.

Treatment guidelines for chronic hepatitis B (CHB) do not recommend antiviral therapy for patients in the immune-tolerant phase of the disease, which generally occurs in children who acquire hepatitis B virus (HBV) vertically and may last for decades. On the basis of promising results of a pilot study, we conducted a randomized, controlled, multicenter study to evaluate the efficacy and safety of antiviral therapy in children and adolescents with immune-tolerant CHB.Fifty-nine children aged 3 to18 years hepatitis B e antigen-positive with an HBV DNA titer20,000 IU/mL and persistently normal alanine aminotransferase levels were randomized to 56 weeks of antiviral therapy with an oral nucleoside analogue [entecavir or lamivudine], combined with subcutaneous peginterferon alfa-2a from week 8, or 80 weeks of untreated observation. The primary efficacy outcome was hepatitis B surface antigen loss 24 weeks post-treatment in the antiviral therapy group or at the end of observation in the control group.Enrollment was terminated after the results of two similar studies showed that similar antiviral regimens were ineffective in children and adults with immune-tolerant CHB. At 24 weeks post-treatment, 1 of 26 patients in the antiviral treatment group experienced HBsAg loss (vs none of 33 patients in the control group). No serious treatment-related adverse events were reported, and no patients discontinued treatment because of adverse events.The antiviral regimen evaluated in this trial had an acceptable tolerability profile, but was ineffective in children and adolescents with immune-tolerant CHB.

Understanding the response to viral infection in the context of respiratory diseases is of significant importance. Recently, there has been more focus on the role of the nasal epithelium in disease modeling. Here, we provide an overview of different submerged, organotypic 3D and spheroid cell culture models of nasal epithelial cells, which were used to study asthma and allergy with a special focus on virus infection. In detail, this review summarizes the importance, benefits, and disadvantages of patient-derived cell culture models of nasal- and bronchial epithelial cells, including a comparison of these cell culture models and a discussion on why investigators should consider using nasal epithelial cells in their research. Exposure experiments, simple virus transduction analyses as well as genetic studies can be performed in these models, which may provide first insights into the complexity of molecular signatures and may open new doors for drug discovery and biomarker research.

Myosin Vb (MYO5B) is a motor protein that facilitates protein trafficking and recycling in polarized cells by RAB11- and RAB8-dependent mechanisms. Biallelic MYO5B mutations are identified in the majority of patients with microvillus inclusion disease (MVID). MVID is an intractable diarrhea of infantile onset with characteristic histopathologic findings that requires life-long parenteral nutrition or intestinal transplantation. A large number of such patients eventually develop cholestatic liver disease. Bi-allelic MYO5B mutations are also identified in a subset of patients with predominant early-onset cholestatic liver disease. We present here the compilation of 114 patients with disease-causing MYO5B genotypes, including 44 novel patients as well as 35 novel MYO5B mutations, and an analysis of MYO5B mutations with regard to functional consequences. Our data support the concept that (1) a complete lack of MYO5B protein or early MYO5B truncation causes predominant intestinal disease (MYO5B-MVID), (2) the expression of full-length mutant MYO5B proteins with residual function causes predominant cholestatic liver disease (MYO5B-PFIC), and (3) the expression of mutant MYO5B proteins without residual function causes both intestinal and hepatic disease (MYO5B-MIXED). Genotype-phenotype data are deposited in the existing open MYO5B database in order to improve disease diagnosis, prognosis, and genetic counseling., publishedVersion

