Search

The term neuroendocrine neoplasms (NEN) encompasses a molecularly and biologically very heterogeneous group of tumors, which have in common their origin in neuroendocrine cells. The also very heterogeneous subgroup of gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN) is the best classified and investigated group. This article provides a systematic review of the current classification, diagnostics and treatment options of GEP-NEN. In order to achieve a better overview, it was consciously decided not to use an approach based on the primary localization. Instead, a thematic organization according to classification, clinical phenotype, diagnostics and treatment was chosen.

ZusammenfassungAufgrund der weltweit zunehmenden Prävalenz von Übergewicht und Adipositas gewinnen medikamentöse Therapien zur Gewichtsreduktion mehr und mehr an Bedeutung. Einen neuen Therapieansatz stellt der Glukagon-like Peptid 1 (GLP-1) Rezeptoragonist Liraglutid dar (Handelsname Saxenda®), der seit März 2015 erstmals zur alleinigen Behandlung der Adipositas in der EU zugelassen ist. Dabei scheinen die gewichtsreduzierenden Effekte von Liraglutid sowohl peripher über eine verzögerte Magenentleerung, als auch zentral über die Beeinflussung von appetitregulierenden Hirnarealen, vermittelt zu sein. In verschiedenen Studien konnte in den letzten Jahren eine signifikante Gewichtsabnahme durch Liraglutid in unterschiedlichen Probandenkollektiven, wie z.B. übergewichtigen und adipösen Patienten ohne aber auch mit Diabetes, nachgewiesen werden. Liraglutid bestätigt sich außerdem als überwiegend gut verträgliche medikamentöse Therapie der Adipositas, wobei die häufigsten berichteten Nebenwirkungen vorübergehende leichte bis moderate gastrointestinale Beschwerden, wie Übelkeit oder Völlegefühl, sind.

The increasing incidence of metabolic diseases, such as type 2 diabetes mellitus, poses a major problem for the healthcare system. Healthy food habits represent an important therapeutic measure to prevent health sequelae, such as cardiovascular diseases. According to recent data these are less due to individual dietary components and more to the composition of nutrition. A positive effect on glucose and fat metabolism in type 2 diabetes has been confirmed for various forms of nutrition. In addition to the type of nutrition, the so-called glycemic index of foodstuffs is also decisive for blood glucose control. Additionally, beneficial effects for particular foodstuffs, such as coffee, could be determined in patients with diabetes.

Childhood cancer survivors are at risk of cancer- and treatment-related chronic health conditions. Since these sequelae may occur years after the end of treatment, many patients are already adults and have completed pediatric oncological care. Thus, successful transition is essential in order to ensure long-term surveillance.The present review outlines the most frequent late effects of childhood cancer treatment. Moreover, difficulties in transition of these patients are discussed and interdisciplinary models of care are presented.Late effects following childhood cancer treatment occur in over two thirds of patients 30 years after the end of the oncological treatment and can affect different organs. The most frequent sequelae are endocrine disturbances, cardiac conditions, and subsequent neoplasms. Many late effects are effectively manageable if detected early. This necessitates an interdisciplinary approach as well as life-long surveillance.Transition from pediatric to internal medicine care as well as a change in the focus of care, shifting from relapse centered follow-up to late-effects centered surveillance, constitute a special challenge for a successful transition of long-term childhood cancer survivors. Specialized late-effects survivorship clinics offering interdisciplinary care from pediatric oncologists, specialists of internal medicine, and further disciplines enable the early diagnosis and treatment of late-effects.

During a scientific expedition to the Palinurus Rock, Persian Gulf, Iraq, a reef, which was discovered first in 2012, we found a new species which we tentatively assigned to Ciocalypta (Porifera, Demospongiae, Suberitida, Halichondriidae). Genetic results from different authors (Morrow & Cardenas, 2015, Redmond et al., 2013, Erpenbeck et al., 2012) suggest that several species of Ciocalypta and other species from Suberitida (e.g. several Axinyssa, Petromica, Topsentia, Cymbastela, Halichondria (Eumastia)) are indeed no Suberitida but belong to taxa yet unnamed. The species described here genetically clearly belongs to this new taxon outside Suberitida which awaits definition. Morphologically the new species clearly would be classified as Ciocalypta. Therefore the new species is described and compared to similar morphological species, some of them, as the type species, true Suberitida and true Ciocalypta, others belong to taxa still in need of a name.

