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Outbreaks of infectious diseases pose particular challenges for hospitals and intensive care units.Typical infectiological scenarios and their significance for modern intensive care medicine are presented.Selected pathogens/infectious diseases that have significantly strained the resources of intensive care units are described.Intensive medical care is necessary in severe cases of many infectious diseases. In the context of epidemics/pandemics, many critically ill patients have to be admitted within a short time. Examples are the 2009 H1N1 influenza pandemic, the 2011 enterohemorrhagic Escherichia coli (EHEC) outbreak in northern Germany, the 2014/2015 Ebola fever outbreak and the 2020 coronavirus disease 19 (COVID-19) pandemic. Multidisciplinary teams, protocol development, adequate staffing, and training are required to achieve optimal treatment outcomes, including prevention of healthcare worker infections.Pandemics and epidemics are unique challenges for intensive care unit preparedness planning.HINTERGRUND: Ausbrüche von Infektionskrankheiten stellen Krankenhäuser und Intensivstationen vor besondere Herausforderungen.Es werden grundlegende infektiologische Szenarien und ihre Bedeutung für die moderne Intensivmedizin dargestellt.Ausgewählte Erreger/Infektionskrankheiten, die das Potenzial haben, die Ressourcen der Intensivstationen deutlich zu belasten, werden beschrieben.Eine Intensivmedizinische Betreuung ist bei schweren Verläufen vieler Infektionserkrankungen notwendig. Im Rahmen von Epidemien/Pandemien kann es innerhalb kurzer Zeit zu einer Aufnahme von vielen kritisch kranken Patienten kommen. Beispiele dafür sind die Pandemie im Jahr 2009 durch das Influenzavirus H1N1, der Ausbruch einer Infektion mit enterohämorrhagischen Escherichia coli (EHEC) in Norddeutschland, der Ebola-Fieber-Ausbruch in den Jahren 2014/2015 und die Pandemie durch die Coronaviruserkrankung 2019 (COVID-19) im Jahr 2020. Multidisziplinäre Teams, die Entwicklung von Protokollen, eine adäquate Personalbesetzung und Schulungen sind erforderlich, um ein optimales Behandlungsergebnis zu erzielen. Dies beinhaltet insbesondere auch die Prävention von Infektionen des Gesundheitspersonals.Pandemien und Epidemien sind einzigartige Herausforderungen für die Bereitschaftsplanung der Intensivstation.

Nonvariceal upper gastrointestinal bleeding (UGIB) has a high mortality. Hematemesis sometimes with melena are the leading clinical symptoms. Peptic ulcers and (erosive) inflammation are common, whereas Mallory-Weiss syndrome, neoplasms, angiodysplasia and diffuse UGIB are less common.A risk stratification is based on the medical history, clinical presentation and laboratory tests, which are considered in the Glasgow-Blatchford score; however, which treatment approach is optimal?After stabilisation under restricted transfusion indications, temporary stoppage of anticoagulants and optimized coagulation is beneficial and proton pump inhibitors (PPI) should be started. Prokinetics improve the endoscopic conditions in UGIB. The use of an endoscopic Doppler probe optimizes localization of the bleeding site. The use of the Forrest classification and Helicobacter pylori diagnostics are recommended. Mechanical (clips, injection), thermal (argon plasma coagulation, APC) and topical (hemostatic powder) endoscopic treatment procedures are available. Endoluminal hemostasis is very effective. Only clip application is suitable as monotherapy whereas all other endoscopic options should be combined. Angiography followed by transarterial embolization (TAE) can be used for therapy. Despite the high primary success rate, the risk of rebleeding is high. Surgery as the primary treatment is rarely necessary, although effective. Compared to TAE complications are higher, but there is no difference regarding mortality.Endoscopy remains the gold standard for the initial diagnostics and treatment of UGIB. In cases of rebleeding repeated endoscopy is recommended. With persistent UGIB an endovascular procedure should be evaluated. Surgery remains an important salvage option.