In the 1960s, a solid-hilted sword dating to the second half of the Middle Bronze Age (1450–1300 BC) was dredged up in a gravel quarry in the Rhône river at the village of Champagneux (Savoie, France). The sword belongs to the octagonal-hilted swords (German: Achtkantschwerter). This type, mainly found in the northern Alpine region and southern Scandinavia, was until then unknown in France. X-ray fluorescence (XRF) analyses and high-resolution X-ray computed tomography (μCT) of the hilt were carried out to understand how the hilt was cast and fixed to the blade. Thanks to the opportunities offered by these techniques, we were able to reconstruct the chaîne opératoire of this sword with a close inspection of the internal structure of the hilt. Furthermore, we visualised the surface of the sword’s tang located inside the hilt, which shows a series of five vertically arranged marks. Until now, similar symbols were only known on Late Bronze Age bracelets and tools, predominantly in the eastern part of the Alpine region. Although their exact function remains enigmatic, these marks are believed to be markers left by craftsmen on the object during their manufacture. On the solid-hilted sword from Champagneux, these marks could be linked to a way for the craftsman to remember which blade and hilt were supposed to be joined together, shedding light on the organisation of the production process behind this kind of weapon. Dans les années 1960, une épée à poignée métallique datant de la seconde moitié du Bronze moyen (1450–1300 av. J.-C.) fut draguée dans une gravière du Rhône à Champagneux (Savoie). Il s’agit d’une épée à fusée octogonale (en allemand : Achtkantschwert). Ce type, caractéristique de la région nord-Alpine et du sud de la Scandinavie, était jusqu’alors inconnu en France. Des analyses par spectroscopie de fluorescence X (XRF) et tomographie haute résolution par rayons X (μCT) ont été réalisées afin de comprendre comment la poignée a été coulée puis fixée à la lame. Ces méthodes nous ont ainsi permis de reconstituer la chaîne opératoire de cette épée en réalisant une inspection minutieuse de la structure interne de sa poignée. Nous avons par ailleurs été en mesure de visualiser la surface de la languette de la lame, insérée à l’intérieur du manche, qui présente une série de cinq marques disposées verticalement. Des éléments similaires n’étaient jusqu’à présent connus uniquement sur des outils et parures de du Bronze final, essentiellement dans la partie orientale de l’arc alpin. Bien que leur fonction exacte demeure inconnue, ces marques pourraient être des marqueurs laissés sur les objets au moment de leur fabrication. Dans le cas de l’épée de Champagneux, il pourrait s’agir d’un moyen pour l’artisan d’identifier rapidement dans son atelier la lame et la poignée devant être assemblées. Ces marques nous permettent ainsi d’obtenir de nouvelles informations l’organisation de la production de ce type d’arme.

BackgroundSurveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections is essential for the global containment measures with regard to the ongoing pandemic. Diagnostic gold standard is currently reverse transcription of the (+)RNA genome and subgenomic RNAs and subsequent quantitative polymerase chain reaction (RT-qPCR) from nasopharyngeal swabs or bronchoalveolar lavages. In order to further improve the diagnostic accuracy, particularly for the reliable discrimination between negative and false-negative specimens, we propose the combination of the RT-qPCR workflow with subsequent pyrosequencing of a S-gene amplicon. This extension might add important value mainly in cases with low SARS-CoV-2 load, where RT-qPCR alone can deliver conflicting results.sResultsWe successfully established a combined RT-qPCR and S-gene pyrosequencing method which can be optionally exploited after routine diagnostics or for epidemiologic studies. This allows a more reliable interpretation of conflicting RT-qPCR results in specimens with relatively low viral loads and close to the detection limits of qPCR (CT values >30). After laboratory implementation and characterization of a best practice protocol we tested the combined method in a large pediatric cohort from two German medical centers (n=769). Pyrosequencing after RT-qPCR enabled us to uncover 6 previously unrecognized cases of pediatric SARS-CoV-2 associated diseases, partially exhibiting unusual and heterogeneous presentation. Moreover, it is notable that in the course of RT-qPCR/pyrosequencing method establishment we did not observe any case of false-positive diagnosis when confirmed SARS-CoV-2-positive specimens were used from foregoing routine testing.ConclusionsThe proposed protocol allows a specific and sensitive detection of SARS-CoV-2 close to the detection limits of RT-qPCR. Combined RT-qPCR/pyrosequencing does not negatively affect preceding RT-qPCR pipeline in SARS-CoV-2 diagnostics and can be optionally applied in routine to inspect conflicting RT-qPCR results.

