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ZusammenfassungSeit Beginn der SARS-CoV-2-Pandemie werden zunehmend Abstriche oder andere Beprobungen aus dem oberen Aerodigestivtrakt genommen, da hier vor allen Dingen in frühen Erkrankungsstadien hohe Viruslasten bestehen. Als diagnostische Möglichkeiten sind Abstriche aus der vorderen Nase, dem Nasopharynx oder dem Oropharynx sowie die Gewinnung von Rachenspülwasser oder Speichel möglich. Als Labormethoden stehen in einigen Minuten ablesbare Antigentests oder langwierigere RT-PCR-Methoden zur Verfügung. Abstriche werden von ärztlichem Personal, medizinischem Fachpersonal, Laien und im Eigentest, jeweils nach Instruktionen, durchgeführt. Auf die Aussagekraft und die Sensitivität des gesamten diagnostischen Prozesses haben somit viele dieser Faktoren einen Einfluss. Die PCR-Labormethode ist sensitiver als die Antigenmethode; der Abstrich aus dem Nasopharynx wird als der valideste Abstrichort angesehen. Eine korrekte Durchführung eines Tests kann auch bei nicht professionellen Personen mit guten Instruktionen erreicht werden. Komplikationen werden bei solchen Abstrichen, gemessen an der anzunehmenden Anzahl durchgeführter Prozeduren, sehr selten berichtet. Kurzfristiges Nasenbluten bei traumatischen Abstrichen ist anzunehmen, ohne dass darüber Publikationen aufgefunden werden konnten. Abgebrochene Abstrichträger mussten HNO-ärztlich entfernt werden. Verletzungen der Schädelbasis mit Liquorrhö wurden bisher sehr vereinzelt berichtet, davon 2-mal bei Anomalien wie Meningozelen. Die Wahl eines geeigneten diagnostischen Mediums hängt von vielen Parametern, wie Verfügbarkeit, zeitlicher Ablauf bis zum Ergebnis, Abstrich durch kundiges Personal oder Eigentest und etlichen anderen praktischen Erwägungen, ab.

Die Coronapandemie stellt zurzeit die groste Herausforderung weltweit fur das Gesundheitswesen aller Staaten dar. Das rechtzeitige Erkennen der Erkrankung und die umgehende Separierung und Isolation von Verdachtsfallen sind ein wesentlicher Beitrag zum Durchbrechen von Infektionsketten. Wir haben anhand der ersten 35 Patienten, die mit COVID-19 (Coronavirus-Krankheit-2019) stationar aufgenommen wurden, die verschiedenen Symptome ausgewertet, mit denen Patienten stationar vorstellig wurden. Bei stationarer Vorstellung fanden sich neben Husten und Fieber haufig auch eine reduzierte periphere O2-Sattigung sowie pathologische Atemmuster. In mehreren Fallen standen andere Beschwerden ohne Bezug zu Atemwegserkrankungen im Vordergrund, z. B. neurologische, gastrointestinale oder unspezifische Symptome.

Severe pulmonary impairment can occur after traumatic brain injury or stroke. The resulting brain-lung interactions represent key points for the treatment and the subsequent outcome of the patient. Established treatment approaches, such as permissive hypercapnia and prone positioning, present the intensive care physician with divergent treatment goals in these patients with partially increased intracranial pressure. This case report series shows the instrument-based and noninstrument-based options for the treatment of acute respiratory distress syndrome (ARDS) in the simultaneous presence of intracranial pathologies. This includes equipment based therapies using extracorporeal CO2 elimination, special positioning maneuvers in specially designed hospital beds and positional maneuvers, such as prone positioning. With enhanced neuromonitoring it is possible to optimally adapt treatment measures focused on the lungs early and before secondary damage to the brain.

Duckweed is a potential collector of nitrogen from animal liquid manure and a source of protein suitable as feed for livestock and fish. Therefore, it provides opportunities for circular economy systems. Two duckweed species, Spirodela polyrhiza and Landoltia punctata, were grown in five recirculating systems each connected to a reservoir tank filled with water and graded organic cattle slurry concentrations. Fresh and dry biomass, protein production and amino acid profiles among the nitrogen removal were evaluated. Spirodela polyrhiza showed a significantly higher fresh biomass production but L. punctata dry matter content was generally higher resulting in similar dry biomass production for both species This study shows clearly that the crude protein content, ranging between 29.3 and 37.9% of dry matter, was positively correlated to slurry and total ammonia nitrogen (TAN) concentration of the substrate, independent of the duckweed species. Total crude protein yield was in the range of 1.37–1.95 g m−2 d−1, following a quadratic function regarding slurry and TAN concentrations, with marginal differences between species. Biomass and crude protein yields were optimal for both duckweed species at a TAN concentration of 19 mg l−1, which corresponded to a slurry dilution of 1:8. The results of this study provide important information for operation of recirculating duckweed production systems on slurry and operators should aim to keep TAN concentrations in that range for optimization of protein production in conjunction with TAN removal.

