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Summary Background The influenza season 2017–2018 of the northern hemisphere was the highest since 2001 and was caused predominantly by influenza B virus. Methods We performed a retrospective analysis of all patients in a university hospital in northern Germany with laboratory-confirmed influenza during the winter season 2017–2018 and analyzed underlying conditions, complications, and outcome. Results A total of 272 cases of influenza were diagnosed: 70 influenza A (25.7%), 201 influenza B (73.9%), and 1 co-infection. Of 182 adults, 145 were hospitalized, 73 developed pneumonia, 11 developed myocardial infarction, two a transient ischemic attack, one a stroke, and one perimyocarditis. Eleven of the 145 hospitalized adult patients (7.6%) died, ten of them because of pneumonia. All of them had preexisting diseases. Pneumonia was associated with a mortality of 13.7%. Underlying cardiac insufficiency was correlated with higher mortality (7/51 with versus 4/126 patients without cardiac insufficiency; p p Conclusion Patients with influenza should be monitored for secondary pneumonia and myocardial infarction, and vaccination should be enforced especially in patients with coronary heart disease and cardiac insufficiency.

Treatment results of AML in elderly patients are unsatisfactory. In an open label randomized phase II study, we investigated whether addition of the XPO1 inhibitor selinexor to intensive chemotherapy would improve outcome in this population. 102 AML patients > 65 years of age (median 69 (65–80)) were randomly assigned to standard chemotherapy (3 + 7) with or without oral selinexor 60 mg twice weekly (both arms n = 51), days 1–24. In the second cycle, cytarabine 1000 mg/m2 twice daily, days 1–6 with or without selinexor was given. CR/CRi rates were significantly higher in the control arm than in the investigational arm (80% (95% C.I. 69–91%) vs. 59% (45–72%; p = 0.018), respectively). At 18 months, event-free survival was 45% for the control arm versus 26% for the investigational arm (Cox-p = 0.012) and overall survival 58% vs. 33%, respectively (p = 0.009). AML and infectious complications accounted for an increased death rate in the investigational arm. Irrespective of treatment, MRD status after two cycles appeared to be correlated with survival. We conclude that the addition of selinexor to standard chemotherapy does negatively affect the therapeutic outcome of elderly AML patients. (Netherlands Trial Registry number NL5748 (NTR5902), www.trialregister.nl).

Zusammenfassung Hintergrund Das Erkennen von Kindesmisshandlungen und der Umgang damit sind Herausforderungen im ärztlichen Alltag. Die Dunkelziffer bei Misshandlungen und Vernachlässigungen ist hoch. Ziel der Arbeit Das Ziel der Arbeit war, die Effektivität des neu strukturierten Kinderschutzprogrammes einer großen deutschen Kinderklinik zu untersuchen und durch die Präsentation der Vorteile der neuen Struktur die Verbesserung von Programmen für Kinder und Mediziner in anderen Kliniken anzuregen. Methode Es wurden retrospektiv alle Kinderschutzfälle im Altonaer Kinderkrankenhaus vor und nach Neukonzeption der Kinderschutzarbeit über einen Zeitraum von jeweils 2 Jahren untersucht und miteinander verglichen. Die Kinderschutzgruppe war neu strukturiert worden und wurde nachfolgend von einer hauptamtlichen Kinderschutzkoordinatorin geleitet. Ergebnis Die Prävalenz der Verdachtsfälle und der erhärteten Fälle von Kindeswohlgefährdung ist im Untersuchungszeitraum nach Neukonzeption hoch signifikant erhöht. Im Zeitraum vor der Neukonzeption wurden 24 Fälle mit dem Verdacht auf Kindswohlgefährdung untersucht, 23 erhärtet, danach 124 Fälle untersucht, 89 erhärtet. Eine Stigmatisierung der Familien bei der Abklärung wurde trotz des signifikanten Anstiegs falsch-positiver Verdachtsfälle durch sensibles Vorgehen und eine Konfrontation erst bei Erhärtung des Verdachtes vermieden. Schlussfolgerung Das vorgestellte Konzept zum medizinischen Kinderschutz in Kinderkliniken scheint das Hellfeld bei Kindeswohlgefährdung effektiv auszuweiten. Sowohl die Reduktion nichtdetektierter Fälle mit der Verhinderung potenzieller Eskalation mit prolongiertem Leidensweg als auch die Verminderung der immensen gesellschaftlichen Folgekosten rechtfertigen die personellen Investitionen.