Sowohl der Fortschritt chirurgischer Techniken als auch die demographische Entwicklung mit der Konsequenz vermehrt multimorbider Patienten fordert und fordert die Radiologie neben einer inzwischen beinahe selbstverstandlichen schnellen und prazisen Diagnostik durch minimal-invasive Unterstutzung bei der Therapie. Die Computertomographie (CT) ist nicht nur bei der Diagnose von Abszessen, aktiven Blutungen oder sonstigen Akutpathologien wichtig, sondern erlaubt auch eine radiologische, minimal-invasive Therapie unter Sichtkontrolle. Fur die Blutungskontrolle oder zur perkutanen transhepatischen Cholangiodrainage (PTCD) ist dies mittels digitaler Subtraktionsangiographie (DSA) bzw. Durchleuchtung moglich. Die Radiologie hat sich bei der Behandlung akuter Notfalle und Komplikationen durch das schonende und meist schnelle minimal-invasive Vorgehen auch in der Therapie etabliert. Vermutlich werden MRT-Interventionen in naher Zukunft zunehmende Bedeutung gewinnen und so das Portfolio erganzen. Die Grundtechniken der interventionellen Radiologie sollten von jedem klinisch im Nachtdienst tatigen Radiologen soweit beherrscht werden, dass zumindest eine medizinisch sichere Uberbruckung bis in den Routinebetrieb gewahrleistet ist. Das volle Portfolio verlangt u. a. aufgrund der Materialvielfalt und der Seltenheit mancher Krankheitsbilder eine jahrelange Expertise und wird daher speziellen Zentren vorbehalten bleiben.

Swords are amongst the most significant objects of the Bronze Age. Beyond their defensive function, they have a developed symbolic dimension, which seems of great importance in Bronze Age society. Swords represent rightly or wrongly, the warrior figure. Swords change and develop during the Bronze Age, with a greater variability and an increasing frequency. In this paper, we aim to examine the discovery contexts of these objects and to observe the rhythm and the patterns of their occurrences in the land hoards, as wet finds and as funerary deposits. Through this very symbolic object, we want to question the visibility of the warrior, which varies greatly through time and space: sometimes omnipresent, sometimes excluded from specific contexts or invisible. These variations and rhythms seems to be characteristic of each cultural group. The chronological dimension of the changes in deposition patterns will be considered, by comparing these two vast and very different cultural areas (the Atlantic and the so called “complexe nord-alpin” regions). This approach could help us to discern more clearly the role of swords, and thus, the warrior within the social, funerary and/or ritual practices., Les épées font partie des objets très signifiants de l’âge du Bronze. Au-delà de leur fonction d’armes offensives, leur charge symbolique semble extrêmement forte, parfois peut-être même essentielle. Elles sont considérées, à tort ou à raison, comme les principaux témoins de la figure du guerrier. Tout au long de l’âge du Bronze, les épées vont se développer, leurs types devenant de plus en plus variés, leurs occurrences de plus en plus nombreuses. Dans le cadre de cette communication, nous souhaitons nous intéresser aux contextes de découvertes de ces objets, en observant les rythmes et les formes d’apparition au sein des dépôts, en milieux humides comme en milieu terrestre, ainsi que dans les sépultures. À travers cet objet symbolique, c’est la visibilité du guerrier qui varie au fil du temps, parfois omniprésente, parfois réservée à un domaine spécifique, à d’autres moments totalement absente. Ces variations et leur rythme sont propres à chaque groupe culturel. S’il semble nécessaire d’observer les modalités d’abandon des épées d’un point de vue chronologique, la comparaison entre deux grandes aires culturelles ayant des fonctionnements distincts tout au long de l’âge du Bronze, le domaine atlantique d’une part, et le domaine nord-alpin d’autre part, pourrait permettre de mieux comprendre la place des épées, et à travers elles, celle de la figure du guerrier, à l’intérieur des pratiques sociales, funéraires et/ou rituelles.