Anastomotic leakage is still the most frequent cause of postoperative mortality following esophageal and cardial surgery. The German Advanced Surgical Study Group recommended that endoscopy should be the first diagnostic method if leakage is suspected. The German Surgical Endoscopy Association developed and validated a definition and severity classification of anastomotic leakage following esophageal and cardial resection.In 2010 the international study group on insufficiency published a definition and severity grading of anastomotic leakage following anterior resection of the rectum, which was validated in 2013. The severity of anastomotic leakage should be graded according to the impact on clinical management: type I requires only conservative management, type II requires interventional radiological or endoscopic treatment and type III requires surgical revision. In contrast to the rectal classification type III is divided into a category without (type IIIa) or with (type IIIb) conduit resection and diversion. The validation was carried out on a 10-year collective from the university hospitals in Heidelberg and Tübingen.From 2006-2015 all 92 patients who developed an anastomotic leakage following esophageal and cardial resection were enrolled in the study. We found a significant increase in the length of stay in the intensive care unit (ICU) with increasing classification type (p 0.0143). Furthermore, there was a significant correlation with the general classification of postoperative complications according to Clavien-Dindo as well as with mortality (p 0.001).Standardized parameters are the prerequisite to be able to compare the results between hospitals and studies. The validation of the suggested classification shows that the differentiation between the groups is substantiated by the correlation to the length of ICU stay, Clavien-Dindo and mortality and will therefore contribute to a better comparability of data on leakage following esophageal resection in the future.

In this case report, we describe the clinical course of a patient with Ebola virus disease who was transferred to the Highly Contagious Pathogens Treatment Unit at the Hamburg University Medical Center. High volume turnover, electrolyte imbalances, paralytic ileus, sepsis with multiresistant gram-negative pathogen, and respiratory failure due to blood aspiration were major clinical challenges.

Web applications tend to continuously evolve and thus need thorough, yet lean and automatic, regression testing. In this installment of Software Technology, Andreas Kornstadt and his colleagues describe automatic regression testing for Web applications that uses the Selenium testing framework. Selenium is portable open source software available for Windows, Linux, and Macintosh. Tests are written as HTML tables or in a number of programming languages and can run directly in most Web browsers. Andreas and his colleagues also provide many useful testing hints for practitioners. We look forward to hearing from both readers and prospective column authors about this column and the technologies we want to know more about.

In this case report, we describe the clinical course of a patient with Ebola virus disease who was transferred to the Highly Contagious Pathogens Treatment Unit at the Hamburg University Medical Center. High volume turnover, electrolyte imbalances, paralytic ileus, sepsis with multiresistant gram-negative pathogen, and respiratory failure due to blood aspiration were major clinical challenges.

Introduction: Systemic sclerosis (SSc)-related pulmonary arterial hypertension (PAH) has emerged as a major mortality prognostic factor. Mutations of transforming growth factor beta (TGFβ) receptor genes strongly contribute to idiopathic and familial PAH. Objective: To explore the genetic bases of SSc-PAH, we combined direct sequencing and genotyping of candidate genes encoding TGFβ receptor family members. Materials and methods: TGFβ receptor genes, BMPR2, ALK1, TGFR2 and ENG, were sequenced in 10 SSc-PAH patients, nine SSc and seven controls. In addition, 22 single-nucleotide polymorphisms (SNP) of these four candidate genes were tested for association in a fi rst set of 824 French Caucasian SSc patients (including 54 SSc-PAH) and 939 controls. The replication set consisted of 1516 European SSc (including 219 SSc-PAH) and 3129 controls from the European League Against Rheumatism Scleroderma Trials and Research group network. Results: No mutation was identified by direct sequencing. However, two repertoried SNP, ENG rs35400405 and ALK1 rs2277382, were found in SSc-PAH patients only. The genotyping of 22 SNP including the latter showed that only rs2277382 was associated with SSc-PAH (p=0.0066, OR 2.13, 95% CI 1.24 to 3.65). Nevertheless, this was not replicated with the following result in combined analysis: p=0.123, OR 0.79, 95% CI 0.59 to 1.07. Conclusions: This study demonstrates the lack of association between these TGFβ receptor gene polymorphisms and SSc-PAH using both sequencing and genotyping methods.

