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Purpose To determine the nature and frequency of duplicate prescriptions (DPs) in the emergency department (ED) by utilization of a novel categorization of DPs which differentiates between appropriate DPs (ADPs) and potentially inappropriate DPs (PIDPs). Methods In this retrospective cohort study, adult patients who presented to the ED for internal medicine of a large university hospital in northern Germany in 2018 and 2019 were screened for the presence of DPs. Descriptive statistical methods were used to characterize the nature and frequency of PIDPs compared to the frequency of ADPs. Results A total of 4208 patients were enrolled into the study. The median age of the study population was 63 years (interquartile range (IQR) 48–77), 53.9% were female. The patients took a median of 5 drugs (IQR 3–9). 10.9% of the study population were affected by at least one PIDP (at least one grade-1 PIDP: 6.1%; at least one grade-2 PIDP: 4.5%; at least one grade-3 PIDP: 1.1%). Non-opioid analgesics accounted for the majority of grade-1 PIDPs, while inhalatives were most frequently responsible for grade-2 and grade-3 PIDPs. Nearly half of the study population (48.6%) displayed at least one ADP. Conclusion PIDPs pose a frequent pharmacological challenge in the ED. The medication review should comprise a systematic screening for PIDPs with a particular focus on non-opioid analgesics and inhalatives. ADPs were detected more frequently than PIDPs, questioning the predominant notion in the medical literature that DPs are exclusively deleterious.

Radiology reports mostly contain free-text, which makes it challenging to obtain structured data. Natural language processing (NLP) techniques transform free-text reports into machine-readable document vectors that are important for creating reliable, scalable methods for data analysis. The aim of this study is to classify unstructured radiograph reports according to fractures of the distal fibula and to find the best text mining method.We established a novel German language report dataset: a designated search engine was used to identify radiographs of the ankle and the reports were manually labeled according to fractures of the distal fibula. This data was used to establish a machine learning pipeline, which implemented the text representation methods bag-of-words (BOW), term frequency-inverse document frequency (TF-IDF), principal component analysis (PCA), non-negative matrix factorization (NMF), latent Dirichlet allocation (LDA), and document embedding (doc2vec). The extracted document vectors were used to train neural networks (NN), support vector machines (SVM), and logistic regression (LR) to recognize distal fibula fractures. The results were compared via cross-tabulations of the accuracy (acc) and area under the curve (AUC).In total, 3268 radiograph reports were included, of which 1076 described a fracture of the distal fibula. Comparison of the text representation methods showed that BOW achieved the best results (AUC = 0.98; acc = 0.97), followed by TF-IDF (AUC = 0.97; acc = 0.96), NMF (AUC = 0.93; acc = 0.92), PCA (AUC = 0.92; acc = 0.9), LDA (AUC = 0.91; acc = 0.89) and doc2vec (AUC = 0.9; acc = 0.88). When comparing the different classifiers, NN (AUC = 0,91) proved to be superior to SVM (AUC = 0,87) and LR (AUC = 0,85).An automated classification of unstructured reports of radiographs of the ankle can reliably detect findings of fractures of the distal fibula. A particularly suitable feature extraction method is the BOW model. Key Points: Citation Format