The indication for resuscitation room care is an acute (potentially) life-threatening patient condition. Typical causes for this are polytrauma, acute neurological symptoms, acute chest and abdominal pain or the cause remains unclear at first. The care is always provided in a suitably composed interdisciplinary team. This requires cause-specific standards tailored to the care facility and requires a mutual understanding of the partners involved with regard to specialist interests and care processes.Whole-body CT is established for polytrauma imaging and usually each institution has already defined an institutional standard. For the other causes, first imaging with CT is just as common, but the protocols and procedures to be used are often not as clear as in the case of polytrauma.For polytrauma service, ATLS and procedures according to ABCDE already serve as a largely standardized framework in the resuscitation room. For every other group of causes, comparable concepts should be developed and institutionally strive for objectification of continuous improvement. This refers not only to the resuscitation room stay but also to the interfaces before and after resuscitation room service.After the patient has arrived, it has to be determined whether the assessment of a vital risk is retained. If so, institutionally defined care standards must be followed for the various causes. This concerns the interface logistics, the definition of a team leader including associated tasks, the supply processes including the CT examination protocols as well as the close communication.

Gaucher disease (GD) is a recessive metabolic disorder caused by a deficiency of the GBA gene‐encoded enzyme β‐glucocerebrosidase. We characterized a cohort of 36 Albanian GD patients, 31 with GD type 1 and 5 affected by GD types 2, 3, and an intermediate GD phenotype between type 2 and type 3. Of the 12 different GBA alleles that we detected, the most frequently observed was p.Asn409Ser, followed by p.[Asp448His;His294Gln]. The prevalence of the p.Leu483Pro allele was approximately 10‐fold lower than reported in other populations. We identified a novel pathogenic missense variant (c.1129G>A; p.Ala377Thr). All five of our non‐type 1 patients had genotypes consisting of the p.[Asp448His;His294Gln] allele in combination with another severe GBA allele. The median Lyso‐Gb1 level of treated patients carrying the p.[Asp448His;His294Gln] and no p.Asn409Ser allele was significantly higher than that of treated individuals homozygous or compound heterozygous for the p.Asn409Ser allele. In conclusion, the most important distinguishing features of the Albanian GD patient population are the underrepresentation of the p.Leu483Pro allele and an unusually high number of p.[Asp448His;His294Gln] alleles originating from a common Balkan founder event. The presence of at least one p.Asn409Ser allele is associated with mild disease and low Lyso‐Gb1 biomarker levels, while compound heterozygosity involving p.[Asp448His;His294Gln] and no p.Asn409Ser entails severe phenotypes and high Lyso‐Gb1 levels.

To objectify effects of an anatomical viewing scheme on the respective correctness of (a) findings, (b) interpretations, and (c) self-assessments of readers in chest radiographs acquired in one plane and the assessment of other influencing factors.In all, 20 radiologists with 3-60 months of full-time radiography experience evaluated 12 chest radiographs of varying difficulty: once with and once without using an anatomical viewing scheme with at least 1 month in between (n = 480). In consensus of 3 radiological experts (a) and (b) were determined by means of a current computed tomography. The self-assessment (c) of readers was queried.(a) Findings were either missed or not described in 21%. Another 20% were recognized, but incorrectly described, (b) 62% of interpretations and 31% of derived clinical consequences were wrong and (c) in 39% of items the readers overestimated themselves. Experts were faster and better than novices, but for the scheme usage no further significant differences were detected (p 0.5, respectively). The most pronounced effect was found in comparison with the routine report produced by the joint evaluation of novices and experts being clearly superior even to the expert study results (a), (b) and (c) alone (p 0.001, respectively).Reporting of chest X‑rays acquired in one plane was often incomplete or even wrong, and the evaluators overestimated themselves, which was not influenced by the use of the anatomical viewing scheme. Since errors between the evaluators sometimes differed greatly, duplicate evaluation of the radiographs by two different radiologists, which is already the case in many training facilities, may possibly be advisable in general.