During pregnancy thyroid hormones have profound effects on embryonal/fetal development and maternal health. Therefore, thyroid gland disorders should be immediately diagnosed and adequately treated. Pregnancy-specific physiological alterations during pregnancy cause changes in the reference interval for thyroid-stimulating hormone levels and trimester-specific thresholds must be taken into account. This article summarizes the most important diagnostic and therapeutic aspects before, during and after pregnancy. With reference to the period prior to pregnancy, the article discusses iodide supplementation, preconceptional examination of thyroid gland metabolism and the importance of thyroid gland functional disorders for fertility and fulfilling the desire to have children. With a view to the period during pregnancy, the effect of hypothyroxinemia, hypothyroidism, and hyperthyroidism as well as the effects of their treatment on the development of the child are explained. Finally, a description is given of what must be paid attention to in the breast-feeding period and in postpartum thyroiditis.

Sponge species are infamously difficult to identify for non-experts due to their high morphological plasticity and the paucity of informative morphological characters. The use of molecular techniques certainly helps with species identification, but unfortunately it requires prior reference sequences. Holotypes constitute the best reference material for species identification, however their usage in molecular systematics and taxonomy is scarce and frequently not even attempted, mostly due to their antiquity and preservation history. Here we provide case studies in which we demonstrate the importance of using holotype material to answer phylogenetic and taxonomic questions. We also demonstrate the possibility of sequencing DNA fragments out of century-old holotypes. Furthermore we propose the deposition of DNA sequences in conjunction with new species descriptions.

The diabetic emergencies diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS) and hypoglycemia represent severe and potentially life-threatening complications of diabetes mellitus that require prompt diagnostics and treatment. Absolute or relative insulin insufficiency is characteristic of DKA und HHS along with severe dehydration. They differ by the prevalence of ketone bodies and the severity of acidosis; however, the treatment regimens are similar. In contrast, hypoglycemia is the limiting factor for achieving ambitious glucose targets. This article decribes the clinical presentation, diagnostics and emergency management of these metabolic derangements.

Humans live in symbiosis with billions of commensal bacteria. The so-called microbiota live on different biological interfaces such as the skin, the urogenital tract and the gastrointestinal tract. Commensal bacteria replace potentially pathogenic microbes, synthesize vitamins and ferment dietary fibre. An imbalance in the bacterial composition of the intestinal microbiota has been associated with various diseases including gut-associated disorders such as inflammatory bowel diseases, colorectal cancer and nonalcoholic fatty liver disease. Furthermore, a shift in the microbiota composition appears to be of pathophysiological relevance which renders the specific modulation of the intestinal microbiota a promising approach in the treatment of the above mentioned diseases. Our intestinal microbiota composition is mainly modulated by dietary macro- and micronutrients but also by secondary plant compounds and synthetic food additives such as emulsifiers and artificial sweeteners. Nutritional interventions with the purpose to modulate the intestinal microbiota show only limited therapeutic potential in the treatment of gut-associated disorders, which may be due to individual differences in the intestinal microbiota composition and a lack of specificity. A combination of newly established technical analytic approaches involving a machine-learning algorithm may bridge the currently existing limitations by providing a personalized, highly-specific and consequently therapeutically effective microbiota modulation.

Hintergrund Neben der Hypoglykamie sowie dem hyperglykamen nichtketotischen Syndrom (HNKS) des Typ-2-Diabetes stellt die diabetische Ketoazidose (DKA) trotz Verbesserungen in der Therapie eine bedeutende Komplikation v. a. des Typ-1-Diabetes dar.