There is increasing evidence of cardiac involvement post-SARS-CoV-2 infections in symptomatic as well as in oligo- and asymptomatic athletes. This study aimed to characterize the possible early effects of SARS-CoV-2 infections on myocardial morphology and cardiopulmonary function in athletes. Eight male elite handball players (27 ± 3.5 y) with past SARS-CoV-2 infection were compared with four uninfected teammates (22 ± 2.6 y). Infected athletes were examined 19 ± 7 days after the first positive PCR test. Echocardiographic assessment of the global longitudinal strain under resting conditions was not significantly changed (− 17.7% vs. − 18.1%). However, magnetic resonance imaging showed minor signs of acute inflammation/oedema in all infected athletes (T2-mapping: + 4.1 ms, p = 0.034) without reaching the Lake-Louis criteria. Spiroergometric analysis showed a significant reduction in VO2max (− 292 ml/min, − 7.0%), oxygen pulse (− 2.4 ml/beat, − 10.4%), and respiratory minute volume (VE) (− 18.9 l/min, − 13.8%) in athletes with a history of SARS-CoV2 infection (p

Since the beginning of the SARS-CoV-2 pandemic, swabs or other samples have increasingly been taken from the upper aero-digestive tract, since high viral loads exist here, especially in the early stages of the disease. As diagnostic options, swabs from the anterior nose, from the nasopharynx, from the oropharynx or the extraction of throat rinse water or saliva are possible. The laboratory methods available are antigen tests that can be read in a few minutes or more lengthy RT-PCR methods in a lab. Swabs are carried out by physicians, medical staff, laypeople and in the self-test, in each case according to prior instructions. Many of these factors therefore have an influence on the informative value and the sensitivity of the entire diagnostic process. The PCR laboratory method is more sensitive than the antigen method; the swabs from the nasopharynx are considered the most valid smear site; correct execution of a test can be achieved even with non-professional individuals with good instructions. Complications with such swabs are reported very rarely, given the assumed number of procedures performed. Short-term nosebleeds after traumatic smears can be assumed without publications about it being found. Broken parts of swabs had to be removed by an ENT doctor. There are only very few reports on injuries to the skullbase with CSF-leaks, including 2 times with anomalies such as meningoceles. The choice of a suitable diagnostic medium depends on many parameters such as availability, the timing of the result, a smear test by knowledgeable staff or a self-test, and a number of other practical considerations.Seit Beginn der SARS-CoV-2-Pandemie werden zunehmend Abstriche oder andere Beprobungen aus dem oberen Aerodigestivtrakt genommen, da hier vor allen Dingen in frühen Erkrankungsstadien hohe Viruslasten bestehen. Als diagnostische Möglichkeiten sind Abstriche aus der vorderen Nase, dem Nasopharynx oder dem Oropharynx sowie die Gewinnung von Rachenspülwasser oder Speichel möglich. Als Labormethoden stehen in einigen Minuten ablesbare Antigentests oder langwierigere RT-PCR-Methoden zur Verfügung. Abstriche werden von ärztlichem Personal, medizinischem Fachpersonal, Laien und im Eigentest, jeweils nach Instruktionen, durchgeführt. Auf die Aussagekraft und die Sensitivität des gesamten diagnostischen Prozesses haben somit viele dieser Faktoren einen Einfluss. Die PCR-Labormethode ist sensitiver als die Antigenmethode; der Abstrich aus dem Nasopharynx wird als der valideste Abstrichort angesehen. Eine korrekte Durchführung eines Tests kann auch bei nicht professionellen Personen mit guten Instruktionen erreicht werden. Komplikationen werden bei solchen Abstrichen, gemessen an der anzunehmenden Anzahl durchgeführter Prozeduren, sehr selten berichtet. Kurzfristiges Nasenbluten bei traumatischen Abstrichen ist anzunehmen, ohne dass darüber Publikationen aufgefunden werden konnten. Abgebrochene Abstrichträger mussten HNO-ärztlich entfernt werden. Verletzungen der Schädelbasis mit Liquorrhö wurden bisher sehr vereinzelt berichtet, davon 2-mal bei Anomalien wie Meningozelen. Die Wahl eines geeigneten diagnostischen Mediums hängt von vielen Parametern, wie Verfügbarkeit, zeitlicher Ablauf bis zum Ergebnis, Abstrich durch kundiges Personal oder Eigentest und etlichen anderen praktischen Erwägungen, ab.