Conventional mammography is a decisive tool in detecting breast cancer. Continuous efforts are undertaken in order to further improve the image quality as well as to reduce the applied doses. The purpose of our study was to compare diagnostic image quality of dose reduced computed mammography with a new needle-based detector system to full dose powder imaging plates.We retrospectively compared 360 randomly chosen mammographies performed on a GE Senographe DMR running the Agfa DX-M needle-based imaging plate system (NIP) with their preliminary examinations which were acquired at standard dose with the same GE mammography device and an Agfa CR85-X powdered storage phosphor imaging plate system (PIP). NIP-based mammographies were about 29.8 % dose-reduced. The preliminary examinations had to be performed not earlier than 2 years before the recent investigations. Exclusion criteria were changes in ACR level and appearance of the scored targets and not optimally positioned and exposed mammographies. The images were blinded and read separately twice by 2 mammography experts according to a 3-point score on diagnostic image quality and the visualization of parenchyma, cysts, fibroadenomas, physiologic lymph nodes, solitary microcalcifications and macrocalcifications.Dose reduced NIPs showed a significantly better visualization of parenchyma at ACR II/III and solitary microcalcifications at ACR I-III mammographies (p 0.001) whereas the difference in scoring macrocalcifications, cysts, fibroadenomas and physiologic lymph nodes was not significant. The reading showed an excellent intra- (r = 0.97/0.94) and interobserver agreement (r = 0.92).With computed mammography using the needle-based detector system a significant dose reduction is possible without loss of diagnostic image quality.

The mean number of trauma room admissions and applied CT dose increase as the severity of injuries decreases. Therefore, appropriateness of established procedures should be re-evaluated.Considering severely injured patients with an Injury Severity Score (ISS) ≥16, whole body CT (WB-CT) compared to selective CT decreased mortality by about 25%. Thus, the ISS is a good indicator for the severity of injuries. However, since ISS can only be determined after diagnosis, it does not help with the primary assessment.In addition to the currently used very fast WB-CT protocol with the highest diagnostic precision, a second protocol should be established applying a substantially lower dose. Under ongoing resuscitation, WB-CT often makes a substantial contribution towards targeted therapy or to justifying the discontinuation of resuscitation measures. The WB-CT findings should be performed several times and, at least in the acute emergency situation, it should follow the ABCDE scheme as close as possible.In the trauma room it should be initially decided whether the classification as polytrauma is to be maintained. If yes, every institution should provide a dose-reduced WB-CT protocol in addition to the maximum variant used so far. Dose-reduced WB-CT seems to be appropriate for stable and oriented patients, who receive a CT primarily because of the trauma mechanism. Even under resuscitation conditions, WB-CT is easy to perform and medically as well as ethically of high value. The reporting and communication should be structured according to "diagnose first what kills first".

Purpose Thrombus features on admission CT are useful imaging markers for clot characterization, stroke pathogenesis and outcome prediction. In this context, thrombus perviousness is a promising parameter, but reliable assessment in daily clinical practice is demanding. The aim of the present study was to evaluate an easy to assess measuring method for thrombus permeability at the time of admission. Methods The CTA-index, which measures relative thrombus attenuation on admission CTA, was compared to the known perviousness parameter in a cohort of 101 patients with large-vessel occlusions of the middle cerebral artery and correlated to clinical outcome parameters (mRS after 90 days, ≤2 rated as favorable). For validation, this correlation was tested in a second independent cohort (n = 87), and possible associations between the CTA-index and outcome measurements (NIHSS/mRS/mTICI) were assessed. Results In the first cohort a coherence between conventional perviousness measurements and the CTA-index was shown. The CTA-index differed significantly between favorable (−0.55 ± 0.16) and non-favorable outcomes (−0.64 ± 0.14, p = 0.01). In the validation cohort this result could be independently reproduced (−0.52 ± 0.13/−0.70 ± 0.09, p p p p = 0.04). Conclusion The CTA-index is an easy to assess imaging parameter on admission CTA in the acute stroke phase and is associated with angiographic and clinical outcome. It can be considered as a simplified measuring method for thrombus perviousness, which is known to provide useful information for further stroke progress and clinical course as well as therapeutic and rehabilitative decisions.