The COVID-19 pandemic has caused a significant impact on the medical care of many diseases and has led to reduced presentations to the emergency department. Reduced presentations may be due to overwhelmed capacities of hospitals or collateral damage from fear of infection, lockdown regulations, or other reasons. The effect on patients with liver cirrhosis is not established.We aim to assess the impact on the care of patients with liver cirrhosis in a tertiary center in Northern Germany.All patients presenting to the emergency department with a diagnosis of cirrhosis between March 1 and May 31 from 2015-2020 were included. Reasons for presentation, duration of symptoms, the severity of liver disease, and 30-day mortality were assessed and compared between patients presenting during the COVID-19 pandemic and pre-COVID-19.Overall, 235 patients were included. Despite an overall decline in presentations to the emergency department by 11.7%, the frequency of patients presenting with liver cirrhosis has remained stable (non-significant increase by 19.5%). No significant difference could be detected for the MELD score, the CLIF-organ failure subscores, and the 30-day mortality before and during the COVID-19 pandemic. Up to 75% of patients with liver cirrhosis had symptoms24 h before presenting to the emergency department.Despite the overall trend of reduced emergency presentations during the COVID-19 pandemic, the frequency of presentations of patients with liver cirrhosis did not decline. Morbidity and mortality were not affected in a setting of disposable healthcare resources. The late presentation to the emergency department in many cirrhotic patients may open opportunities for interventions (i.e., with early telemedicine intervention).Die COVID-19 Pandemie hat einen deutlichen Einfluss auf die medizinische Versorgung und zu einer Abnahme von Vorstellungen in der Notaufnahme geführt. Die Gründe sind unklar, diskutiert werden eingeschränkte Versorgungskapazitäten der Krankhäuser, Angst vor einer Infektion oder Lockdown-Regelungen. Der Effekt auf Patienten mit einer Leberzirrhose ist unklar. ZIEL: Den Einfluss auf die Notfallversorgung von Patienten mit Leberzirrhose in einem tertiären Zentrum in Deutschland zu untersuchen.Alle Patienten mit der Diagnose Leberzirrhose, die sich zwischen dem 1. März und 31. Mai 2015–2020 in der Notaufnahme vorgestellt haben, wurden eingeschlossen. Die Gründe für die Vorstellung, die Dauer der Beschwerden, die Schwere der Lebererkrankung und die 30-Tage Mortalität wurde erfasst und zwischen den Patientkollektiven, die sich vor und während der COVID-19 Pandemie vorstellten, verglichen.Insgesamt wurden 235 Patienten eingeschlossen. Trotz einer Abnahme aller Notfallvorstellungen um 11.7%, blieb der Anteil von Patienten mit Leberzirrhose stabil (nicht signifikanter Anstieg um 19.5%). Kein signifikanter Unterschied konnte in Bezug auf den MELD-Score, den CLIF-organ failure Score und die 30-Tage Mortalität festgestellt werden. Bis zu 75% der Patienten mit Leberzirrhose hatten die Beschwerden, die zur Vorstellungen führten,24 Stunden.Trotz des insgesamt vorliegenden Trends reduzierter Notfallvorstellungen, bleibt die Anzahl an Notfallvorstellungen von Patienten mit Leberzirrhose gleich. Die Morbidität und Mortalität werden nicht beeinflusst bei ausreichenden Versorgungskapazitäten. Die Zeitspanne zwischen Beschwerdebeginn und Vorstellung in der Notaufnahme von Patienten mit Leberzirrhose lässt Möglichkeiten zur Intervention, z.B. durch Telemedizin.

Background Hand injuries are common in sports and associated with high dropout rates and costs. Hence, efforts should strive for further risk prevention measures in order to increase safety in sports. This implies knowledge of sports injury risk profiles. So far, major surveillance programs exist mainly in Anglo-American countries, reflecting the specific concerns of sports in this part of the world. Data on sports injuries within Europe are scarce. As sports behaviour appears to vary demographically, we hypothesised that risk injury profiles differ as well. Methods To assess whether the described sports injuries of the hand are applicable to the German population, we performed a five-year retrospective, single-centre analysis of sports-related hand injuries, using data from the Enterprise Clinical Research Data Warehouse of the Hannover Medical School. Results Notable differences in comparison to other data were observed. Ball sports, cycling and equestrian sports caused most of the recorded hand injuries, which were predominantly fractures of the wrist and hand. Hand injuries in equestrian sports were associated with significantly higher operation and hospitalisation rates as well as a significantly longer inpatient treatment. Conclusion Risk profiles for sports-related hand injuries appear to differ not only in terms of age- and sex, but also geographically. Nation- and Europe-wide hand trauma registries as well as a broad registry participation are necessary in order to accurately assess the risk patterns in Europe; henceforth reducing hand injuries and their sequelae.