Soaking hay before feeding has been documented to reduce airborn respirable particles and water-soluble carbohydrate (WSC) content which may have positive benefits for horses suffering from Equine Asthma (EA) or Equine Metabolic Syndrome (EMS). Prolonged soaking also leaches minerals, but to-date no measurement of the loss of small intestine digestible crude protein has been documented. One aim of this study was to investigate various soaking durations on nutrient contents of hay, WSC, macronutrients, and trace elements levels. Another objective was to determine the prececal digestible crude protein (pcd CP) and amino acid (pcd AA) fraction contents and prececal digestibility (pcD). Four different batches of meadow hay were soaked in water (20° C during preparation) for 0 minutes, 15 minutes, 30 minutes, 60 minutes, and 12 hours and drained for 20 minutes. A 15 minutes soaking duration significantly reduced the levels of nearly all investigated nutrients (e.g. for fructans, and WSC, macronutrients and trace elements). However, the crude fiber, acid detergent fiber (ADF), and acid detergent lignin content increased. Metabolizable energy (ME) contents decreased by 5-15 %, pcd CP and pcd AA fell by 35 %, and the pcD declined by up to 49 %. In contrast, the pcD was 56 % before soaking. Longer soaking durations did not enhance the wash-out effect. Horse owners should be aware that soaking hay, regardless of reason, may negatively alter the nutritional value. The wide range of wash-out effects may pose risks in calculating the correct dry matter portion to prevent weight loss and maintain ME, pcd CP and pcd AA requirements, especially for horses with EMS and EA.

Objectives Rotavirus infections are common causes of infant hospitalization. The present study examined the effectiveness of anti-rotavirus vaccination in preventing rotavirus-related hospitalizations in Germany, following its state and nationwide introductions in 2008 and 2013, respectively. Methods During 15 consecutive seasons 9557 stool samples of hospitalized children of 5 years and younger with acute gastroenteritis were screened for rotavirus A. Rotavirus G and P genotypes were assessed after vaccine introduction. Vaccine effectiveness was determined by comparison of rotavirus incidence in pre-vaccine and post-vaccine cohorts. The herd effect was calculated as the difference between the observed reduction of rotavirus-related hospitalizations and the expected direct vaccine effect. Results The number of rotavirus-related hospitalizations declined after vaccine introduction. Approximately 26% (503/1955) of prevented cases could be attributed to the herd effect. Human rotaviruses of genotypes G3P[8], G1P[8], G9P[8], G4P[8], G2P[4] and G12P[8] were most frequent. Uncommon genotypes remained rare. The direct, indirect, total and overall vaccine effectiveness was 86% (95% confidence interval (CI) 83.2–89.1%), 48% (95% CI 42.8–52.6%), 93% (95% CI 91.3–94.3%) and 69% (95% CI 66.5–72.0%), respectively. There was no significant difference in vaccine-type or in genotype-specific vaccine effectiveness. Conclusions Anti-rotavirus vaccination efficiently reduced rotavirus-related hospitalizations in Germany in the past decade. The vaccines analysed in this article provide a broadly heterologous and long-lasting protection. The herd effect substantially contributed to the observed drop in the number of incidences of severe rotavirus infections. Presumably, constant high vaccine coverage will lead to a continued upward trend in the overall vaccine efficiency.

BackgroundThe causes of the onset and progression of rheumatoid arthritis (RA) are complex and not yet understood. Some studies suspect viruses as triggers of inflammatory processes (1). Increased numbers of immunomodulatory cells have already been detected in patients with RA infected with the cytomegalovirus (CMV) (2) (3). Understanding the role this infection has on RA-specific disease parameters could help clarify predisposing and prognostic factors.ObjectivesThe aim of this study was to determine the relationship between CMV serostatus and disease activity in patients with rheumatoid arthritis.MethodsWe performed a retrospective study in adult patients diagnosed with RA. The data was collected between 2008 and 2021 in the rheumatological outpatient department of the University Hospital in Leipzig, Germany. The parameters examined included age, gender, CMV-IgG and CMV-IgM, and the following parameters to record the disease activity of RA: disease duration, joint erosions, rheumatoid factor, anti-CCP antibodies, CRP, disease activity score (DAS28), visual analog scale (VAS) for pain detection, Health Assessment Questionnaire (HAQ), medication with DMARDs and prednisolone.ResultsA total of 89 RA patients were included, 78.7% of them were female. The mean age was 61.44 ± 10.89 years and the mean duration of illness was 9.48 ± 9.13 years. 56.2% of the patients were CMV-IgG positive, 2.2% CMV-IgM positive. With an OR of 5.04 (95% CI 1.63-15.64), the CMV-IgG titer in women was significantly higher than in men (115.16 vs. 50.75 p = 0.007). This has already been shown in other studies (4). One of the reasons discussed is the women’s closer relationship with children at work. It has also been shown that among women those medicated with DMARDs had significantly higher CMV-IgG titers (126.82 vs. 58.84 p = 0.036). This could be explained by an increased predisposition for CMV reactivation due to the intake of medication. Women with joint erosions were also more likely to be CMV-IgG positive (OR = 3.2; 95% CI 1.02-10.03) and had higher CMV-IgG titers (147.44 vs. 97.23 p = 0.024). Furthermore, seropositive RA women were significantly more likely to be CMV-IgG positive (p = 0.05). This association supports the assumption that CMV may play a role in the pathogenesis of RA.ConclusionThe data presented shows that there is indeed a relationship between infection with CMV and parameters for disease activity in patients with RA. In summary, the integration of a CMV status determination into everyday clinical practice in patients with high disease activity could be quite useful and should be discussed.References[1]Davis, John M., et al. A profile of immune response to herpesvirus is associated with radiographic joint damage in rheumatoid arthritis. Arthritis Research & Therapy. 14, 2012, 1.[2]Almanzar, Giovanni, et al. Significant IFNγ responses of CD8+ T cells in CMV-seropositive individuals with autoimmune arthritis. Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology. 77, 2016.[3]Hooper, M., et al. Cytomegalovirus seropositivity is associated with the expansion of CD4+CD28- and CD8+CD28- T cells in rheumatoid arthritis. The Journal of rheumatology. 26, 1999, 7.[4]Cannon, Michael J., Schmid, D. Scott und Hyde, Terri B. Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection. Reviews in medical virology. 4, 2010, 20.Disclosure of InterestsNone declared.