BACKGROUND AND PURPOSE: There are sparse data on the microstructural integrity of salvaged penumbral tissue after mechanical thrombectomy of large-vessel occlusions. The aim of the study was to analyze possible microstructural alteration in the penumbra and their association with clinical symptoms as well as angiographic reperfusion success in patients undergoing mechanical thrombectomy. MATERIALS AND METHODS: All patients who underwent mechanical thrombectomy for large-vessel occlusions in the anterior circulation and who received an admission CT perfusion together with postinterventional DTIs were included (n = 65). Angiographic reperfusion success by means of modified Thrombolysis in Cerebral Infarction (mTICI) scale and clinical outcome were recorded. Microstructural integrity was assessed by DTI evaluating the mean diffusivity index within the salvaged gray matter of the former penumbra. RESULTS: The mean diffusivity index was higher in completely recanalized patients (mTICI 3: −0.001 ± 0.034 versus mTICI

Sudden chest pain and sudden abdominal pain are among the most common reasons that lead patients to the emergency room. The heterogeneous field of possible, sometimes serious diagnoses requires a structured and rapid interdisciplinary clarification in order to be able to promptly provide patients with an adequate therapy.Knowing the "usual suspects" of sudden chest and abdominal pain enables the radiologist to quickly select the appropriate imaging method that allows a diagnosis to be made without delay. In addition to pain localization and character, age, gender, any previous illnesses and laboratory results are taken into account in the differential diagnosis.The technical state of computer tomography (CT) now ensures that most diagnoses can be clarified due to its excellent spatial and temporal resolution. In the abdomen, however, ultrasound should continue to be used at least for primary evaluation. Only if there is a further need for abdominal imaging afterwards is CT indicated for clarification. Magnetic resonance imaging is rarely used in the emergency setting of abdominal pain except to avoid radiation exposure in children or pregnant women.Knowledge of the usual diagnoses that cause sudden chest or abdominal pain, as well as knowledge of the appropriate examination procedures and classic radiological signs are essential to avoid errors and delays in the emergency diagnosis of sudden chest and abdominal pain.