Identification of child abuse is a daily challenge in medical work. The estimated number of unreported cases of child abuse and neglect is high.The aim of this study was to investigate the effectiveness of the redesigned clinical child protection program of a major German pediatric hospital and to improve programs in other hospitals for children and physicians through presentation of the advantages of the new structure.All cases of child protection at the Altona Children's Hospital were retrospectively analyzed before and after restructuring of the clinic's child protection program for a two-year period each, and a comparison was made. The child protection program was restructured and the new program subsequently managed by a fulltime coordinator.The prevalence of both suspected and substantiated cases of child abuse was significantly higher after restructuring of the child protection program. Before the change, 24 cases were investigated, of which 23 were substantiated; afterward, 124 cases were investigated and 89 were substantiated. Despite the high number of false-positive suspected cases, stigmatization of the families during the clarification progress was avoided by using a very sensitive approach, and the family was not confronted until the suspicion was affirmed.The presented concept of child protection in medical clinics seems to facilitate a higher detection rate of child abuse cases. The reduction in the number of undetected cases and thereby prevention of possible escalation of abuse, as well as the decline in the immense social follow-up costs, justifies the increased personnel costs.

The present study summarizes the effects of processing conditions and substrate cleaning procedures on the structure, chemistry and bonding of Cu/(0001)Al2O3 interfaces as determined by advanced transmission electron microscopy techniques. The Cu/(0001)Al2O3 samples were prepared by molecular beam epitaxy (MBE) and solid-state diffusion bonding. Investigations of the MBE samples showed that the Al2O3 cleaning procedure alters the interfacial bonding. Metallic bonds occurred for an Ar+ ion sputtering and subsequent ultra-high vacuum (UHV) annealing treatment. Strongly ionic–covalent bonds were found for a wet chemical cleaning process followed by UHV annealing. The interfacial electronic structure did not reveal any significant changes compared to the bulk electronic structure for samples where the substrate surface was annealed in an oxygen-containing atmosphere after Ar+ ion pre-sputtering and UHV annealing. The results obtained at the solid-state diffusion-bonded Cu/Al2O3 samples indicated that the processing parameters such as temperature and load do not change the bonding behavior. Post-annealing of the solid-state diffusion-bonded Cu/Al2O3 samples in a well-defined oxygen partial pressure led to the formation of CuAlO2 at the interface between Cu and Al2O3, which improved the adhesion.

The microstructures of diffusion-bonded Cu/(0001)Al2O3 bicrystals annealed at 1000 degrees C at oxygen partial pressures of 0.02 or 32 Pa have been studied with various microscopy techniques ranging from optical microscopy to high-resolution transmission electron microscopy. The studies revealed that for both oxygen partial pressures a 20-35 nm thick interfacial CuAlO2 layer formed, which crystallises in the rhombohedral structure. However, the CuAlO2 layer is not continuous, but interrupted by many pores. In the samples annealed in the higher oxygen partial pressure an additional reaction phase with a needle-like structure was observed. The needles are several millimetres long, approximately 10 microm wide and approximately 1 microm thick. They consist of CuAlO2 with alternating rhombohedral and hexagonal structures. Solid-state contact angle measurements were performed to derive values for the work of adhesion. The results show that the adhesion is twice as good for the annealed specimen compared to the as-bonded sample.

A combined approach of high-resolution transmission electron microscopy and electron energy-loss near-edge structure studies was employed to determine the atomic structure and bonding mechanisms at Cu/Al2O3 interfaces in dependence on the α-Al2O3 substrate orientation. The investigated specimens were prepared by molecular beam epitaxy using ultrahigh vacuum conditions, which led to atomically abrupt interfaces. The results show that intermetallic Cu–Al bonds occur at the investigated Cu/ (112̅0)Al2O3 interface, while ionic-covalent bonding contributions are observed at the Cu/(0001)Al2O3 interface. The interfacial microstructure of diffusion-bonded Cu/ (0001)Al2O3 samples was changed by annealing treatments under various oxygen partial pressures. Annealing resulted in the formation of a CuAlO2 reaction phase at the interface between Cu and Al2O3.