Very little is known about the genetic basis of behavioral variation in courtship behavior, which can contribute to speciation by prezygotic isolation of closely related species. Here, we analyze the genetic basis and architecture of species differences in the male courtship behavior of two closely related parasitoid waspsNasonia vitripennisandN. longicornis.Both species occur microsympatrically in parts of their ranges and have been found in the same host pupae. Despite strong postzygotic isolation mechanisms between these twoNasoniaspecies, viable hybrid females can be produced in the laboratory if both species are cured of theirWolbachiaendosymbionts. We used haploid F2hybrid males derived from virgin F1hybrid females of two independent mapping populations to study the genetic architecture of five quantitative and two qualitative components of their courtship behavior. A total of 14 independent Quantitative Trait Loci (QTL) were found in the first mapping population (320 males), which explained 4-25% of the observed phenotypic variance. Ten of these QTL were confirmed by a second independent mapping population (112 males) and no additional ones were found. A genome-wide scan for two-loci interactions revealed many unique but mostly additive interactions explaining an additional proportion of the observed phenotypic variance. Courtship QTL were found on all five chromosomes and four loci were associated with more than one QTL, indicating either possible pleiotropic effects of individual QTL or individual loci contributing to multiple courtship components. Our results indicate that these two evolutionary young species have rapidly evolved multiple significant phenotypic differences in their courtship behavior that have a polygenic and highly interactive genetic architecture. Based on the location of the QTL and the publishedNasoniagenome sequence we were able to identify a series of candidate genes for further study.

Severe pulmonary impairment can occur after traumatic brain injury or stroke. The resulting brain-lung interactions represent key points for the treatment and the subsequent outcome of the patient. Established treatment approaches, such as permissive hypercapnia and prone positioning, present the intensive care physician with divergent treatment goals in these patients with partially increased intracranial pressure. This case report series shows the instrument-based and noninstrument-based options for the treatment of acute respiratory distress syndrome (ARDS) in the simultaneous presence of intracranial pathologies. This includes equipment based therapies using extracorporeal CO

Thoracic surgery for lung resection is associated with a high incidence of postoperative pulmonary complications. Controlled ventilation with a large tidal volume has been documented to be a risk factor for postoperative respiratory complications after major abdominal surgery, whereas the use of low tidal volumes and positive end-expiratory pressure (PEEP) has a protective effect.To evaluate the effects of ventilation with low tidal volume and PEEP on major complications after thoracic surgery.A double-blind, randomised controlled study.A multicentre trial from December 2008 to October 2011.A total of 346 patients undergoing lobectomy or pneumonectomy for lung cancer.The primary outcome was the occurrence of major postoperative complications (pneumonia, acute lung injury, acute respiratory distress syndrome, pulmonary embolism, shock, myocardial infarction or death) within 30 days after surgery.Patients were randomly assigned to receive either lung-protective ventilation (LPV group) [tidal volume 5 ml kg ideal body weight + PEEP between 5 and 8 cmH2O] or nonprotective ventilation (control group) (tidal volume 10 ml kg ideal body weight without PEEP) during anaesthesia.The trial was stopped prematurely because of an insufficient inclusion rate. Major postoperative complications occurred in 23/172 patients in the LPV group (13.4%) vs. 38/171 (22.2%) in the control group (odds ratio 0.54, 95% confidence interval, 0.31 to 0.95, P = 0.03). The incidence of other complications (supraventricular cardiac arrhythmia, bronchial obstruction, pulmonary atelectasis, hypercapnia, bronchial fistula and persistent air leak) was also lower in the LPV group (37.2 vs. 49.4%, odds ratio 0.60, 95% confidence interval, 0.39 to 0.92, P = 0.02).The duration of hospital stay was shorter in the LPV group, 11 [interquartile range, 9 to 15] days vs. 12 [9 to 16] days, P = 0.048.Compared with high tidal volume and no PEEP, LPV combining low tidal volume and PEEP during anaesthesia for lung cancer surgery seems to improve postoperative outcomes.ClinicalTrials.gov number: NCT00805077.