Background & aims Spontaneous bacterial peritonitis is a severe complication in patients with cirrhosis leading to acute kidney injury, hepatic encephalopathy and a high mortality. In this study, we aimed to investigate the impact of proton pump inhibitors and the potential relevance of the taken dosage on the incidence and clinical course of spontaneous bacterial peritonitis. Methods Overall, 613 consecutive patients with decompensated cirrhosis were included. All patients were carefully evaluated for proton pump inhibitors intake including the applied dosage and were further followed up for spontaneous bacterial peritonitis development as well as for the incidence of clinical complications like hepatic encephalopathy, acute kidney injury and mortality. Results Cumulative spontaneous bacterial peritonitis incidence did neither differ between the proton pump inhibitors and the no-proton pump inhibitors group nor between those taking the high (>40 mg/d) and the low (10-40 mg/d) proton pump inhibitors' dose. However, proton pump inhibitors' intake was associated with an impaired clinical course of spontaneous bacterial peritonitis reflected by a higher likelihood for acute kidney injury (71% vs 43%; P = .002), severe hepatic encephalopathy (15% vs 0%; P = .04) and an increased mortality (24% vs 0%; P = .008) within 28 days after spontaneous bacterial peritonitis diagnosis. In particular, patients with proton pump inhibitors dosages >40 mg/d had an increased short-term risk for acute kidney injury (adjusted hazard ratio: 1.86; P = .009) and mortality (adjusted hazard ratio: 2.05; P = .02). In contrast, there was no effect of proton pump inhibitors on acute kidney injury, hepatic encephalopathy and mortality in patients without spontaneous bacterial peritonitis irrespective of the applied proton pump inhibitors dosage. Conclusions High dosages of proton pump inhibitors are associated with an adverse outcome in patients with spontaneous bacterial peritonitis. Thus, indication for high-dosage proton pump inhibitors therapy should be evaluated carefully in these patients.

The Logical Observation Identifiers, Names and Codes (LOINC) is a common terminology used for standardizing laboratory terms. Within the consortium of the HiGHmed project, LOINC is one of the central terminologies used for health data sharing across all university sites. Therefore, linking the LOINC codes to the site-specific tests and measures is one crucial step to reach this goal. In this work we report our ongoing efforts in implementing LOINC to our laboratory information system and research infrastructure, as well as our challenges and the lessons learned. 407 local terms could be mapped to 376 LOINC codes of which 209 are already available to routine laboratory data. In our experience, mapping of local terms to LOINC is a widely manual and time consuming process for reasons of language and expert knowledge of local laboratory procedures.

Background & aimsBacterial infections, in particular a spontaneous bacterial peritonitis (SBP), are a major threat in patients with liver cirrhosis. Recently, it has been shown that the impact on mortality might be underestimated by established risk-scores. Onset of infection was suggested to define a distinct stage of cirrhosis. However, it remains unclear whether all stages of decompensated cirrhosis are equally affected. Moreover, if there is such a distinct stage, it must be determined whether it is reversible after the infection has resolved. In this study we aimed to further analyze the impact of a current as well as a resolved SBP in different stages of decompensated liver cirrhosis.MethodsA number of 579 patients with liver cirrhosis and ascites were included. MELD-score was used to determine the stage of liver disease. Low (25) MELD-groups were compared. Patients were followed up for 90 days. Primary endpoint was overall mortality. Statistical analyses were performed using the log-rank test, Cox regression and competing risk analysis.ResultsMortality was significantly higher in patients with nosocomial-acquired SBP (nSBP) compared to patients without SBP (pConclusionsDevelopment of nSBP is independently associated with increased mortality supporting the concept of a distinct status of cirrhosis. Importantly, the prognosis remains unfavorable even after resolution of nSBP. This could be particularly relevant for patients with intermediate MELD-scores, who have limited chances for a donor liver.

The Logical Observation Identifiers, Names and Codes (LOINC) is a common terminology used for standardizing laboratory terms. Within the HiGHmed consortium, LOINC is used as a central terminology for health data sharing across all university hospital sites. Therefore, linking the LOINC codes to the site-specific tests and measures is one crucial step to reach this goal. In this work we report our ongoing work in implementing LOINC to the laboratory information system, our challenges and lessons learned.