The aim of palliative medicine is to adequately care for and attend to patients suffering from life-threatening and incurable medical conditions according to their needs. This implies that for these patients it is not a matter of dealing with diseases that can be treated separately but with their existence in the face of their approaching death.This article investigates which ethical questions are currently prioritized for discussion in palliative medicine.Review of the current medical and ethical literature and own reflections with a relational ethics approach that puts patient wishes at the centre of attention.Palliative medicine is not a "luxury medicine" but has to be considered as primary care to which every person is entitled. If there is a need for improvement of care, promoting it is an ethical obligation. In this respect the question of a "good death" is extremely complex. The term is connected to the ethics of a good life and includes the dimensions of happiness-suffering as well as meaning-futility; therefore, the best possible treatment of symptoms, most of all pain is just as important as recognizing subjective questions of meaning. Dealing with the wishes of patients, including possible wishes to die, are the starting point for elaborating palliative care measures. It is concerned with finding the right point in time for each patient individually, in their best interests and according to their wishes, at which dying should no longer be held back but for their own benefit the patient should be accompanied and supported during dying.In the current construction of palliative medicine, including its normative configuration within the law and medical ethics, the criteria which are essential for the quality of life up to death are being discussed.

Cachexia is a multifactorial and complex syndrome characterized by progressive functional impairment and ongoing loss in quality of life, which lead to a deterioration of the prognosis for affected patients. The prevalence of cachexia can be very high and is up to 80 % in patients with malignant tumors.The aim of the study was to assess the relevance of exercise and nutrition in the prevention and therapy of cachexia.An evaluation of the current literature on exercise and nutritional therapy in patients with cachexia or with advanced stage diseases where a high prevalence of cachexia is probable, was carried out.There is a lack of scientific evidence for the benefits of exercise in cachexia. A major problem of relevant studies was that cachexia was frequently not defined according to valid criteria; however, data indicate a benefit of exercise training in patients with advanced diseases associated with a high prevalence of cachexia. A solely nutritional intervention and dietary counselling seem to be of minimal benefit. The administration of omega 3 fatty acids is controversially discussed.Although there is a lack of data on the effects of exercise and nutritional therapy in cachexia, there is evidence for the benefits. The present data indicate the necessity for the use of a multimodal treatment including exercise, nutritional and pharmacological therapy in cachexia. There is a great necessity for prospective studies.

Osteoporosis is the most common clinical disorder of bone metabolism. Treatment decisions should be made on an individual basis, taking into consideration the relative benefits and risks in different patient populations. Drug selection should be based on the form (primary/secondary) and severity of osteoporosis, age, sex, the specific contraindications and precautions for using the various available medications, and existing comorbidities.

Die Arthrosis deformans stellt eine verbreitete Erkrankung dar und weist in allen ethnischen Gruppen eine hohe Pravalenz auf. Alle Gelenke konnen betroffen sein. Genetische Faktoren beeinflussen die Entstehung. Leitsymptome der Erkrankung sind der Schmerz und die zunehmende Immobilitat. Die Behandlung ist in den Anfangsstadien konservativ. Im Endstadium ist die Implantation eines Kunstgelenks, gelenkabhangig auch eine Versteifung, moglich. Zu einer Heilung fuhrende medikamentose oder genetische Therapieansatze existieren noch nicht, die Forschung auf diesen Gebieten wird jedoch intensiv betrieben.

The desire for a long life is deeply embedded in nearly all men. Fortunately life expectancy has remarkably increased over the past decades, on the other hand advancing age is frequently associated with a rise in morbidity. Above simply prolonging life there is a need to search for strategies to improve the quality of life in the elderly. Different substances to prevent premature aging, cancer and degenerative disorders appear to be promising candidates. Since it has been suggested that the decline of different hormones over the lifespan is closely related to the aging process replacement of these hormones may be a strategy against aging. Especially hormones like growth hormone, DHEA, testosterone and melatonin were considered as anti-aging agents. This review is focusing on the theoretical background and the previously known effects of different hormones to slow aging processes. Despite some promising results in a variety of studies conducted over the past years presently available data do not justify the broad use of hormones for anti-aging purposes. However, although no single hormone can be recognized as a 'rejuvenating' and life extending agent, some of their actions may be beneficial for the aging process.