ZusammenfassungDie abdominelle Sonografie ist geeignet, Folgeschäden und Begleiterkrankungen des Diabetes mellitus an Leber, Pankreas, Nieren, Gastrointestinaltrakt und abdominell-retroperitonealen arteriellen Gefäßen zu erfassen und zu verfolgen. Darüber hinaus ermöglicht die abdominelle Sonografie die Erfassung von Pankreas- und Lebererkrankungen, die ursächlich für einen Diabetes mellitus sind. Auf der Grundlage einer systematischen Literaturanalyse wird in einer 3-teiligen Übersichtsarbeit der Stellenwert der abdominellen Sonografie bei Patienten mit Diabetes mellitus dargestellt. Teil 1 beschreibt die Relevanz und konkrete Befunde sonografischer Methoden für die Diagnostik der hepatischen Manifestationen und Komplikationen des Diabetes mellitus.

Verletzungen der Extremitaten gehoren zu den haufigen Einsatzbildern in der praklinischen Notfallmedizin. Neben geschlossenen und offenen Frakturen wird der Notarzt vor allem mit Luxationen konfrontiert. Seltener kommt es zur Versorgung penetrierender Verletzungen oder von Amputationen. Die Einsatztaktik wird vom Umfang der Verletzungen bestimmt. Das Ziel der notarztlichen Versorgung o. g. Traumafolgen liegt bei Mehrfachverletzungen oder Polytrauma v. a. in der Abwehr lebensbedrohlicher Situationen. Erst wenn diese erkannt und behandelt, bzw. ausgeschlossen sind, steht die Versorgung der Extremitaten an.

Die Koloskopie ist eine weit verbreitete, komplikationsarme Methode zum Screening des kolorektalen Karzinoms. Eine seltene, jedoch vital bedrohliche Komplikation stellt eine Milzruptur nach Koloskopie dar. Bei der hier vorgestellten Patientin mit Milzruptur nach Koloskopie erfolgte nach verspateter Diagnosestellung eine Splenektomie. Der weitere Verlauf gestaltete sich komplikationsreich. Im Folgenden werden die zu dieser Komplikation beitragenden Risikofaktoren, das diagnostische und therapeutische Vorgehen sowie die Konsequenzen die aus dieser, moglicherweise nicht ganz so seltenen, Komplikation gezogen werden sollten, diskutiert. Die Kernaussage der Autoren ist, dass die Indikation zur Computertomographie bei abdominellen Beschwerden nach Koloskopie groszugig gestellt werden sollte, v. a. wenn kein Anhalt fur eine eventuelle Darmperforation besteht.

Die Aspiration von Mageninhalt ist eine schwerwiegende Komplikation der Allgemeinanasthesie. Vor elektiven Eingriffen wird eine Karenz fur Flussigkeiten von 2 h von der Deutschen Gesellschaft fur Anasthesiologie und Intensivmedizin (DGAI) empfohlen und auf maximal 2 Glaser/Tassen klarer Flussigkeit (400 ml) begrenzt. Praoperatives Fasten spielt eine wesentliche Rolle im postoperativen Stressstoffwechsel mit erhohter Insulinresistenz und Proteinkatabolismus. Ziel der vorliegenden Untersuchung ist es, im Rahmen bariatrischer Chirurgie ein liberaleres Nuchternheitskonzept mit 1000 ml klarer Flussigkeit 2 h praoperativ mit der aktuellen DGAI-Empfehlung zu vergleichen. Die observationelle, prospektive Studie wurde von der Ethikkommission der Universitat Leipzig genehmigt. In der liberalen Gruppe (Glib) zu bariatrischen Operation wurden bis 2 h praoperativ exakt 1000 ml Tee getrunken. In der restriktiven Gruppe (Gres) wurden im Rahmen von nichtbariatrischen, abdominalchirurgischen Operationen bis 2 h praoperativ maximal 400 ml klare Flussigkeit getrunken. Nach Intubation erfolgte die Anlage einer Magensonde, uber die sofort das gastrale Residualvolumen (GRV) und der pH-Wert bestimmt wurden. Zusatzlich wurde die Aspirationsrate klinisch erfasst. Eingeschlossen wurden 98 Patienten (Glib n = 50; Gres n = 48) mit einem Body-Mass-Index (BMI) von Glib 51,1 kg/m2 und Gres 26,5 kg/m2. Die Dauer der praoperativen Flussigkeitskarenz war signifikant verschieden (Glib 170 min vs. Gres 700 min, p < 0,001). Das bestimmte GRV war nicht unterschiedlich (Glib 11 ml, Gres 5 ml, p = 0,355). Der pH-Wert lag im Median bei 4,0 und 3,0 (p = 0,864). Eine Aspiration trat nicht auf. Unsere Ergebnisse unterstreichen die Durchfuhrbarkeit und Sicherheit eines praoperativen Flussigkeitsregimes mit Trinkmengen von 1000 ml in der bariatrischen Chirurgie.