Type 2 diabetes mellitus (DM) is a frequent comorbidity among patients with liver cirrhosis. However, data regarding the impact of DM on spontaneous bacterial peritonitis (SBP) are quite limited. Our aim was to analyze the impact of DM and HbA1c values on the incidence of SBP and mortality in patients with liver cirrhosis and ascites. A number of 475 consecutive patients with liver cirrhosis and ascites were analyzed. Presence of DM as well as HbA1c was assessed at the time of the first paracentesis. Patients were followed up for a mean of 266 days. Primary endpoints were SBP development and mortality. Overall, 118 (25%) patients were diagnosed with DM. DM patients had an increased risk for developing a SBP during follow-up (HR: 1.51; p = 0.03). SBP incidence was particularly high in DM patients with HbA1c values ≥6.4%, significantly higher than in DM patients with HbA1c values

Quinine activates the hydrolysis of phosphatidyl choline suspensions by phospholipase C (E.C. 3.1.4.3) obtained from Clostridium welchii . Low levels of calcium are an absolute requirement for this activation: Mg 2+ , Ba 2+ , Sr 2+ , and Zn 2+ are ineffective. The induction period, or lag phase for this enzyme is dependent upon both calcium concentration and substrate interfacial surface area. At low concentrations (less than 50 μM) calcium ions affect the induction period but not the maximal rate of hydrolysis, whereas guinine predominantly affects the rate of hydrolysis by alterations in the surface charge carried by the substrate.

Es ist moglich, mit Kulturen von Saugetiercarcinomgeweben in vitro exakte quantitative Untersuchungen anzustellen. Die Abweichung des Wachstums der Halften einer Kultur unter identischen Bedingungen ubersteigt in der Regel nicht 5%.

1. Die Residualenergie und die inhaerente Wachstumsenergie von Carcinomzellen in Tyrodelosung ist nicht groser als die von normalen Gewebezellen, sondern eher kleiner. 2. Carcinomgewebe, denen vorher normales Gewebe zugesetzt worden war, zeigen eine grosere Residualenergie, die auf die Summe der Nahrungsmaterialreserve in beiden Geweben zuruckzufuhren ist. 3. Carcinomgewebe in Serum zeigen ein bedeutend groseres Wachstum, wenn sie kurze Zeit vorher in Beruhrung mit normalen Zellen gewesen sind. 4. Durch Kontakt mit normalen Zellen bekommen die Carcinomgewebe ein akzessorisches Prinzip, das nicht nutritiver Art ist, sondern einen Accellerator des Zellaufbaus aus Serum darstellt. Dieser Faktor ist identisch mit den Desmonen. 5. Die aus dem blosen Kontakt mit normalen Zellen, gleichgultig welcher Art, gewonnenen akzessorischen Faktoren sind eine der wichtigsten Ursache fur die unbegrenzte Proliferation im Organismus. Hiermit wird das heterotope Wachstum erklart. 6. Carcinomzellen sind empfindlich gegenuber Embryonalextrakt und gewissen Proteosenpraparaten. Mit zunehmender Konzentration nimmt die Wachstumsgrose zunachst zu. In hoheren Konzentrationen sterben die Zellen rasch. 7. Carcinomzellen reagieren gegenuber Embryonalextrakt wie Leukocyten.

1. Gewebe des Ratten-Sarkoms last sich durch Behandlung mit Alkohol-Ather oder Aceton in ein Trocken-Praparat uberfuhren, in dem Glykolase wirksam ist. 2. Unter diesen Umstanden ist das Koferment so weit geschadigt oder entfernt, das bei Einwirkung des Tumor-Materials auf Hexosephosphat sich bildendes Methylglyoxal nicht verbraucht, sondern angesammelt wird. Der Ertrag belauft sich auf 52% der Theorie. 3. Da auch unter den gewahlten Versuchsbedingungen ein Teil des entstandenen Methylglyoxals noch umgewandelt wird und als Substrat hinzugefugtes Methylglyoxal verschwindet, ergibt sich, das der Weg der Milchsaurebildung im Tumor der gleiche ist wie bei anderen glykolytischen Systemen. 4. Mit dem selben Vorgehen gelingt es, die Entstehung von Methylglyoxal im embryonalen Gewebe des Huhns darzutun. Die Ausbeute ist ebenfalls gut.

An hypothesis is presented to explain the red cell lysis which accompanies an acute malarial infection, as well as the mode of action of certain schizonticidal drugs in the quinoline and acridine series. Quinine and a number of other antimalarial drugs have been found to counteract the inhibition by protein of fatty acid-induced lysis, when tested in anin vitrosystem. It is suggested that these schizonticides exert their chemotherapeutic effect by inducing the premature lysis of the parasitized red cell, as a result of relieving the inhibition by protein of haemolysis.