Alle Bemuhungen, die auf gegenwartigen Konzepten von Adipositas basieren, haben die Epidemie nicht stoppen konnen. Bislang konzentrierte sich die Frage nach der Regulation des Korpergewichts hauptsachlich auf den Hypothalamus. Wir zeigen hier eine neue Sichtweise, in der das Gehirn (zerebrale Hemispharen, Hypothalamus) aktiv Energie aus dem Korper (Allokation) oder aus der Umwelt (Nahrungsaufnahme) anfordert. Wenn diese zerebrale Energieanforderung gestort ist, entstehen Erkrankungen wie Adipositas, das metabolische Syndrom und Diabetes mellitus Typ 2. Hier betrachten wir die derzeitige Literatur aus einer neuartigen Perspektive ― mit dem Gehirn im Mittelpunkt des gesamten Energiemetabolismus.

Diabetic kidney disease is a leading cause of renal failure in Germany. Albuminuria is an early diagnostic indicator of renal damage in diabetes and, aside from renal failure, a major risk factor of cardiovascular disease. An early diagnosis of diabetic kidney disease is of great importance to reduce associated cardiovascular mortality; glycemic control should aim for HbA1c levels of 7 %. Guidelines on blood pressure differ, but it should generally be reduced to 140/90 mmHg; stricter limits should be applied if albuminuria is present. ACE inhibitors (ACE-I) or angiotensin receptor blockers (ARB) should be preferred for blood pressure control. A combination of ACE-Is and ARBs or a renin-inhibitor therapy does not improve cardiovascular outcome, instead it increases the rate of adverse events, e.g., hyperkalemia or renal failure. Lipid control, usually with statins, should be started at an early phase of renal failure. Vitamin D receptor activation and uric acid reduction might play a future role in the treatment of diabetic kidney disease. Pharmacological modification of inflammatory signaling appears to be promising but is not yet of clinical relevance.

Hypokalaemic hypertension is the classical presentation of primary hyperaldosteronism but may also result from other mineralocorticoid activity, such as liquorice ingestion. Onset of hypertension as well as serum renin and aldosterone levels are central for the diagnosis. Liquorice ingestion has been reported to induce hypertension, hypokalaemia and metabolic alkalosis due to inhibition of the enzyme 11-β-hydroxy steroiddehydrogenase 2. Here, we report the case of a hypertensive emergency with acute visual impairment due to hypertensive retinopathy in clear conjunction with a considerable consumption of liquorice.

The incidence of obesity in the western world has increased dramatically during recent decades. Epidemiological data suggest that obesity is associated with an increased risk of several but not all types of cancers, with clear sex-specific differences. The underlying mechanisms are still a matter of debate. This review focuses on the potential factors linking obesity to cancer. Current experimental evidence suggests that insulin resistance and a chronic, subclinical inflammation in the visceral fat are the major metabolic events causing alterations in the levels of insulin, glucose, free fatty acids, insulin-like growth factor 1 (IGF-1) and 2, adipose tissue-derived proinflammatory cytokines and other bioactive molecules, such as adipokines (e.g. leptin and adiponectin), vascular endothelial growth factor (VEGF), sex hormones, gut microbiota and secondary bile acids. All these factors may act directly or indirectly on the tumor microenvironment to drive tumor progression via stimulation of cell survival/antiapoptosis, cell proliferation, angiogenesis and invasion/metastasis of the cancer cells. Therapeutic strategies that target dysfunctional or inflamed fat and have been shown to benefit patients include bariatric surgery, while other cell or hormone-directed interventions, such as conversion of visceral fat macrophages to an anti-inflammatory M2 phenotype or the pharmacological modulation of serum adipokine levels are still theoretical and need to be clinically evaluated for their ability to successfully treat or prevent obesity-related cancers.