Aspiration of stomach content is a severe complication during general anaesthesia. The DGAI (German Society for Anesthesiology and Intensive Care Medicine) guidelines recommend a fasting period for liquids of 2 h, with a maximum of 400 ml. Preoperative fasting can affect the patients' recovery after surgery due to insulin resistance and higher protein catabolism as a response to surgical stress.The aim of the study was to compare a liberal fasting regimen consisting of up to 1000 ml of liquids until 2 h before surgery with the DGAI recommendation.The prospective observational clinical study was approved by the ethics committee of the University of Leipzig. In the liberal fasting group (GIn all, 98 patients with a body mass index (BMI) of GThere is evidence suggesting that a liberal fluid fasting regimen (1000 ml of fluid) in the preoperative period is safe in patients undergoing bariatric surgery.

ZusammenfassungAdipositas ist sowohl in medizinischer als auch in sozioökonomischer Hinsicht ein ständig wachsendes Problem der Industriestaaten. Der anästhesiologischen Versorgung adipöser Patienten kommt daher eine immer größere Rolle zu. Es ist notwendig, die besondere Pathophysiologie adipöser Patienten, deren Begleiterkrankungen und die mit morbider Adipositas assoziierten Komplikationen genau zu kennen. Eine fundierte präoperative Evaluation des perioperativen Risikos adipöser Patienten ermöglicht ein differenziertes Vorgehen in der perioperativen Betreuung, das zusammen mit einer gesteigerten Aufmerksamkeit aller Beteiligten und einer adäquaten postoperativen Überwachung zu einer Reduktion des perioperativen Risikos für den Patienten führen kann. Neben der Kenntnis physiologischer Besonderheiten sind pharmakologische Konsequenzen der Adipositas zu berücksichtigen. Apparative Ausstattung und logistische Voraussetzungen sowie entsprechende Erfahrungen des Anästhesieteams tragen zur Risikominimierung für diese Patientengruppe bei.

A rare G8P[4] rotavirus, designated GER1H-09, was detected in a stool sample from an infant suffering from repeated episodes of emesis for 2 days without diarrhea. Sequencing of all genomic RNA segments was performed, and complete coding sequences were determined. The VP7 amino acid sequence revealed a close phylogenetic relationship to human G8P[6] and G8P[8] isolates from Slovenia and Africa. GER1H-09 shared typical amino acid residues within variable regions VR3 to VR7 with those strains, and their subclassification as lineage G8-II rotaviruses is proposed. The variability in VR3 was identified as the likely reason for the failure in genotyping G8-II rotaviruses by commonly used multiplex PCR. Furthermore, the sequences of associated structural and nonstructural proteins showed high amino acid identities to DS-1-like rotaviruses. The genotype composition of GER1H-09 (G8-P[4]-I2-R2-C2-M2-A2-N2-T2-E2-H2) suggests the occurrence of reassortment events between G8 genotypes and human DS-1-like G2P[4] rotaviruses.

In patients with diabetes mellitus, abdominal ultrasonography is the appropriate diagnostic technique to detect and to follow-up secondary and accompanying diseases of the liver, the kidneys, the pancreas, the gastrointestinal tract and of abdominal vessels. Moreover, pancreatic and hepatic diseases may be realized which are of etiological importance for diabetes mellitus. Based on a systematic survey of the published literature, this review in 3 parts will describe the value of abdominal ultrasonography in patients with diabetes mellitus. Part 1 deals with the diagnostic relevance and particular findings of ultrasonographic methods in hepatic manifestations and complications of diabetes mellitus.

Objective Since there is no therapeutical standard for the anaesthesiological approach during liver transplantation (LTX) in Germany at the moment, we have evaluated the current anaesthesiological procedures during LTX. Methods All departments of anaesthesiology (n = 24) cooperating with transplantation centers in Germany received a questionnaire via mail regarding following complexes: anaesthesiological methods, anaesthetics, blood components therapy, perioperative monitoring, supportive cardiovascular therapy and staff. Results The answers (n = 16) showed following results: Balanced anaesthesia with continuous application of opioids was the standard method (80 %). Different volatile anaesthetics as well as different opioids were used, isoflurane (66.7 %) and fentanyl (53.3 %) were the most common. Veno-venous bypass was never or occasionally used (86.7 %). The differentiated use of catecholamines, based on discussions in the last years, was also reflected in the results. Dobutamine/noradrenaline as combination seemed to be the first choice (46.7 %). Whereas there was an accordance with the employment of blood components, there was a large variation in the effectively applied blood products. Aprotinin was given in 60 % of all clinics occasionally, in 20 % every time and in 20 % aprotinine was never used. In most departments > or = 2 anaesthesiologists (80 %) and 1 nurse (53.3 %) were needed for intraoperative observation. Postoperative medical attendance was provided on anaesthesiological as well as surgical guided intensive care units (ICU). Generally accepted was an early extubation after arrival at the ICU (86.7 %). Conclusion Even though there was a consensus in the anaesthesiological approach during LTX some departments still use different procedures. This is the first study that will give a basis for discussion of anaesthesiological approaches during LTX.