The number of inconspicuous results of esophagogastroduodenoscopies (EGDs) in childhood appears to be disturbingly high. The aim of this study was to analyze the diagnostic yield of EGD and to determine its relevance of specific clinical indications.We performed a retrospective analysis of 380 consecutive pediatric patients who underwent diagnostic EGD in two German level I pediatric gastroenterology departments in 2015 and 2016.44% of the 380 patients were male and 17% were younger than 5 years old. 55% of all EGDs (n=210) did not yield a pathological result. 27% (n=104) of all EGDs were performed due to nonspecific symptoms (epigastralgia, nausea). Strikingly, in this group, 88% (n=91) showed normal results and in only 12% a diagnosis was made: reflux esophagitis (n=5), Helicobacter pylori (HP) gastritis (n=6) or hemorrhagic gastritis (n=1). Fewer inconspicuous EGDs were performed in patients with dysphagia (68%) or heartburn and reflux (61%). 59 patients were examined due to serologically elevated celiac antibodies. Here, the diagnosis could be confirmed histopathologically in 78% (n=46). Of the 37 patients with abdominal pain and a previously positive non-invasive HP test, EGD served to establish the diagnosis of HP gastritis in 84%.The diagnostic yield for EGDs is increased in patients with more specific symptoms (i. e. dysphagia, heartburn, HP, celiac disease). Consequently, as an invasive procedure, EGD warrants a strict indication.Die Zahl der unauffälligen Befunde der Ösophago-Gastro-Duodenoskopien (ÖGDs) im Kindes- und Jugendalter scheint beunruhigenderweise hoch zu sein. Das Ziel der folgenden Studie war es, den diagnostischen Stellenwert von ÖGDs bei Kindern zu analysieren und die Relevanz von spezifischen, klinischen Indikationen für auffällige ÖGD-Befunde zu ermitteln.Wir führten eine retrospektive Studie von insgesamt 380 durchgeführten ÖGDs bei pädiatrischen Patienten in 2 großen pädiatrischen gastroenterologischen Abteilungen in den Jahren 2015 und 2016 durch.44% der 380 Patienten waren männlich und 17% der Patienten waren jünger als 4 Jahre alt. 55% aller durchgeführten ÖGDs (n=210) ergaben keine pathologischen Befunde. 27% (n=104) aller ÖGDs wurden aufgrund von nicht-spezifischen Symptomen wie Oberbauchschmerzen oder Übelkeit durchgeführt. Interessanterweise hatten in dieser Gruppe 88% (n=91) der Patienten einen unauffälligen Befund und in nur 12% konnte eine eindeutige Diagnose gestellt werden: Refluxösophagitis (n=5), Helicobacter pylori (HP) Gastritis (n=6) oder hämorrhagische Gastritis (n=1). Weniger unauffällige ÖGD-Befunde waren v. a. bei Patienten mit Dysphagie (68%) oder Sodbrennen und Reflux (61%) vorkommend. 59 Patienten wurden einer ÖGD aufgrund serologisch erhöhter Zöliakie-Autoantikörper unterzogen. Hier konnte die Diagnose histopathologisch in 78% (n=46) bestätigt werden. Von den 37 Patienten mit Bauchschmerzen und einem positiven nicht-invasiven HP-Test, konnte mittels ÖGD die Diagnose einer HP-Gastritis in 84% der Fälle nachgewiesen werden.Der diagnostische Nutzen von ÖGDs ist v. a. bei Patienten mit spezifischen Symptomen hoch (Dysphagie, Sodbrennen, HP, Zöliakie). Die Indikation zur ÖGD als invasives diagnostisches Instrumentarium sollte v. a. bei Kindern streng gestellt werden.

Mediastinal, hilar, and peripheral pulmonary lymphadenopathy is a hallmark sign of different benign and malignant diseases of the chest. Contrast-enhanced (CE) chest CT is a test frequently applied to examine thoracic lymph node zones. We attempted to find out whether mediastinal, hilar, and peripheral lymph nodes delineate equally in CE chest CT with reduced dose (CE-LDCT, about 1 mSv) when compared with accepted standard CE chest CT (CE-SDCT). In this ethics committee-approved, mono-institutional, retrospective (20 months) matched case–control study, two independent, blinded observers compared measurable lymph node delineation (yes–no) in six different International Association for the Study of Lung Cancer (IASLC) zones (upper mediastinal, aortopulmonary, subcarinal, lower mediastinal, hilar, peripheral) between 62 CE-LDCT cases and 124 CE-SDCT controls (respective tube charge, 100, 120 KVp, computed tomography dose index, 1.66 ± 0.51, 5.36 ± 2.24 mGy, automatic exposure control-modulated 64-row multi-detector chest CT with iterative image reconstruction). Individual matching for gender (53% female), age (53 ± 19 years), body height, weight, anterior–posterior and transverse diameters of chest and lung ruled out pre-test confounders. Lymph node size (cut-off value, 1 cm) was a potential post-test confounder. Two-tailed T test and Chi-square test were significant for p