Die jahrliche Untersuchung eines Diabetespatienten auf Mikroalbuminurie sollte selbstverstandlich sein. Denn die erhohte Albuminausscheidung weist nicht nur auf eine diabetische Nephropathie hin, sondern ist auch ein Signal fur ein gesteigertes kardiovaskulares Risiko. Zur Reduktion der Mikroalbu minurie reicht die konsequente Einstellung des Blutzuckers nicht aus. Mit geeigneten Antihypertensiva muss vor allem der Blutdruck in den Normbereich gebracht werden.

Die Problematik von Hypoglykamien umfasst ein multifaktorielles Geschehen, bei dem physiologische Parameter und das Verhalten der betroffenen Patienten im Rahmen der Selbstkontrolle miteinender interagieren. Insbesondere die zunehmende Therapie mit Insulin und nahe-normoglykamische Blutglukoseeinstellung haben die Hypoglykamie zu einem bedeutenden Problem im Rahmen der diabetesbedingten Akutkomplikationen werden lassen. Eine fruhzeitige Diagnostik und Therapieeinleitung sind daher unerlasslich um die erhohte Mortalitat zu senken. Neben der Akuttherapie der Hypoglykamie umfassen die erweiterten therapeutischen Masnahmen die Modifikation der Diabetestherapie, Patientenschulungen sowie ein spezielles Hypoglykamiewahrnehmungstraining.

In Deutschland haben bereits 36% aller neuen chronischen Dialysepatienten ursachlich eine diabetische Nephropathie als renale Grunderkrankung. Die meisten dieser Patienten sind Typ-2-Diabetiker. Insgesamt verursacht die uberhohte Morbiditat und Mortalitat dieser Patienten eine erhebliche Kostenbelastung fur das deutsche Gesundheitswesen.

The high temperature structure above 700 °C of the oxygen superionic conductor La0.9Sr0.1Ga0.8Mg0.2O2.85 has been analyzed by means of a combined neutron and high resolution synchrotron powder study. The splitting of reflections and the absence of any superstructure reflections leads to the conclusion that the correct space group is R3¯m. This is the first example of this space group appearing within the subgroup family of the ideal parent perovskite structure with Pm3¯m symmetry. Uber die Kristallstruktur von Sr/Mg-dotiertem Lanthangallat bei hohen Temperaturen. Der erste Perowskit-Typ mit R3¯m-Symmetrie Die Kristallstruktur des schnellen Sauerstoffionenleiters La0.9Sr0.1Ga0.8Mg0.2O2.85 wurde in situ bei Temperaturen oberhalb von 700 °C mit Pulverbeugungsmethoden unter Nutzung von Neutronen- und Synchrotronstrahlung untersucht. Die beobachtete Reflexaufspaltung und die Abwesenheit jeglicher Uberstrukturreflexe last auf einen Perowskit-Typ mit der Raumgruppe R3¯m schliessn. Dies ware unseres Wissens das erste Beispiel einer Perowskitstruktur mit einer solchen Symmetrie.

[1] Coralline sponge skeletons are excellent tools for reconstructing the carbon isotope history of dissolved inorganic carbon (DIC) in tropical surface waters. Carbon isotope records from coralline sponges clearly reflect the industrial 12C increase in atmospheric CO2 with a precision that permits quantitative interpretations. We find from a set of δ13C records of four Caribbean sponge specimens that the isotopic response of surface water DIC to the changing isotopic composition of atmospheric CO2 varied dynamically during the last century, depending on the rate of atmospheric change. Three of our sponges provide 600 year long δ13C records. For the first time, we can reconstruct surface water δ13CDIC for the full history of the industrial CO2 release as well as the preceding preindustrial period back to the beginning of the Little Ice Age. This provides a well-founded estimate of the anthropogenically uninfluenced, preindustrial background level of surface water 13C/12C ratios. Our records show small but systematic variations that appear to be linked to the climate fluctuations of the Little Ice Age.