Altere Patienten stellen einen grosen Anteil aller in einer Notaufnahme behandelten Patienten dar. Ein haufiger Grund fur eine stationare Einweisung lautet: „Verschlechterung des Allgemeinzustands“. Selten wird hierfur eine Alkoholintoxikation als Ursache in Betracht gezogen. Die Haufigkeit eines Alkoholmissbrauchs in dieser Altergruppe wird unterschatzt, zumal die klinische Symptomatik haufig unspezifisch ist. Wir berichten uber den Fall einer 94-jahrigen Patientin, die aufgrund einer Verschlechterung des Allgemeinzustands mit dem Rettungsdienst in die Notaufnahme eingewiesen wurde. Als einziger Grund fur die schlechte Verfassung fand sich ein Blutalkoholgehalt von 2,2‰.

Mediastinal emphysema is usually seen in cases of blunt thoracic trauma or cervical injury accompanied by tracheobronchial or esophageal perforation. Characteristic of this injury is severe retrosternal pain. We present the case of a man with extensive mediastinal and cervical emphysema caused by a simple midfacial fracture and accompanied by no symptoms.

A sensitive and reproducible method for the routine determination of amino acids in plasma and in protein hydrolysates based on reversed-phase high-performance liquid chromatography and o-phthaldialdehyde pre-column derivatization is described. The resolution of all amino acids was found to be good. The total time for analysis, including separation and reconditioning, ranged from 38 min for protein hydrolysates to 62 min for 29 physiological amino acids. The precision of hydrolysate analysis was within a relative standard deviation of 0.8–7.3% depending on the use of internal or external standards. The relative standard deviations of peak areas for physiological amino acids (standard) ranged between 1.8 and 5.6%. The relative standard deviations of retention times were less than 0.5% for all amino acids. This method can be used for routine analysis. One single column with 4-μm end-capped C18 material was found to be sufficient for 400–500 successive runs.

The multidrug resistance 1 gene (MDR1) encodes P-glycoprotein (Pgp), a member of the ATP-binding cassette (ABC) transporter family that confers tumor drug resistance by actively effluxing a number of antitumor agents. We had previously shown that MDR1 transcription is regulated by epigenetic events such as histone acetylation, and had identified the histone acetylase P/CAF and the transcription factor NF-Y as the factors mediating the enzymatic and DNA-anchoring functions, respectively, at the MDR1 promoter. It has also been shown that MDR1 activation is accompanied by increased methylation on lysine 4 of histone H3 (H3K4). In this study, we further investigated histone methylation in MDR1 regulation and function. We show that the mixed lineage leukemia 1 (MLL1) protein, a histone methyltransferase specific for H3K4, is required for MDR1 promoter methylation, as knockdown of MLL1 resulted in a decrease in MDR1 expression. The regulation of MDR1 by MLL1 has functional consequences in that downregulation of MLL1 led to increased retention of the Pgp-specific substrate DIOC2(3), as well as increased cellular sensitivity to several Pgp substrates. Regulation of MDR1 by MLL1 was dependent on the CCAAT box within the proximal MDR1 promoter, similar to what we had shown for MDR1 promoter acetylation, and also requires NF-Y. Finally, overexpression of the most prevalent MLL fusion protein, MLL-AF4, led to increased MDR1 expression. This is the first identification of a histone methyltransferase and its leukemogenic rearrangement that regulates expression of an ABC drug transporter, suggesting a new target for circumvention of tumor multidrug resistance. Cancer Res; 70(21); 8726–35. ©2010 AACR.

Mediastinal emphysema is usually seen in cases of blunt thoracic trauma or cervical injury accompanied by tracheobronchial or esophageal perforation. Characteristic of this injury is severe retrosternal pain. We present the case of a man with extensive mediastinal and cervical emphysema caused by a simple midfacial fracture and accompanied by no symptoms.

The p53 tumor suppressor continues to hold distinction as the most frequently mutated gene in human cancer. The ability of p53 to induce programmed cell death, or apoptosis, of cells exposed to environmental or oncogenic stress constitutes a major pathway whereby p53 exerts its tumor suppressor function. In the past decade, we have discovered that p53 is not alone in its mission to destroy damaged or aberrantly proliferating cells: it has two homologs, p63 and p73, that in various cellular contexts and stresses contribute to this process. In this review, the mechanisms whereby p53, and in some cases p63 and p73, induce apoptosis are discussed. Other reviews have focused more extensively on the contribution of individual p53-regulated genes to apoptosis induction by this protein, whereas in this review, we focus more on those factors that mediate the decision between growth arrest and apoptosis by p53, p63 and p73, and on the post-translational modifications and protein-protein interactions that influence this decision.

The six-port receiver concept offers new possibilities on the way toward multi-band/multi-mode low cost receiver frontends for high frequencies up to the nun-wave range. The expense for the reduced effort on the analog side is claimed as higher complexity on digital side. Especially, the synchronization of the receiver by considering the necessary calibration leads to a significantly higher computational load. This paper presents a new way to reduce the calibration to a linear equalization, which allows applying standard well known baseband architectures, used in conventional receiver designs. Herein, the six-port effects are processed in conjunction with the channel equalization.