The unexpected identification of myoglobin (MB) in breast cancer prompted us to evaluate the clinico-pathological value of MB, haemoglobin (HB) and cytoglobin (CYGB) in human breast carcinoma cases. We further screened for the presence of neuroglobin (NGB) and CYGB in tumours of diverse origin, and assessed the O(2) -response of HB, MB and CYGB mRNAs in cancer cell lines, to better elicit the links between this ectopic globin expression and tumour hypoxia.Breast tumours were analysed by immunohistochemistry for HB, MB and CYGB and correlated with clinico-pathological parameters. Screening for CYGB and NGB mRNA expression in tumour entities was performed by hybridization, quantitative PCR (qPCR) and bioinformatics. Hypoxic or anoxic responses of HB, MB and CYGB mRNAs was analysed by qPCR in human Hep3B, MCF7, HeLa and RCC4 cancer cell lines.78.8% of breast cancer cases were positive for MB, 77.9% were positive for HB and 55.4% expressed CYGB. The closest correlation with markers of hypoxia was observed for CYGB. Compared to the weakly positive status of MB in healthy breast tissues, invasive tumours either lost or up-regulated MB. Breast carcinomas showed the tendency to silence CYGB. HB was not seen in normal tissues and up-regulated in tumours. Beyond breast malignancies, expression levels of NGB and CYGB mRNAs were extremely low in brain tumours (glioblastoma, astrocytoma). NGB was not observed in non-brain tumours. CYGB mRNA, readily detectable in breast cancer and other tumours, is down-regulated in lung adenocarcinomas. Alpha1 globin (α1 globin) and Mb were co-expressed in MCF7 and HeLa cells; CYGB transcription was anoxia-inducible in Hep3B and RCC4 cells.This is the first time that HB and CYGB are reported in breast cancer. Neither NGB nor CYGB are systematically up-regulated in tumours. The down-regulated CYGB expression in breast and lung tumours is in line with a tumour-suppressor role. Each of the screened cancer cells expresses at least one globin (i.e. main globin species: CYGB in Hep3B; α1 globin + MB in MCF7 and HeLa). Thus, globins exist in a wide variety of solid tumours. However, the generally weak expression of the endogenous proteins in the cancer argues against a significant contribution to tumour oxygenation. Future studies should consider that cancer-expressed globins might function in ways not directly linked to the binding and transport of oxygen.

Evolution of hemodynamic monitoring revealed many septic shock patients on high catecholamines without proper fluid loading before. The aim of our study was to show that it is possible in quite a few cases to reduce these agents by a forced volume resuscitation combined with active reduction of catecholamines.

In den vier Serumgruppensystemen sind im Familienmaterial erhebliche Abweichungen vom Gleichgewicht nachHardy-Weinberg nachweisbar, indem besonders in Ehen von entgegengesetzten Homozygoten die heterozygoten Kinder benachteiligt sind. Zu vermuten sind pranatale Selektionsvorgange, da in den Bevolkerungen Altersunterschiede zwischen den Serum-Phanotypen nicht bewiesen sind.

An einer Serie von 240 geisteskranken Anstaltsinsassen aus dem Rheinland wurden die Blutgruppen und das Rhesus-System ausgetestet. Es fanden sich keine Zusammenhange zwischen Art der Erkrankung und Blutgruppenzugehorigkeit bzw. Rhesus-Untertypen. Bei einem Vergleich der Gen-Haufigkeiten in verschiedenen Bevolkerungen Westeuropas ergeben sich Haufigkeitsunterschiede, die bei den Fisher-Race-Typen deutlicher wird als bei Annahme der Wienerschen Multiplen-Allelie-Theorie.

Es wird die Verwendung von Hall-Sonden zur punktweisen Ausmessung von Magnetfeldern mit einer Genauigkeit besser als 0,1% beschrieben. Die erforderlichen Masnahmen zur Herabsetzung der Wirkung der Temperatureffekte und zur optimalen Ausnutzung der Empfindlichkeit werden diskutiert.

The accumulated combination (X2 = 11.28 greater than 9.21) of Gm 1+ with Rh(CC) and of Gm 1-with Rh(cc) demonstrates the synteny of both markers on chromosome 1.

663 breech deliveries between 1976 and 1985 at Hannover Medical School have been studied retrospectively. The overall frequency of breech deliveries was 4.5%. 6.1% were primigravid women. Comparisons were made to a group of deliveries with vertex presentation. Matched pairs were identical regarding the year of delivery, the method (vaginal delivery/caesarean section) and parity. 26.2% of breeches were born through the vagina. The frequency of vaginal deliveries after the 37th week of gestation ranged from 13.5% to 46.9% per year. For vaginal delivery the following prerequisites are defined at out institution: normal pelvic measures and physique, expected birth weight between 2500 g and 3500 g and informed consent. Until 1979 the frequency of vaginal deliveries ranged from 12% to 25%. Since 1980 an increasing number up to 45% was noted. For deliveries before the 38th week of gestation primary indicated caesarean section was preferred. The rate of maternal complications after caesarean section was high compared to vaginal deliveries (29.0% versus 8.6%; p less than or equal to 0.05). Also, these complications usually were more serious. Injuries of the newborn were more often observed following vaginal delivery than following caesarean section (7.5% versus 2.9%). No significant differences were found between the apgar scores after vaginal deliveries and caesarean sections. However, the percentage of reduced pH values was significantly higher after vaginal breech deliveries (57.5% versus 24.7%; p less than or equal to 0.05). No severe acidosis was observed. No difference was seen between the fetal outcome of deliveries from primiparous and multiparous women. Perinatal mortality according to WHO criteria was 1.1%.(ABSTRACT TRUNCATED AT 250 WORDS)