We show that orthogonal space-time block codes may be identified with packings on the Grassmann manifold. We describe a general criterion for packings on the Grassmann manifold that yield coherent space-time constellations with the same code properties that make orthogonal space-time block codes so favorable. As an example, we point out that the rate 3/4 orthogonal space-time block code motivates a packing on the Grassmann manifold that allows for a simplified maximum likelihood detection rule using the newly introduced framework. As a side product, this packing defines a noncoherent space-time constellation that may be regarded as a generalization of certain existing noncoherent space-time codes.

The p53 tumor suppressor gene continues to be distinguished as the most frequently mutated gene in human cancer; this gene can be found mutated in up to 50% of human tumors of diverse histological type. It is generally accepted that the ability of p53 to induce either growth arrest or programmed cell death in response to diverse stimuli underlies the powerful selection against this protein in the development of cancer. It is somewhat surprising, then, to find p53 and several target genes in this pathway containing polymorphisms that impair their function. The nature of these polymorphic variants, and the mechanism whereby they impair the function of the p53 pathway, are reviewed here-in. The impact of these polymorphisms on cancer risk and the efficacy of therapy are only now becoming unraveled. Of particular relevance in these efforts will be the generation of mouse models of polymorphic variants in p53 and its target genes. Equally important will be better-controlled human studies, where-in haplotypes for p53 (that is, combinations of different polymorphisms in the p53 gene) and for p53-target genes are taken into account, instead of analyses of single gene variants, which have largely predominated to date. Studies in both regards should shed light on an emerging area in cancer biology, the significance of inter-individual differences in genotype on cancer risk, prognosis, and the efficacy of cancer therapy.

Since there is no therapeutical standard for the anaesthesiological approach during liver transplantation (LTX) in Germany at the moment, we have evaluated the current anaesthesiological procedures during LTX.All departments of anaesthesiology (n = 24) cooperating with transplantation centers in Germany received a questionnaire via mail regarding following complexes: anaesthesiological methods, anaesthetics, blood components therapy, perioperative monitoring, supportive cardiovascular therapy and staff.The answers (n = 16) showed following results: Balanced anaesthesia with continuous application of opioids was the standard method (80 %). Different volatile anaesthetics as well as different opioids were used, isoflurane (66.7 %) and fentanyl (53.3 %) were the most common. Veno-venous bypass was never or occasionally used (86.7 %). The differentiated use of catecholamines, based on discussions in the last years, was also reflected in the results. Dobutamine/noradrenaline as combination seemed to be the first choice (46.7 %). Whereas there was an accordance with the employment of blood components, there was a large variation in the effectively applied blood products. Aprotinin was given in 60 % of all clinics occasionally, in 20 % every time and in 20 % aprotinine was never used. In most departmentsor = 2 anaesthesiologists (80 %) and 1 nurse (53.3 %) were needed for intraoperative observation. Postoperative medical attendance was provided on anaesthesiological as well as surgical guided intensive care units (ICU). Generally accepted was an early extubation after arrival at the ICU (86.7 %).Even though there was a consensus in the anaesthesiological approach during LTX some departments still use different procedures. This is the first study that will give a basis for discussion of anaesthesiological approaches during LTX.

We propose a new class of space-time block codes that provide full spatial diversity and preserve the mutual information of the original channel. The remaining degrees of freedom may be exploited to optimize the codes with respect to other criteria like the distance profile after the channel. The constructed codes are based on a layered transmission where each layer is encoded by an orthogonal space-time block code. A real-valued transmission model is used to compare the new codes with known space-time block codes like, for example, linear dispersion codes or multi-stratum space-time codes. This model includes many different space-time codes. Encoding and decoding is always carried out by applying a single spreading matrix at the transmitter and the receiver, respectively. Due to the simplicity of the model, well known code properties may be easily deduced and new design criteria become obvious.

We derive two theorems that enable us to determine the bit error rate performance of orthogonal space-time block codes in an analytical way if the channel impulse response is measured by pilot based maximum likelihood estimation at the receiver. The first one gives an exact solution, but requires numerical integration. The second one provides an approximation that is improving with increasing number of antennas. The analysis is based on a real-valued transmission model which allows for a representation of orthogonal space-time block codes as linear spreading matrices. That means, encoding and decoding the space-time block code is carried out by a single matrix multiplication at the transmitter and the receiver, respectively.

The paper addresses two aspects related to orthogonal space-time block codes (STBCs). First, it is shown how to embed orthogonal STBCs into a truly linear matrix transmission model using real-valued notation. Thus, orthogonal STBCs may be interpreted as linear spreading in space and time. It simplifies analytical analysis considerably and puts them on a common basis with other multi subchannel schemes. Second, we consider channel estimation for orthogonal STBCs. We provide a brief analytical analysis on the degradation that is due to pilot based maximum likelihood channel estimation. Further, we exploit the fact that Alamouti's scheme does not only provide a simple maximum likelihood estimate of the data, but may also be deployed to obtain independent estimates of the MIMO channel impulse responses by a linear transformation simply using arbitrary detected data symbols. It is also shown how this fits into the framework of real-valued notation.